Statement by Dr. Lee

Week 21 of the Coronavirus Saga. August 3, 2020

Running in Place and Don’t Forget

So the virtual learning decision made by the BOE didn’t come as a shock, maybe even some relief, but still hit home. It’s the right call. They’re just too many variables and we’ve let down our guard nationally. Social distancing and summer vacations just don’t go together. Schools and colleges will be breeding grounds for ongoing transmission and national data continues to show a steady, not declining, rate of ongoing cases and …deaths. Testing is available but the turnaround time for results is unacceptable. Two recent daycare “scares” showed our practice how stressful this is on everyone even in a relatively protected area. It’s too much and I don’t have much available space for more gray hairs!

Nevertheless, schools will be resuming. Teachers will be dedicating their time. Teaching plans and instruction will be organized and sent out and we’ll have to organize a family’s “best practices” setup for success. That will require some thoughtfulness and preparation. Setting the stage for success is a mindset. Our children will get their cues from us; our frustration becomes their frustration, our angst becomes their angst. If we can stay positive hopefully our kids can too.

These are tough times. That’s not changing in the foreseeable future. We really need the foundation of family functioning to be in place and the foundation of positive parenting to be internalized. I don’t have the answers about how to educate our kids at home but we need to have the structure in place, and the attitude in place, to move forward. The basics of family functioning is something I can relay and hopefully explain and I’m in the process of organizing a videocast to go over that.

How the schools will outreach to us will be determined. I’d like to hear the perspectives of our principals, guidance counselors and teachers as we move forward. We need to be a team. I’m sure they’re reeling too. Many of our teachers are parents as well, don’t forget. They have a double whammy. We’ll need to double up on the participation trophies for them!
That’s the running in place part.

The Don’t Forget commentary brings us back to racial equality and social justice. I recently led a panel discussion on racism which we are posting (link below). The panel included our Frederick County Health Dept. Director, Dr. Barbara Brookmyer, and two national authorities on the subject, Dr Jackie Douge and Dr. Michael Baren, who both happen to live in our county. I think it opened up further awareness and understanding on a topic that does not allow for easy sound bytes or infographics (and nor should it – it’s too important and complex an area that deserves thought and reflection). We plan to push this out to school and community authorities, colleagues and of course you. After reviewing it myself, I felt I wanted to break it down into more understandable units based on age that may help each of of us appreciate this discussion from a developmental perspective. Racism affects all of us – no matter who we are or where we live. It strikes me that there is no better example of “teachable moments” than this but we can’t teach if we don’t understand or only see things through a single lens. We need to open up – in so many ways – to understanding and tolerance. And that starts with us – each and every one of us – to open up our minds and hearts to learn, be examples and to be the best versions of ourselves- for ourselves and our children!

Talking about race is not racist; Not talking to our children about race reinforces the status quo. (click button above for video)

Week 19 of the Coronavirus Saga. July 20, 2020

Plan for the worse, hope for the …(oops)

No way can we put this pandemic on the back burner which is frustrating on so many levels. School reopening plans, although not clarified locally yet, is increasingly going virtual, at least at the outset. Up-trending coronavirus rates creep closer to us, but not too close so far, which has been our tendency but we’re clearly slipping backwards on the national level. And no matter how you put a spin on it, that’s the case in terms of numbers, hospitalizations and an ever increasing death toll.

The politicalization of all of this has obscured our scientific input and continues to pit the individual vs. community best-interests dichotomy as a battle ground. This goes back to my former commentary on citizenship. We know more clearly than ever that not using face masks, not maintaining physical distancing and being indoors are risk factors pure and simple. Contagiousness by age is surprisingly understood too. Kids under 10 are less contagious. Don’t ask me why. But that’s the point, we learn over time and respond to that. As Dr Fauci as often stated, the virus determines the timeline (and the rules of the game), not us.

So getting back to schools, it’s becoming clearer to me that we need to become accustomed and prepared for virtual learning. If not 100%, certainly at least 50-60% and most local jurisdictions are starting off with all virtual learning. Frederick County would be an outlier if we did not go that way at the onset at least.

So how can we get beyond the “Woe Is Me”? School will be in session this fall, even if the classroom is your kitchen and the campus is your backyard! As a non educator and as a grandparent, I am looking from the outside in as we go into round 2 of this. Last time (only 4 months ago but it does seem longer than that), we had no time to huddle or come up with a game plan. This time we seem more concerned about the where than the what. I hope our educators are working up a virtual learning game plan (they also have been appropriately questioning their own safety and well being). But that still leaves our children and parents in a quagmire. Beyond education, helping our families on the social-emotional level needs to be addressed. We all are struggling. We’re tired of this, frustrated and don’t have a good plan. These are tough times. It will take resilience.

Interesting word, resilience. You’ve heard me mention it before. It’s what we need for ourselves and what we want for our kids. It’s not inherent, it’s developed and can be fostered. And it starts in early childhood and is rooted in positive family functioning. It’s based in stable and nurturing relationships that allows for connection and emotional well being. Kids that have that security are more emotionally buoyant. They can handle adversity. They can adjust. They become resilient. That’s what is called upon all of us at this time.

So how do we get there? We plan for the worse and hope for the best. (My mom would be so proud of me!) Planning part 1 is getting our family functioning act together. Security is based in routines. Those routines of sleep, meals, together times, play times, outdoor times (and a wink at media usage – both our friend and enemy). We need to be ready this fall at home. We need to be the adults in the room. We need to be emotionally ready.
I see this as a priority and according to our recent survey, so do you! What’s best practices for family functioning? Can I purpose our family care plan? All the fundamentals are there. Please look at it seriously and then maybe we can talk it through as a group. It’s that important! If we’re going to get through this in the fall, we need to be in a good place family-wise.

Planning part #2 is to lean (and learn) on our educators. I’m concerned that they are not in a good place right now either but this is a team effort, not us vs. them. They’ve spent a lot of time on contingency planning. But remember the time zone were in- we’re in the coronavirus time zone- and you can’t change that. I think we’re all sincere. I think they want to be as good educators as I want to be a good doctor as much as you want to be a good parent. If we all have a common goal and thread, the best interests of our children, then we can work together.

So school readiness this fall may not be about getting our kids ready for school but about getting our families ready for school. Not in anger or frustration, but in resiliency and determination. I’ve used historical analogies before. We have faced huge obstacles in the past – world wars, crippling economic depressions, even flu pandemics. We’ve made it through. Hopefully we’ve learned from them. I’m concerned that we don’t all see a common enemy as we have in the past. But as parents and as citizens, we have an obligation to our children and to our community, to be the best versions of ourselves. It’s our turn. It’s ok to lean on one another – that’s what friends and families do. Let’s learn, lean and maybe even love one another a little. Remember stable and nurturing relationships? Well that’s all of us – working together.

Week 18 of the Coronavirus Saga. July 13, 2020

Clear As Mud

And back to the pandemic we go. I’ve been commenting on school return issues for several weeks now. Always with some apprehension and lack of clarity. Well, that lack of clarity seems even more evident now.

