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Heidi Feldman: A Behavioral Developmental Pediatrician’s Perspective on Healthcare

Listen to a behavioral developmental pediatrician’s perspective on healthcare from Heidi Feldman as she joins Rob Oliver on the Perspectives on Healthcare Podcast. Heidi is a professor of pediatric medicine at Stanford University in California. She is a member of the Baby Boomer generation and is also a practicing clinician.

Here are 3 things that stood out as Heidi Feldman gave us a behavioral developmental pediatrician’s perspective on healthcare:

· Quality healthcare starts with a practitioner that respects, almost reveres, the individual that they are serving
· There are three components of quality healthcare
1. Recognition of the scientific basis of healthcare
2. Treating people with compassion and respect
3. The patient or family is invited to be part of the process
· The nature of medicine has changed. The system is designed for treating acute issues and must evolve to deal with more and more patients with long-term conditions.

You can learn more about Heidi Feldman through the links below:


Here is a transcript of Heidi Feldman: A Behavioral Developmental Pediatrician’s Perspective on Healthcare:

Rob Oliver: Welcome. And thank you for being here today. My guest is someone that I have known for. Let’s just say a while, and that way we don’t date ourselves or anything like that. Her name is Heidi Feldman. She is a professor of Pediatrics at Stanford University. She is located out in California. She’s a member of the baby Boomer generation, and it is my privilege to say this. Heidi Feldman, welcome to Perspectives on Healthcare.

Heidi Feldman: Thank you so much for having me.

Rob Oliver: Absolutely. Can you tell me a little bit about yourself and your role in health care?

Heidi Feldman: Sure. So I’m a developmental behavioral pediatrician, and I’ll probably call that developmental pediatrician as we go on, just because it’s less of a mouthful. And that means that I’m a pediatrician who focuses on issues of children’s development and children’s behavior. Sometimes children are at risk for having developmental delays or behavioral difficulties because of, let’s say, a medical condition early in their life, and sometimes even without any risk factors, children end up on a slightly different developmental track, and their families are looking for explanations and for direction in how to proceed so that they can meet their potential. So I am a clinician and I work with children and families. I’m also a teacher of Pediatrics, so I particularly train residents, pediatric residents who are going to be the primary care physicians of the future. And I train fellows who are going to be sub specialists like me in the future. I also do a little bit with medical students and undergraduate students, but not as much of that. And I am also a researcher. So I ask questions about children’s development and try and come up with sensible answers. And finally, I’m an administrator. So I try and run the clinical program.

Rob Oliver: You are a person with an extremely large hat rack for all of the different hats that you are wearing. So one of the things when we were working together, we were looking at just this question. And that is what does quality health care mean to you?

Heidi Feldman: I’ve been thinking a lot about this, Rob, and I think that quality health care begins with a practitioner who honors and respects and almost reveres the individual with whom they’re working and the context in which that individual lives, their family and their community. And I think if healthcare doesn’t rest on that really profound understanding that people come to you because in some ways they are hurting. And if we don’t, as healthcare providers, understand that our job is to relieve that hurt. And I think we can’t really arrive at high quality health care. So everything rests on the reverence that the clinician has for the patient. And I think to some extent the respect that the patient has for the practitioner. And then there are the details on which we build a healthcare system. And I think that there are three components that I think really make up quality health care. First, there is a recognition of the scientific foundation of medicine and health care, so we don’t want to go off and come up with our own cockamey ideas about how to proceed. We want to follow in a strong scientific tradition that has tried to show benefit and risk in a systematic way. We do that number two with compassion and respect. So we try, for example, to make sure that our language is understandable. We can’t have high quality health care if the clinician is uttering mumbo jumbo. And the third element is that the patient or the family is invited in to the process to contribute what they can contribute to the health care activity. So high quality health care is not a one way street, it’s not a megaphone, it’s a dialogue, and the dialogue engages and involves the patient and or family fully in the process.

Rob Oliver: Can you give me an example of quality health care and what that looks like?

Heidi Feldman: Okay. So in my business, I see many children these days where parents have been reading about autism and they’re very concerned about whether their child meets the criteria for autism. So they would come to somebody like me to present their concerns. So the first thing is I have to have a strong scientific foundation. I have to know what autism is and what it is not, and I have to know what the right questions to ask are, what the right how the answer should emerge. If I’m going to decide the child does have autism or not, I have to do that in a way where I’m really kind and respectful of the child and the family. Some of what I’m going to do is play with the child, and I’ve got to be willing to get down on my bum on the floor and roll balls around and blow bubbles and share tea set and just really do what it takes to make the child feel very comfortable because I’m not going to be able to make this decision. This really important decision. If the child is terrified or anxious and then I have to really listen hard to the family. I have to see what their concerns are. I have to have them set up a set of scenarios where they’ve been worried. I have to engage them in the process. I have to check that my observations, maybe in the clinic or in a telehealth window, are reflective of what they see on everyday life. So we have to have a really strong dialogue. And at the moment where I’ve made the decision, maybe, yes, maybe. No. I think your child meets the criteria for autism. Or maybe I don’t I have to keep checking in that my impressions, my conclusions are resonant with their observations and their understanding so that we come to common ground.

Rob Oliver: Okay. And sometimes I would imagine that there’s a next step that goes with that. If you’re giving them a negative diagnosis to say, okay, your child does not have autism, then there would have to be a next step that says, okay, is there something else going on as well? Is that right?