The resurgence of the pandemic, mainly in southern and western states, has put us back on our heels. A national recovery policy is not practical, we’re not even close to recovery at the national level!

The fact that we can have a discussion about schools reopening here locally is encouraging but also very complicated. Threading a needle is a fun term but hard to complete in reality.

There’s uncertainty at both ends of the issue. Kids learn better in school is a basic assumption. I agree. Return to school is not risk-free. That’s also unquestionably true. How does one balance the risk-benefit? Plus each of our personal situations is unique and integral to decision making. What’s our bubble? How important is that bubble at both a theoretical and also at a more specific/personal level?

The opt-out is a continuation of total virtual learning for now. Presumably least risk, public health-wise, but at what sacrifice for a student’s overall academic and socioemotional growth? For some students that could be profound. For others less so (l see that old zip code coming back again) although a return to school plan is vitally needed and necessary. We need to get back to school but . . .

The implications of reopening are almost too complicated to articulate and a hybridized schedule is not easier to implement even if theoretically “safer”. The AAP addressed criterion to establish safe return policies to school but that just pushes the canoe out into the stream. Where it goes from there is up in the air.

The implications are profound, at both medical and economic levels. The phasing recommendations made sense (as far as I can tell) but were hard to abide by at both a community and individual level in many areas (although not ours!). What’s happened in the states with resurgence reflects that although we’re also challenged by a novel virus – it doesn’t necessarily have predictable rules.

So could a phased-in school return plan work if the community positivity rate was low and stayed low? But the ripple effects of school return are exponential because it overlaps with daycare, parental return to work, etc. And then there are all the school systems employees and their safety and well being. And what about sickness and exposures in the school? Is every fever COVID till proven otherwise? What’s the quarantine timeline? 14 days is a long time. Does more and more of it become virtual learning just because we end up being at home for one reason or another?

You certainly can’t take your finger out of the dike willy/nilly. You don’t know if it will be a leak or a busted dam. That’s why school systems are going slow and, again, nationally, we’re at a resurgence, not a recovery scenario. There is no national standard to go by. We have to make the best calls we can.

For those of you who have been following me along on this saga, you know I like to find the silver lining in the cloud but this is a tough one. We just don’t have enough clarity to make a consensus decision. Public health and safety is priority # 1. We also have a responsibility to those around us (e.g., the elderly) and actually to each other to keep us all out of harm’s way. I’m not sure we’re there yet. Stay tuned!

Week 17 of the Coronavirus Saga. July 6, 2020

July 4th – What it means to me this year

I’ve been struck as I’ve crisscrossed the coronavirus saga with our calendar of national holidays and celebrations and the emerging, intensely introspective and serious discussion on race. What does citizenship mean? A year ago, I wouldn’t have even thought about or given much consideration to the topic (much less write about it). Citizenship, patriotism, freedom, sacrifice were all mixed into a pot of “Americanism”.

The confluence of coronavirus and it’s sudden and dramatic impact on our lives and the equally dramatic confrontation of racism – both in real time -has given me and I suspect many of us pause as we “celebrate” our national holiday- July 4th.

What does freedom mean? Freedom to march, demonstrate, not wear a mask, say whatever we want, go wherever, whenever, do whatever, whenever?
What does sacrifice mean? Stand in harms way, think of the common good over individual needs, listen before we speak, winning isn’t everything. It has both personal and nationalistic meanings.

And what does patriotism mean?

And what does citizenship mean?

Is it important and why in the world would a pediatrician be writing about it in a blog?

Well, because we live in a society that is made up of all sorts of people, with all sorts of needs, with all sorts of backgrounds that co-exist, even though our backgrounds, needs and aspirations may be completely different. We embraced the melting pot a century ago (or did we really?), now we recoil from it. We struggle to differentiate our individual, personal freedoms from those of the common good. That seems to be a unique American struggle. All magnified by the combined explosiveness of a pandemic and our inflection point with racism- we can’t nor should turn away from either of these.

But the unique freedom that makes July 4th so important is the right to opportunity. Unfortunately that access to opportunity is not equal. We’re learning that lesson more obviously now -intensified by a pandemic on top of a history of unequal opportunities. And those markers of the past, both literal and figurative ones, are also brought into question. What do those statues mean? And is the meaning universal? Clearly no. It lifts some of us and pushes some of us down, even if not done purposefully. History is subjective. It’s an interpretation but is burned into our psyche and becomes our foundation of understanding of who we are. It represents us, it validates us and becomes our values. So when that foundation, that history, is questioned or damaged, it rocks us, unsettles us, possibly angers us and we can either react in kind or stand back and try to listen and learn.

So what do we teach and tell our children? That our stories are different just like our skin color could be different. And those stories come from different histories and backgrounds. And to live in a free and open society, we need to listen to those stories and try to understand those stories. Being a citizen means being able to listen. It’s not easy. There are those that see this as right /wrong, good/ bad dichotomy. That’s intolerance and force and violence is their outlet. And it makes the news and leads the headlines and reinforces polarization. And it stokes fear and resentment and spins us away from one another. That may be an understandable reaction when we’re at an inflection point and one we’ll have to work through. Listening and re-understanding our histories will take time. How profound this is may depend on your own background and stories but I think it will speak loudly about what type of society we will become. What and how we teach and tell our children now may well lead the way to what we will become as a society and as a humanity. Just like public health, it takes all of us and we all share in it equally. That’s why it’s important we start to have those conversations – here and now.

Week 16 of the Coronavirus Saga. June 29,2020

And Then There Was This Pandemic- Our Neighbor’s Neighbors

So this coronavirus saga commentary just keeps going on and on …just like the pandemic that gave it its birth. And even though it’s hard not to get a little desensitized to it all, we’re into month four after all, we now stand at a death toll exceeding 120,000. Remember when I was appalled when it was 50,000? That’s not that long ago. It continues to be surreal (that’s how I started my commentary back in week 1). Fortunately, as has been the case, the fires of this pandemic burn around us – but more distantly at this point. We’ve been blessed- by zip code, steady governance and good neighbors. And we’ve been lucky – although not completely by accident as we’ve learned.

Our positivity rate locally is now < 5% which has been our goal. Why aren’t we celebrating? The problem is we don’t live in isolation- to some extent we’re only as safe as the cumulative positivity rates all around us. We may be able to trust our neighbors but can we trust our neighbor’s neighbors (metaphorically at least)? So we’re kind of stuck- we can move around a little – make our bubble is a bit bigger but it’s still a small bubble!

Why are some things that should be so simple, be so hard? So here’s a quiz: What matters most to reduce virus transmission? Face masks, hand washing or 6 ft. social distancing? It’s social distancing and that makes sense, doesn’t it? Keep your distance and it minimizes risk (don’t get me wrong, the other two are darn important too!). And it’s the young folk- those partying twenty somethings- that seem to pose the most risk to ongoing transmission (my apologies if I stereotyped or overly generalized – I can take a little poetic license). Yes, statistics are on their side. They’re likely to weather it. But who are their neighbor’s neighbors? And this old song just keeps playing on and on and on.

And that brings us back to schools. Buckle your seat belts. Two of our local jurisdictions (Fairfax and Arlington) are doing a hybrid plan. In school twice a week, distance learning the remaining days. Wow; if you told me back in March that was how this was going to play out, I wouldn’t have placed that bet. That’s threading the needle but do I have a better recommendation, balancing all of our public health and student needs? The AAP just came out with a school return policy statement. Wonderful; problem is I needed a study break to get through it and a math degree to keep up with all the either/or options. Don’t get me wrong- It’s better to be too long than too short on this topic and some very good professionals have given us the best recommendations they can. That’s praise worthy. It’s just that this is a big mess and that …rhymes with luck.

Kids need to go back to school;at least a large majority do – for a variety of reasons – most of which is beyond their control. We, as parents, are not educators and school is more than whiteboards (or Chromebooks) and teaching plans. School is a community that serves multiple roles for kids. But it’s not risk free and risk/ benefit analysis is hard to deal with at the emotional level – when it’s your kid. And what about our neighbor’s neighbors? It seems to come back to that – who wants to burst the bubble of protection?

But forge ahead we must go. We can, and should, question the rules but so far good decisions have been made to protect our public health as best as possible at the local level. It seems our planners have made good calls and I give them credit and therefore continue to support them to make the tough calls. Good luck!

In week one I proclaimed that it was our turn, the health professionals, to stand up to face this pandemic. In this next chapter it’s all our turns to stand up. Public health is an equal responsibility that requires all of our participation and we’re all equally important. The face mask protects all of us equally and keeping our distance is a common courtesy- didn’t our moms teach us that? Courtesy and kindness matters. Oh, but we’re the adults in the room now. We’re the role models. We set the standard. We face a challenge – at some emotional, core parenting level we’re fearful but we can also show our kids, and our neighbor’s neighbors, that just as important as being a good student, being a good citizen really matters. It can define us- just as our ancestors who bravely moved here as immigrants, who defended us in wars and who sacrificed for us to make our lives better- let’s be that type of citizen – for our kids.

Week 15 of the Coronavirus Saga. June 22, 2020

Dad’s Turn

So even if it’s a Hallmark holiday, a shout out to dads is appreciated. But we do know that it’s more than an acknowledgement, dads play a critical role in promoting optimal child development. I was struck from reading an article that dads promote risk taking – in a good way – they encourage us to jump into the deep end of the pool, scramble from one rock to another, push us beyond our comfort zone. We know how important the overlapping role of both parents can be in the progression of healthy, normal child development. I don’t want to get caught up in the stereotypes. I get it, some of us are pushers, some pullers, some not sure but before we microanalize ourselves and our upbringings, what relevance does this have to our previous discussions about family functioning and its implications?

The centerpiece of family functioning is stable and nurturing relationships. Those relationships start at birth and in early childhood and form the foundation of security and trust. So what does stable and nurturing mean? Stable means predictability. Are we a steady presence in our child’s life? And is that presence both physically and emotionally predictable? And nurturing- do we offer security? Are we attuned to the needs of our child? Is it about them or about us? And this goes back to our childhood, our parents and how we were raised and loved.

The generational impact of parenting intrigues me, especially for fathers. Our understanding of what dads should be, what their role is and what they represent has really changed over the past couple generations. I’m sorry to keep going back to this, but the tenants of positive parenting didn’t even exist two generations ago. (I know because that’s when my parenting experience started). We pinned our parenting (and fathering) approach on punishment- there had to be consequences for being “bad” – spare the rod and spoil the child was the theme and sentiment. We now see that those were short term fixes but not long term solutions. Fear works temporarily, but it undermines understanding and connection. It’s lazy parenting to some extent. It may have fixed a problem and made you feel in control but what did the child learn? Discipline and punishment are not the same. If that’s news to you, you better get that copy of No Drama Discipline right away!

You may think this is pediatrician BS but when we look at vulnerable kids in vulnerable settings, kids that don’t have stable and nurturing relationships, their emotional growth is stunted. Fear begets fear, yelling begets yelling, acting out begets acting out.

So, sorry dads, if you were looking for high fives and aren’t we great commentary, I led us down another path but I challenge us, as dads, that our role isn’t who yells the loudest but who is steady and reliable – who kneels down and listens, who knows that there is more to be gained from a tough loss than an easy win, that reading a book (and wearing a mask) demonstrates manhood too. And we need to do the cannonball plunge into the pool because…life is fun, life in the shallow end of the pool isn’t the goal; if we don’t challenge ourselves, we’ll never know if we could do it and dads make that happen. And fatherhood isn’t just about playing a role of preconceived notions. We help set the foundation of how our families function – be it routines, meal times, play time, exploring nature or encouraging family traditions that are meaningful to us and want to be important to our children. And most importantly, we want to let our child know that we’re crazy about them! Why? Well because they’re our kid! Let them ride on your shoulders, push them off on their two wheeler and be there in the deep end of the pool to catch them – to see that smile, that sense of accomplishment, that feeling that you got them…and they know it. That’s what parenting means. Yes dads, we matter. Maybe more than we know.

Week 14 of the Coronavirus Saga. June 15, 2020

Schools, pandemics, decisions…oh my;

Racism, Inequality, Bias…so much

My original intent this week was to comment on school return decisions. But even in the past few days, plans are being forged (sort of). Are we ready? Who makes the decisions? Who do they listen to? How do you feel, how will you react?

Equally unclear is how we move forward as a country following George Floyd’s death and its repercussions. We said we were at an inflection point. What does that mean? How does racism affect you, us and our community?
Decisions and conversations – all complex- all very personal and yet out in the open. Is this somebody’s else’s issue, does it have meaning and concern to me, my family, my neighbors, my community? How can we learn from one another – talk with one another and grow, as individuals and as a country?

Regarding schools, what strikes me is how truly ambivalent we all are. There doesn’t seem to be a clear, successful pathway. Recent polling (admittedly 2 weeks ago is a pandemic century and I suspect where you live is a major determinant) indicates that between 50-60 % of parents are unsettled (my word) about their children’s return to school this fall and 20% of teachers feel the same way. Overall, 40% of parents or teachers have significant concerns about their child’s or other family members personal health being affected by a return to school. School systems have not been too transparent- they presumably aren’t significantly more informed than we are and maybe don’t know what to say. But what are the implications if we don’t agree? What recourse do we have? Distance/ home learning has not been sufficient. Educational regression is occurring in our most vulnerable students and academic stagnation is being lost on our students who excel. Much less the social, interactive and community aspect of education for our children that is also vitally necessary for an overall well rounded academic experience.

Equally important is our newly emerging conversation about racism, inequality and bias. Where is that platform, who are those speakers? Where do any of us fit in with what is almost by definition an uncomfortable discussion?

How can we have a conversation, relevant to us personally that reflects our community that allows us to listen, learn and interact with one another, our neighbors and in our community?

I and FCP want to be part of those conversations – be it as health professionals, listeners or at least as a comfortable landing zone for all of us to engage. These are all public health issues that impacts on our collective well being. Our “lane” is family functioning, support and education with the back drop of being the medical home for our families.