Heidi Feldman: Yeah. Absolutely. Let’s go back to first premise. These are people who were hurting for some reason, and they came to me because they really needed to understand. So if I think that the child does not meet criteria for autism, then I’m obliged to understand what was the nature of their worry and what does explain that worry. So it could be that the child has a different developmental disorder, and it would help them to know what it is and to treat that developmental disorder as specifically as possible. It could be that the family has a misconception of what children are like, and they have very, very high expectations, like, I will be doing calculus. But the child’s two, and I don’t mean to be flipped. But anyway, I have to come to a meeting of the minds with what is a fair expectation for the child. I want to say that that doesn’t happen very often, but it does happen very often that especially as children go from infants to colors and they get a little feisty and they don’t do the things that their parents always expect of them. Sometimes there is some education about what is typical two year old behavior and what are the criteria for autism. So those are some examples.

Rob Oliver: Thank you very much. What do you wish people understood about your role in health care?

Heidi Feldman: fOne thing that I think is really important is that I work in an outpatient setting almost exclusively. Occasionally we’re asked to do an inpatient consultation, but that’s fair. And I think a lot of health care has been built for kind of inpatient high drama, surgically type focused care and this cognitive end of the business in an outpatient setting where we accumulate information over time, where there’s a lot of conversation between parents and families. This is a lot of what healthcare is, where I think a lot of the decisions are made for that more high drama end of health care. That’s one thing I’d really like people to know. Just yesterday, I was asked a question about mask policy in the hospital. Okay, we happen to be living in the COVID era, and masks are important protection for health care workers and for patients and for families. So of course, there are mass policies. So someone said, Well, I have a two year old and she doesn’t like to wear a mask. I come into your office, so I said, I want to look at the mask policies, and I went to the website. And boy, I couldn’t find an easy place to find mass policy for ambulatory care. I just asked a lot about visitation in the hospital. So that’s one thing, the second thing that I think is really important that people have to understand is that the nature of Pediatrics and indeed, medicine has really shifted almost in the course of my career. You mentioned my birth cohort we have been moving more and more towards the care of chronic concerns. We have been so successful in the treatment and management of acute problems that now a lot of the concerns that bring people in to see us are long term. They’re chronic concerns. Right. So child is born prematurely. There’s a lot of drama, and then that child survives. Most children survive pre term birth these days. It’s fighting. It’s wonderful. And they have these long term consequences of that early event, that early healthcare crisis. And so our systems are also built more effectively to manage acute problems, even though we are dealing more and more and more with these long term issues. So I really wish that people would be thinking about that and then thinking about the building the systems that are supportive of this long term relationship between the health care team and the patient or family.

Rob Oliver: Yeah. I would imagine that people, when you’re dealing with long term or chronic issues, they want the same type of acute care responses on that. So this has been something that’s been going on for a while, and they want to come in. And as you kind of alluded to, they want the immediate diagnosis and treatment, even though it’s been a more chronic condition. Are you finding that

Heidi Feldman: There’s that, like, sometimes there’s a sense of urgency that the family feels that I may not feel again. I have to honor that because it could be that they had had this ongoing issue. But something shifted, and now the suffering has become acute. I think I have to be aware of that. But also, we have to build systems for this long term relationship. So we need to build electronic health records that make it easier to figure out who’s a long term primary care provider, Where’s the team who’s taking responsibility for which aspects of the care? There’s so many issues where we’re doing it on the fly rather than building a system that’s designed to do a really excellent job over the long haul.

Rob Oliver: Got it. What excites you about the future of health care? Well, what excites me? The capabilities that we now have, Rob, are just stunning. I’m really excited that we can do so much more with medicine rather than surgery. We can offer cancer treatments. We used to completely smash the body with all these really toxic chemicals. And now we have highly targeted biologic agents that can be very specific and maybe target a cancer without destroying your hair, your taste buds, your skin and other body parts. So I think we’ve got some really incredible capabilities. And now what we have to do is build a system that helps people get through that and look carefully and thoughtfully in any long term consequences and gives people the long term support that they need. Not just that magic of the immune therapy or that the robotic surgery that can take care of the X without Harding the Y.

Rob Oliver: Got it. Heidi, last question for you. What is one thing medical professionals can start doing today to improve the quality of health care?

Heidi Feldman: I think that we can listen more openly and think more broadly and dialogue more honestly with our patients and their families. And that would really help not so much with that part of health care. That’s the scientific foundation, but with the compassionate communication and with the engagement of families in shared decision making.

Rob Oliver: Can you expand on that a little bit for me?

Heidi Feldman: Yeah. I think health care feels these days more like an industry and less like a profession. We’re told how much time we have allotted for visits. That’s really nice if you’re a patient, because if you’re told your visit is at ten, it’s really nice to go in at ten and be seen at ten. But on the other hand, if you have a bigger concern than you were able to deal with in the slotted time that you got, we need for the clinicians to be able to listen and think and share and figure out how the full extent of your problem can be realized. So you may need more visits. You may need longer visits. We may need to customize for your issues, and we’ve built a system where customization is a bit challenging. So I think what we can do as individual clinicians is listen so that we can begin to customize and meet the needs of our patients and their families and not give them a standard and somewhat thoughtless response.

Rob Oliver: A well made point. Heidi Feldman, thank you so much for joining me today. I really appreciate your perspective on health care.

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Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.

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