A major part of the anxiety is what lies ahead- we don’t know- so how do we parent in uncertain times? As a start, acknowledging our uncertainty is key. Our kids get their read form us – how we react. Almost always our issues are more alike than different. But when discussing issues of race and inequality, our common ground may not be so common. My instinct is to listen and to try and find that common ground. My hope is to find the right platform and panel to lend their thoughts and perspectives. It’s a start.
Is this in the realm of pediatrics? Yes, the AAP encourages advocacy and I’ve spent my entire professional career here. This is my home and community too. I want to make this a better place. So if not us, who? If not now, when?

I see the summer as an opportunity to push this out. Who knows what the fall may bring?

We plan on organizing 2 programs- details to be worked out- and your input is very important to how we will approach it.

Parenting in Uncertain Times:

  1. Covid 19 and the pandemic; Family coping strategies and how to deal with uncertainty
  2. Racism and Inequality; Listen, learn, discuss

We want your input regarding interest, content and platform. Please help us help one another. It’s our turn, your turn. As I’ve said before, this may define what really matters – in our lives, our families lives and in the life of our community. Our participation matters. Maybe I should use the oldest cliche out there – do it for the children!

Please spend a few minutes completing the survey we have posted on facebook. We appreciate your time and interest.

Week 13 of the Coronavirus Saga. June 8, 2020

I first want to thank all of you who passed along support for my last commentary about racism. I’m glad it resonated. We can only only hope that we’re at an inflection point in this country’s open wound with systemic racism and all its implications. The persistence and seriousness of the marchers and demonstrations (peacefully, thankfully) impresses me. Are we listening as a nation, can that result in institutional change?

The day I’m writing this is June 6 – D Day. 76 years ago we led the world to turn back tyranny and authoritarianism. It could have been our finest hour as a nation. It allows us today to speak freely, demonstrate openly and be the beacon to the world promoting democracy. It’s a fundamental right but also a responsibility that we can never forget or take for granted. Our personal aspirations and achievements can only be accomplished in a society that values those rights – for everybody- and is willing to defend and fight for them.

Understanding Childhood Adversity:

Over several commentaries I’ve touched upon childhood adversity. In the past 20 years we’ve become increasingly aware of the social determinants of health (sociological, economic, educational, ethnic) as critical to healthy childhood development and well being. We now realize that these factors, starting in early childhood, can last life long and impacts both our mental and physical well being and can be passed along from generation to generation. Nature and nature are absolutely interconnected.

The biology of childhood adversity is fascinating and important to understand as it helps explain its implications and manifestations. We now speak of trauma in both physical and psychological terms. Persistent exposure to trauma (be it physical or emotional/psychologic) all results in the same release of stress hormones (cortisol). The stress area of our brain (the amygdala) literally expands in size and stress hormones (cortisol) are chemically elevated persistently. Conversely, our modulating center of the brain (the pre-frontal cortex) is underutilized and ultimately under- develops. As a result, exposure to stimuli, real or perceived, triggers our fight or flight (cortisol) receptors and we are in a state of reactivity. Conversely, our ability to counteract or regulate the threat is poorly connected and disorganized. We can’t think through the options, we react (flight or fight) as option one and option two. This has nothing to do with race or economic status. Being poor and a minority are cofactors but we all respond in the same way to stress at a biological/ brain level. All of this starts in childhood and childhood adversity (adverse childhood experiences or ACEs) sets the stage for a life long over- reactivity and maladjustment to stress. Additionally, and equally important and almost unbelievably, persistent stress exposure affects us at the cellular level and can be passed on genetically and also increases our bodies inflammatory response which are directly linked to basic adult diseases such as CV disease, asthma, autoimmune conditions with resultant impact on life expectancy.

The cliff note description of ACEs may be too short and incomplete to understand its profound importance but the sentinel work on the subject was by a pediatrician, Dr. Nadine Burke Harris, and her remarkable book, The Deepest Well and the foundation she helped create, the Center for Youth Wellness, helped form the basis of our Family Care Plan.

This certainly may seem depressing and not relevant to our lives but one central question that comes up when discussing ACEs is why one individual can overcome adversity while another can’t, even if they live in the same circumstances or environment. It’s not luck or biology as we found out. One person is not “stronger” or has inherent better survival skills.
The magic potion starts with what we call stable and nurturing relationships (love and stability) – the foundation of basic family functioning and the infrastructure for that is the foundation of the family care plan. Our biology is the same, our needs are the same, the foundations of family function is the same. It comes down to all the other sling and arrows of life we have to deal with, especially if our genetics are all messed up after generational exposure to stress and how we deal with it or how our closet relationships either help us or hurt us with coping.

As time goes on, I hope to take a deeper dive into each of the elements of the family care plan but I want to emphasize the central importance of positive family functioning, positive parenting and stable and nurturing relationships as interconnected or interchangeable in my view and that this is an universal message , applicable to all of us , no matter our circumstances but especially critical to those exposed to stressors beyond their control. Our better understanding of ACEs and how to understand and support its modulating effects is a huge component as we work through societal change we’re currently experiencing and hopefully confronting. It’s a public health issue but more importantly a personal issue that we all can relate to and help us better understand, and care, for one another. We each have a role in helping making our society better- it starts with education and connectedness.

Week 12 of the Coronavirus Saga. June 1, 2020

Our zip code

I originally was going to write a “commencement speech” to the 2020 graduates of FCP – from age 5 to 25. I thought it was both unique and a pandemic opportunity that I hoped would be a little humorous, thoughtful and maybe inspirational. But events this past week in our country, nothing to do with coronavirus but everything to do with what kind of country we are, made a faux commencement address seem out of place. But on second look, everything that has gone off the rail with our pandemic is reflected in what has gone off the rail every day in our country.

When I’ve commented in the past how I’ve felt we’ve been on the edge of the pandemic – looking from the outside in – I didn’t realize how true that was- but not by luck or accident – but by zip code. FCP is in the 21774 zip code. My practice is 80-85% Caucasian and 82% commercial insurance. We’re on the good side of the pandemic because we’re on the good side of all things when it comes to public health. Your health outcome is mainly influenced by the color of your skin and where you live – your zip code. We could have predicted which cites, which races and which age groups would have been slammed by this virus- it’s where you live and where you come from, not the microbiology of the virus.

And how you’re perceived, treated and understood. It’s all the same thing. It’s all the same zip codes. Where you stand on the innocent/guilty pendulum has less to do with what you did than what you look like. We’ve heard it all before. In fact, we’ve heard it forever. What struck me so vividly about the pictures and images that I saw in Minneapolis and many other cities across our country this past weekend was that they were the same pictures I saw over 50 years ago as a boy growing up in Montgomery County just south of here watching the 1968 riots in Washington. The same fires, the same smashed windows, the same armed police – the same people – two generations later. I grew up only 20 miles from those riots, but I might as well have been a planet away. In the same manner, what I watch about the pandemic is playing out the same way- more on television- than in our office. Fortunately for sure, and certainly not without some fear and loathing on our part, but nevertheless we’re on the right side of the zip code lottery.

We’ve come so far as a culture and yet we haven’t moved an inch. Inequality, at all conceivable levels, economic, educational, health, you name it, is as marked now, statistically, as ever. That’s hard to comprehend. Maybe not so hard to understand depending on your zip code I suspect.
This pandemic will cost us trillions to recover from. To resume our former ways of life. How lucky for me, how unlucky for others. You come out it as you went into it except there is a bill to pay. Is trillions of dollars of debt even comprehensible? Which services, which cities, which organizations won’t recover, won’t get their share back? Take a guess. And the repercussions of that? The same photos of the same cities of the same people, two generations later, 50 years from now.

Outside of my practice, I’ve spent the later half of my career involving myself in community pediatrics, primarily on the Frederick County Early Education Council (IECC). It’s given me much more than I given to them. I’ve learned so much more, understand so much more and it’s given me meaning and purpose…and relevance to my practice of pediatrics. The family care plan initiative spawned from what I saw and learned from those meetings and those professionals and what I learned from them about family function and health and economic inequities – from families most in need.

Remarkably, the initiatives are universal. Successful family function builds from the same set of principles, the same guiding light. And resilience builds from that base. And it’s that resilience (and support structures) that can carry us away from this vicious cycle. Not easily for sur;, entrenched poverty & racism are huge, possibly overwhelming, barriers but we know from sociological science that the principles work and that money invested in early education and family support pays off – if given a chance (and time).

But I’m also not here to throw our (my) zip code under the bus. That disrespects my parents who worked so hard to improve their lives and mine – by hard work and sacrifice. And I have too – willingly and thankfully, successfully – tried to do the same for my family. But I’ve never been judged by the color of my skin or have had to plead for my innocence or worried that how I dress, talk or act may cause me harm. I’ve come to know that I cannot judge that which I do not know or understand. I have not walked in those shoes. I realize that’s it more important to listen than to talk, to observe more than react, to care more and to be kind – to be forever thankful for what we have, including our zip code, and to appreciate that not all of us are so lucky. And to work for the greater good – for all of us.

Maybe that was the graduation speech I was suppose to give after all.

Week 11 of the Coronavirus Saga, Memorial Day

Memorial Day: Before I move on to my regular weekly commentary, I want to take a moment to acknowledge another important national holiday; Memorial Day. It should be our most solemn holiday but it seems to get lost in the commotion of the start of summer but we need to take a moment to appreciate its significance to each and every one of us. Thousands upon thousands of our fellow Americans, many of them young and who never ever had the opportunity to experience a life full of opportunity, lost their lives to protect us and our way of life. They are the true American heroes- they made the ultimate sacrifice to give us everything. Thank you.

Part II. The new normal – family style

Last week I discussed how our new technologies, thrust upon us by necessity, have become our new normals, medically and personally. Prior to that, I had introduced a family support toolkit from the Center of Youth Wellness that I thought presented a wonderful framework for family functioning in general and especially when experiencing stress. I had mentioned then and reiterate now how important these principles are to laying the foundation of family and personal wellness and wellbeing. It’s my hope to integrate these concepts into the mission of Frederick County Pediatrics – that beyond medical care, these principles serve as an equally important foundation of the values we want to promote and represent.
Without artistic flare to make them stand out more, here are the fundamentals of my vision of a Family Care Plan:

    1. Building Relationships & Supporting Emotional Well-being. The core importance of understanding the concepts built into promoting positive parenting 
    2. Healthy Eating. Making it fun and life long
    3. The central importance of sleep and routines
    4. The value of play and exercise – both age appropriate and sustainable throughout our lives
    5. The relevance and fundamental need of getting outside & connecting with nature – as a lifelong passion and as a guardian of our earth
    6. Being in the moment and self awareness. Understanding mindfulness and gratitude
    7. Reading. Always the gift that keeps on giving

And giving back. From our family to yours. Not only in times of need but as a core family value.

My dream? Incorporate these principles into our day to day mission of promoting health and wellness as integral to supporting positive family functioning. Well child anticipatory guidance can be so much more than a checklist of concerns and requirements and can extend beyond the exam room and our office into the community and into your home.

Can there be a place for a family-learning virtual classroom that these concepts can be promoted and discussed and championed by all of us? Can this be the new normal? That in times of stress, we determine and articulate what really matters and make that the standard from which we move forward?

I know this sounds flowery and maybe supercilious but I stand by the importance and relevance of each and every one of these principles. They matter and are truly the foundation of successful parenting, family function and raising thriving, resilient kids. And that’s what really matters.

Does any of this resonate? Is there a passion or personal motivation that pulls you in or you want to promote or have a resolution to improve? They all matter from reading to healthy eating to exercise to nature connection. They all connect in one way or another but #1 is not there by accident. Ultimately the human experience is about building relationships, one step at a time, beginning with our core relationships. Those core relationships are built on the foundation of these principles. We first need to understand, then believe in and finally put into motion all of these principles, as a team and as a medical home, to strive to make this a living, evolving concept that remains vibrant and meaningful.

The project will never end. There will always be new babies and new families that hopefully will benefit from this set of guiding principles that can be built upon and passed along. That’s the legacy of this practice, spawned in a time of medical crisis, and can be proud of. We are resilient, thoughtful and responsive and came through it better, richer in knowledge and clearer in mind of a set of principles that can be our guiding light that can see us through both good times and bad.

Week 10 of the Cornavirus Saga May 18, 2020

If we’re being phased -in with relaxation of restrictions, I can have a phased -in blog too, right? Part 1 today is on changes in our revamped medical care structure. Part 2 next week is how we can use those changes to expand on our vision of promoting family centered functioning based on a family care plan that I presented a couple weeks back.

Part 1

Even if we locally are neither too anxious nor at the proper phasing stage, the rest of the country sure is and, indeed, I think everyone is looking ahead as we enter month 3 of our saga. The “new normal” even now gets its own segment on the morning news and I think we’re all both a little excited and intimidated by it.

At the medical practice level, I see two overlapping trends that I suspect are here to stay: telehealth and video conferencing.

Telehealth may revolutionize medical practice- that may seem a little overstated in the short term but I think long term it will become integrated into our standard of care. Why? Well, it works (mostly) and even though it can’t completely replace hands-on medicine (although they’re trying), it certainly sets the stage for making medical decision making and can close the deal on many minor primary care issues plus it can be done with less inconvenience to families and be worked into office work flows easily. Telemedicine can also play a role in chronic care management and follow up. I’m not sure seeing patients in their “natural setting” is as valid as reported but that may change as we get more accustomed to it. So, yes, telehealth is a new normal and that’s ok – we need it now and we will make it work.

So zoom is now a noun- we don’t get together, we zoom (at least that’s where I’m at, the techy folks are probably already onto the next stage). Zoom has been ok. If telehealth is an A-, zoom is a B for me. It works, it gets the job done, it allows for meetings or appointments to occur that otherwise may have been cancelled and, again, that convenience factor – it’s nice not having to rush around. But it’s not perfect. There’s less of a natural flow to things and it allows for only single conversations plus you don’t always get the big picture that you can get in a group setting.

So I do see these new technologies fitting into our personal and professional lives. I think there are true benefits and I trust the technological aspects will only improve over time. Certainly in pediatrics this will be a blend; we’ll continue to need to see our patients, especially our little ones, in the office. Convenience is one thing but it should never replace good medical care, however, I do see our waiting rooms become more virtual over time. Collaboration of care, moreover, may be enhanced virtually. Wouldn’t it be nice to have the family, myself and the specialist all in one place at one time? It may not be ideal but missed calls, forgotten emails or wrong assumptions doesn’t work well either. It may take time and some organizational song and dance but if all parties are interested, it could work – actually it will work if we want it to.

So If we’re putting together the new infrastructure of personal care, can we expand this to family based issues too? That’s what part 2 is all about and I’m anxious to present my thoughts and get your feedback.

So it was nice not reporting out scary data and statistics and we still hold our breath on what is around the corner but at least we’re not in emergency mode and can look at the big picture a bit. See you next week …

Week 9 of the Coronavirus Saga – A Homage to Mothers. May 10,2020

Well we made it to May and Mother’s Day -at long last – with freezing temps and snow just north of us! This pandemic does weird things.

In the midst of all the twists and turns of the past two months, we hope and pray that the worst is behind us. I would like to think so but my degree of confidence is . . . ?

Life has found a new rhythm for all of us. Some things seem easier; we’re not rushing around as much, early morning alarm clocks are less frequent, maybe even eating breakfast at something called a kitchen table. Board games and playing cards are showing up more. Have we observed and appreciated spring a bit more? The flowers bloomed, the birds chirped and the wind and rain came and went. But in other ways, it’s been anything but fun. Distance learning has been, at best, a mixed bag. Play times at the park are long gone and family get togethers have been missed – dearly- and there is just an unsettled feeling to it all.

We celebrate Mother’s Day connected but not together for most of us. For me, I haven’t seen or even been able to talk to my 95 year old mother in over eight weeks. She is safe but isolated in a nearby nursing home. She’s OK but at what quality of life do we measure?

It does seem when we peel off the layers of the onion, it comes down to family, connection and community. Back in the 80s, a sit-com called Murphy Brown caused a big uproar revolving around family values. For some, family values was a single word – it could only be defined in one way. But of course it’s two words. There are all different types of families with all different types of values. But at their core, they represent the same thing and the same needs: the need for connection, love and support – the building blocks required to grow and thrive.

And who is in the center of all that? Mothers of course. They’re the glue that holds it all together. They kiss the boo-boos, keep the troops in line, are often the chief cook (and bottle washer), make sure the special touches for all the celebrations are in place and ultimately sacrifice- that the needs of the family outweigh their own needs- time after time after time.

I work in an occupation dominated by moms – so I know what I’m talking about. We sure need our moms now more than ever – to hold us, comfort us and then push us along the path of life and ultimately send us off on our own to become the next generation of mothers and fathers and to appreciate for ourselves the gifts and tribulations that parenthood give each of us.

Thank you moms! Even in the midst of a pandemic we can step back for a moment and appreciate your sacrifice, your love and your commitment to us! We all could use a good hug right about now. That may be the cruelest hoax of all. Does a 6 ft. twinkle in our eyes and smile under a face mask count? I sure hope so!

We will get through this!

Week 8 of the Coronavirus Saga – May 4, 2020

Metaphors for the week: Hanging in there, Light at the end of the tunnel and Canary in the coal mine.  
Metaphor #1. Hanging in there- it seems as if we are or at least we’ve become more accustomed to our new normal (another metaphor?). At the practice level, we’ve expanded our well visits and everybody plays by the rules coming and going. Thank you. Telehealth makes up more than half of our non-well visits and in many ways it’s a good substitute. We feel we can make accurate assessments and push out information at least for the non urgent, less serious situations and it saves time for all of us and seems well received. I wish the quality of both the audio and video could be more reliable but prep work from my staff definitely helps. Welcome to the new age!  

Metaphor #2. Light at the end of the tunnel. Ties in with number one. Is it anxiousness to move on, generally more sporadic local covid news or overall plateauing at the national level? A peek at the Maryland data is discouraging, however, as we continue to trend up, not down and that means metaphor #1 is still the name of the game.  

Metaphor #3. Canary in the coal mine. Do you wish you could go shopping in a mall in Georgia or Alabama? Do those California beaches call out to you? Or do you prefer to watch this play out from the comfort of your living room? I’ll take option 2 but I’m biased as a healthcare professional. It’s amazing how alarming “mild flu like symptoms” are these days and what the implications imply- quarantine at home, out of work rule now up to 10 days. It’s generally a benign illness, except when its not and then all heck breaks loose. And we don’t understand why some cases get so severe, so quickly. We’re still learning about this novel virus – you don’t hear any expert taking this lightly.   As frustrating as it is, how nice it would be to play at the park or visit the family or eat out at our favorite restaurant- we’re just not there yet. We all worry and lament the economic implications, the lost educational opportunities, the uncertainty of what lies ahead. That’s the challenge.

So how do we hang in there ? Can I offer this link from the Center for Youth Wellness:

I know you’re inundated with family support and self care information but I feel this collection is the best organized, helpful and spot on references I’ve come across. And not just in pandemic times but in our day to day lives.

Could one of the outcomes of this terrible ordeal be a better appreciation for what really matters, how to help each other as a family and how to become more resilient in difficult times? Do you know that resiliency can be learned, that it’s more than just a personality trait? We can teach resiliency and we can become more resilient ourselves. And the toolkit is the basis for this. It’s not a chapter in a self help book, it’s a series of principles that make us and our families cope and understand and function better together. If we can truly incorporate these principles into our daily lives, we’ll feel and function better – as individuals, as families and as a community. These represent my practice initiatives and my value systems. In some ways there is nothing more important I can pass along to you, as a doctor or as friend, to enhance the quality of all our lives. Maybe it takes something like a pandemic to understand this or to appreciate its importance. And that’s not a metaphor!  

Week 7 of the Coronavirus Saga – April 27, 2020

Phrase of the week: steady as it goes. Fortunately for me and us, I feel like I’m watching the national melodrama play out all around but not aimed at us. Two back to back stories in the local paper summed it up for me: “Stay at home order could be lifted by early May” and “Covid 19 cases appear to be plateauing, but more time needed for confirmation”. Yep, that’s kind of where we stand.

As we watch the teeter-totter of public health experts and politicians deciding on next steps, I’m appreciative that our state seems in step with reasonableness and observation. We may be desensitized and fatigued after 7 weeks of relentless news coverage but over 50,000 Americans (!) have died of covid (that’s more than just a number, those are our fellow citizens) and “plateau” is not the same word as “reduction or elimination”; it just isn’t.

We continue to get mixed news locally of ongoing but relatively few new cases and our hospitals are quiet – even the ER, but the stories in the paper are heart wrenching when it comes down to the human, family level. Testing is available, if you meet criterion but not in any expanded way, at least around here. So there is some good news but there are too many variables: social distancing helps, warm weather helps, testing helps but none are perfect and we sit in limbo. We want to open up our economy and our former way of life but are concerned with its implications.

We all wait anxiously to learn of the school resumption decision; that sort of lays the foundation for everything else. We all have our guesses but so far they seemed to have played it right – go slow, watch the numbers- certainly, when it comes to kids, safety and public health comes first and foremost. Some have questioned why wait? Isn’t it obvious it’s too soon to reopen and the school year is nearly over anyway? Yes, but the implications (and planning) for some of our kids, statewide, is concerning. The lack of steady education, the lack of social connections, the lack of steady meals, the lack of structure that schools provide is critical for our disadvantaged children.

On a similar note, a recent New York Times article reported on concerning reductions in vaccination rates with a 30-40 % decrease for critical vaccines like pertussis and MMR. This emphasizes the importance of maintaining our well visits for all patients and I’m proud of our filled well exam slots. Way to go families!

So all is status quo on the FCP front – we wait as you do to learn next steps and are anxious to get outside more and rekindle our social connections (beyond zoom).

I want to give a shout out to Alyssa Smith, our reception coordinator and newly designated Outreach Advisor, who has spent considerable time updating our website and adding great new content to our positive parenting section. Great use of “down time”!

I also want to acknowledge our practice administrator, Amy T., who has steadfastly kept our ship afloat, tirelessly attending all our morning huddles, submitting our small business loan applications (beyond no fun) and I know has lost sleep worrying about making ends meet. Thanks- quality people step up in difficult times!

Thank you to our providers and nurses who have quickly adjusted to telehealth, parking lot visits, and have displayed endless patience. We are truly seeing teamwork at play and reaping the benefits of team-based care.

And to all the nurses, receptionists and providers out there- we may not be in the headlines (thankfully) but we’re getting the job done with professionalism, grace and hiding great smiles behind our masks!

Week 6 of the Coronavirus Saga – April 20, 2020

Could it really be week 6 of this? Just like newborns – quick weeks and long days! Words of the week for me? Stabilization with just a hint of trepidation.

Although still variable, national trends of COVID 19 activity seem to be plateauing but the state of Maryland is still tracking upwards, unfortunately. From Frederick County and as a pediatric practice, it feels like we’re peering from the outside in. Everyone is itching to lift some sanctions, although national polls support that we as a country and citizenry agree in general with our mitigation measures.

Schools remain closed and our new strategy to slowly liberate mitigation in timelines per COVID activity rates makes sense but has us in a holding pattern here in our state for at least a month if I’m doing the math and understand the recommendations correctly.

The virus remains mysterious to me, at least in it’s more benign form that we see in pediatrics. It seems innocent in some ways and yet highly contagious in others. We really don’t have much experience with pandemics, especially with a novel virus. The public health experts only know so much, inadequate testing leaves large gaps in our understanding. Testing those sick and most suspect is certainly necessary but the extent of spread and overall preponderance of COVID is another factor that we don’t know as we try to reopen our society. That’s the trepidation part for me.
At FCP, we keep plugging along. We’ve gotten into a rhythm with well visits for our younger ones and have the basics of telemedicine down even as we try to improve it technically. There isn’t any widespread illnesses in the community. Yeah!

Information overload is a mixed blessing, isn’t it? It’s good to stay informed if not trying on the psyche. Trends of utilization at pediatric offices are still downward but has given us an opportunity to tighten up on protocols, refresh our handouts and improve chronic care and medication follow up and even rethink follow up care in general (can you say telemedicine?). At least this is promoting quality care measures and not stressing us out as supply ordering, obtaining PPE, etc. does.

So we remain in a holding pattern, no worse for the wear from my perspective although a little fatigued from the day to day subliminal stress that it puts all of us through.

I know families are struggling at home! Cabin fever may be as challenging as COVID fever! It really puts our parenting skills to the test. We’ve put some videos and podcasts from our favorite positive parenting authors on our website. It’s there for your review- I continue to feel that No Drama Discipline is a must-read for all parents. It’s worth the deep dive.

Hang in there, group! We’re so fortunate to be on the margins (although a glance at nursing home incidence near us reinforces that it’s here and dangerous) and the overall lack of serious disease in pediatrics is beyond good news! If the worse for the vast majority of us is to continue to shelter in and practice social distancing, we can do that! This spring may be a wash (pun intended) but if we can pick up the pieces this summer with a transition to a new normal this fall (you know, face masks are bearable – and so is hand sanitizer) with open schools and parks – I’ll take that. Let’s just hope there is a new normal that is not too crazy and restrictive!
Collectively we can keep this silent invader at bay- but it does take all of us to be on board!

Week 5 of the Coronavirus Saga – April 13, 2020

Wow, do you even remember this is spring break? Word of the week for me? Adjusting. We’re adjusting- in so many ways.

As national trends of COVID activity appear to be leveling off, there is an agreement that our national social distancing/sheltering-in policy seems effective and is working. But it seems almost like a brush fire, where flames of activity can be set off quickly and the fear of an NYC-like exacerbation is disturbing, to say the least. The wide variability in disease presentation, its unpredictable severity plus the increasingly known racial differences and fundamental lack of effective treatment options beyond intense supportive care, seemingly overwhelms our health care systems, but in a very fragmented way.

Locally, we continue to be on the edge- fortunately. Although severity continues to be less in pediatrics, whether the younger age group (parents included) are “silent contributors” reinforces the need for our current isolation plan. We need to put out the fire as much as possible!

The impact of COVID on pediatrics seems ironic almost. Despite the appearance of overrun ERs and hospitals, pediatric offices (and hospitals) are quiet. Utilization rates are down significantly -a 60% decrease seems a national average. This reflects families appropriately avoiding health care in general- following sheltering in advice and also knowing there is very little to offer in either testing or treatment options for those with COVID concerns. It’s also a healthier time of year; cold and flu season is largely behind us – hello spring!

FCP reflects this and we continue to follow AAP and CDC guidelines. We actively triage all calls, our telemedicine visits now exceed in-office visits and we slowly (and safely) continue to see our youngest patients for well visits and necessary vaccinations. As a practice, we are healthy and well – we even can put up with one another (not all families can say that!). Could maintaining good communication and speaking truth to power help? From my perspective, it makes all the difference in the world.

My biggest challenge? Death by webinar! Between medical and practice management updates, insurance changes, implementing telemedicine, national and regional updates, understanding CARES, supply chains and connections to other local services and needs, I could be busy every evening and lunchtime. It’s all good but it sure is a lot! I shouldn’t complain, it’s nice to have the overview and recommendations, but I think we’re all stretched a little thin and just wish we could see some light at the end of the tunnel.
And to think, I don’t have to try to be a teacher, activities coordinator, and family cheerleader when I get home (but I do need to be a supportive spouse!)- we really are in a tough fight! And we really are in this all together. Don’t forget that! We need to put out this fire – we can be good campers – our roles (for most of us it’s simply maintaining social distancing and avoidance) may seem insignificant but collectively it is not. Other communities and health care systems may have much more daunting issues – let’s keep ours under control.

Please spend some time each day to relax, close your eyes, slow down your breathing and find whatever that inner Zen means to you. Self-care matters! Remember what we can control and what we cannot. Spring is here- it’s really a beautiful time of year. Be thankful for where we live, for what we have – and for one another!

Week 4 of the Coronavirus Saga – April 6, 2020

The phrase that comes to mind first when I reflect on the past week is “same old – same old”. Our new normal seems a bit more routine even as we continue to work out the kinks.

Fortunately, we’ve had no shock waves run through our practice as we continue to balance “tight triage”, well visits for our youngest age groups and a combination of telemedicine and office (with curbside) sick visits.
We seem to be reflective of national norms with our overall utilization rate down 60%. This is to be expected to some extent as we have appropriately deferred “non-essential” visits and follow-ups for now. Telehealth (I’m not sure yet what the common buzz word will become for video-based telemedicine) is certainly the new player in this game. During the emergency and foreseeably the future, this will be our new adjunct for care. Estimates currently are that Telehealth will make up close to half of sick and follow up appointments and we’ve incorporated this into our workflow with improving success each week I am glad to report.

We’re anxious to expand our well services too as we have both a little fear and excitement about the backlog and expected boom as we work through the crisis and into the summer (hopefully).

My sense, not based in any firm numbers I must admit, is that sheltering-in is working for us locally. Our ER and testing centers are not overwhelmed. Local outbreaks at two nearby nursing home facilities, however, remind us how fragile and exposed the system can be. Our kids and parents may well be minimally (or asymptomatic) ill and reinforce the importance of social distancing and avoidance.

I see the next month, at least, as maintaining the “siege” mentality. I’m concerned that large urban areas and less enforced sheltering-in nationally could allow this to linger and fester. Fortunately or unfortunately, we are all in this together!

Social distancing shouldn’t mean social isolation, however. As I well know, parenting in the best times is challenging (and why we kicked off our positive parenting program this year) -parenting under stress can bring out even more challenges. Homeschooling, working from home, too much togetherness, financial strains are all new issues – for all of us! There are lots of resources out there – are there too many? Megan James and I are organizing a video parenting workshop to offer our voice and input into this new world we’ve unexpectedly been thrown into. Ironically, almost, the themes of our comments are based on our original presentations – were just more rapidly moving into the implementation phase. Stay tuned for details.

So, as always, we’re here for you. Same people, same caring, same dedication- just slightly different scheduling and formatting. Hang in there!
All I ask is that nobody send me a “Please Hug Me” tee shirt!?

Week 2 of the Coronavirus Saga – March 27, 2020

Much has changed and much has not changed as our medical and personal lives have flipped upside down in the past two weeks.

For us at FCP, maintaining our strict patient surveillance and triage remains our biggest and most stressful challenge. Overall lack of covid 19 testing has us “lurking in the dark”. Reportedly there are relatively few cases in Frederick County and no reported pediatric cases but the unsettling knowledge that children (and parents) may present asymptomatically or with minimal symptoms obviously concerns us. Our triage struggles to ascertain not only the status of the patient but relevant family, work and travel history. That all takes time and can be confusing.

Although our PPE is adequate, we always feel we should ration. Other supplies too are limited. Flu and RSV testing for example, helpful to rule our other causes of Covid 19 – like illness, may or may not be available.
Staff safety and morale weighs on all of us. For me, what we see and hear at the national level plus the concern and admiration that I have for my colleagues who are on the front lines in ERs and ICUs is hard to shake. They are the true heroes!

Time lines and expectations are no more clear to us than they are to you- we hear what you hear from our governmental agencies and politicians . As Dr Fauci stated, the virus decides the timeline, not us.

We are also an independent, small business and like many of you, we have bills to pay and payrolls to make. We’ve been asked and want to limit “non essential” sick and well visits to our office – that is proper medical care for the present but not a good long term sustainable business plan.

Fortunately, we have a very conscientious practice administrator and although nobody can plan for such a major disruption in operations, we think and hope the underpinning of our practice is strong and our staff is excellent, dedicated and committed. And I am similarly committed to them.
So we’re hanging in there, fighting the good fight and trying to keep our head above water (sorry, that is a lot of metaphors!) and we’re trying to adapt as best we can with strict separation of sick and well, seeing some of our patients curbside (just to be on the safe side) and have revved up telemedicine. Guess what? It doesn’t always go smoothly!

We’ve been advised to batten down for a 2-3 month “siege” with the philosophy being plan for the worse and hope for the best. And that may be a best case scenario.

Very fortunately, Frederick County is not an epicenter for high covid 19 activity and we have good linkages to both our hospital and health department to monitor conditions and trends.

The medical toll is one thing, the economic and mental health toll is arguably as daunting and concerning. Our friends at the United Way and the Mental Health Association are right with us to support families in need, especially as we wait for federal relief. Our psychology and behavioral health colleagues stand in the wings – let’s hope there isn’t too much pent up business for them!

Medical practices like ours are indeed the front line troops for now and for as long as it takes to confront this public health crisis. I take comfort in knowing that the foundation of my practice is strong and my staff is excellent! We listen and respond to leaders in our profession to help us navigate these rough seas. We’ll hang tough- because we are you and you are us!

Now go wash your hands, take in some nice, deep clearing breaths and enjoy the warmth of an early spring day.

Statement by Dr. James Lee- Beginning of COVID-19; March 20, 2020

It’s been a challenging week, a tough week, a surreal week. In over three decades of practicing medicine, I’ve never experienced anything like it. It’s our turn, the health profession, to stand up to an unknown threat – doing it with incomplete information, incomplete preparation and incomplete resources. We’re concerned if we’re doing it right – for our patients and for our own families.

From early morning huddles, to relentless phone calls, to donning Darth Vader protective gear, to mastering new technologies like telemedicine – we’ve tried our best.

I can’t express my appreciation, respect and, frankly, love that I have for my staff who have bravely stood up during these stressful times . In many ways, we’re you – parents, mothers and fathers, neighbors and friends who face the same fears and concerns that you do. But it’s now our turn and we’ll do our best to help you, educate you and hopefully keep you out of harms way.

We don’t know what’s around the corner, how long this will go on for and what impact it will have on all of us – medically, financially or emotionally. But all I do know is that I wouldn’t want to stand side by side, work side by side or laugh and cry side by side with any other group of professionals or, frankly, just good people, than my staff and I’m beyond fortunate to have them working at FCP . . .and so should you!

We’ll see ourselves through this – somehow – gosh knows hopefully not for an extended period and we’ll fight the good fight – hopefully with grace, determination and professionalism.

Now it’s time to get back to a phone call…

Dr. James Lee, MD

Community Programs

Docs in the Park Reach out and Read Girls on the Run United Way of Frederick Maryland Interagency Early Childhood Committee Mental Health Association LiveWell Frederick Family Resource, Information & Education Network for Down Syndrome