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Nicholas Smith: A Pediatric Psychology Post Doctoral Fellow’s Perspective on Healthcare

Perspectives on Healthcare
Perspectives on Healthcare
Nicholas Smith: A Pediatric Psychology Post Doctoral Fellow’s Perspective on Healthcare

In this episode of the Perspectives on Healthcare Podcast, Rob Oliver interviews Nicholas Smith. Nicholas is a millennial (a member of generation Y) and provides a pediatric psychology postdoctoral fellow’s perspective on healthcare. He is located in Tampa Florida and worked with Johns Hopkins Hospital.

Here are 3 things that stood out to me from the conversation with Nicholas Smith:

· A psychologist is a behavioral health provider (not just someone you talk to about your feelings)
· Mental health affects not just the patient but also the providers
· Assessing some of the social determinants of health

You can connect with Nicholas Smith through LinkedIn:


Here is the transcript of Nicholas Smith: A Pediatric Psychology Post Doctoral Fellow’s Perspective on Healthcare:

Rob Oliver: Thank you and welcome back to Perspectives on Health Care. My perspective today comes from Nicholas Smith. Now, I have to tell you that when you’re starting a podcast, the first thing that you do is you go shake the tree of friends and family. And Nicholas, when I shook the tree, Nicholas fell out of it, which was fantastic. His mom is a friend of mine from when I was in the hospital, when I was 16 years old, and we’ve maintained contact. And I remember his parents before he was born. And now here he comes. And he joins us today. He is a pediatric psychology postdoctoral fellow down in Tampa, Florida. He is a Generation Y member, which makes him a millennial. And he joins us today. Nicholas, welcome to the show, man.

Nicholas Smith: Hey, thanks for having me, Rob. I’m really happy to be here.

Rob Oliver: Absolutely. So let’s jump right into this and tell me about yourself and your role in health care.

Nicholas Smith: First, I want to give you a shout out. I appreciate the walk down memory Lane. My mom will be thrilled to hear she got a shout out, but she still talks about those interactions and how you as a patient touched her life. That’s really good to hear, but just a little bit about my position. Like I said, I’m a pediatric psychology postdoctoral fellow at Johns Hopkins Old Children’s Hospital. We’re at the St. Petersburg campus, so we are affiliated with Johns Hopkins School of Medicine. I’m really lucky in my current position. I kind of have a wide array of pediatric psychology specialties that I touch on. So 50% of my time is for children with oncology and hematology concerns, and that follows inpatient during the hospitalization assessments for bone marrow transplants and also on an outpatient basis. And then around another 30% of my time is for general Pediatrics and with a heavy emphasis on diabetes just based on the population we serve. So I do what we call consultation liaison services for inpatient. So if I have a kid who comes in with a new illness, we assist with coping and connecting them with the subsequent supports that they need. And also if they need linkage with mental health or some other form of behavioral health supports that we’re not qualified to give at the hospital, we’ll link them in with that, and then the rest of my time, ten to 20% of my time is devoted to research. So I’m really excited to be staying at all children’s for a second year of fellowship to be completing a telehealth study focused on promoting resilience in youth diagnose, newly diagnosed with type one diabetes and their families. And as a grant that’s funded by the Juvenile Diabetes Research Foundation. And so that’s my second year of fellowship transitions and kind of begins. I think I’m going to have a little more research time, probably build in there just with the grant and stuff. Like I said, I have a real cool clinical and applied work being in patient rooms and then also on the research side of things as well.

Rob Oliver Okay. So I think I understood. Do you do some outpatient work as well? So you’re working with the inpatient and then are you kind of doing transition work where you’re doing a little bit of work with them as an outpatient to get them to another level, like to another professional, or are you able to kind of see your patients from inpatient all the way through the outpatient process? How does that work for you?

Nicholas Smith Definitely the latter. I see kids. I have an example, one family I’m working with now. I had their kid when he was diagnosed with their daughter. She diagnosed with aroma cancer, completed the bone marrow transplant, had some anticipatory anxiety before that. So we did some exposure and preemptive things before the transplant. So I kind of like thinking about this patient. It was sort of initially inpatient then outpatient, then back to inpatient. Now it was outpatient post successful transplant. And then I know she actually had to be admitted for some fever concern. So like I said, definitely goes back and forth. I have array of settings that I get to work in.

Rob Oliver Yeah. And that’s got to be really cool because they have you as a constant, so to speak, that they know that they’re always going to get a chance to speak with doctors and Doctor Nicholas, whatever the cool name is that you get to go by, tell me then what is your definition of quality health care?

Nicholas Smith: Sure. So when I was thinking about what quality health care means to me, a couple of things stood out. The first coming from a psychology background. I really value a multidisciplinary approach to healthcare. A lot of people, even some of the residents I work with, they really come to us as experts in, like, the mind body connection and how that can play a role. So I really value that interdisciplinary and multidisciplinary approach to addressing health care concerns, whether it’s how a patient and their family is responding to a new illness, whether it is coping with comorbid mental health concerns or anxieties about their illness, just really kind of looking at those things as combined. Essentially, you can’t have good mental health without physical health, and you can’t have good physical health without mental health. Another thing that really stands up to me, and I think this definitely comes from my psychology background. When we talk about quality health care is I’m always trying to really focus my clinical care on health promoting behaviors, as opposed to, like, a health compromising or a detrimental approach in psychology. We talk about how the absence of depression or the absence of anxiety does not necessarily mean we’re happy. So I like to think about just because you’re not obese doesn’t mean that you’re thriving physically or just because you take your insulin three times a day, you still get away with your A one C’s in that seven range that your doctors and endocrinologist one doesn’t mean you’re thriving. So I really try and instill health promotion and health promoting behaviors, particularly in the population I work with, which is Pediatrics so much in, like, two or three years old, up to 21 or 22 years old. Okay. And then if I can say one last thing, the last piece that I think about when I talk about quality health care is feasibility and acceptability. So I know sometimes medical providers and psychologists alike, we might make recommendations that aren’t acceptable to patients or aren’t realistic and coming from a research background and in graduate school, that feasibility piece. And is this something that’s going to work when they leave the hospital is something that I also think is a real part of quality health care should be considered. And it also really helps you that multidisciplinary approach to look at some of those social determinants and things that might really impact the care and subsequent health of our patients.

Rob Oliver Okay. So I love what you’re saying there, and I guess almost interrupted you because I was so excited that the one thing that you’re talking about is just because certain things are absence doesn’t mean that other things are present. My analogy on this is you’ve heard the expression about happy wife happy life, and I actually don’t believe that that’s true. And I think that this goes right into your point. Okay. And the fact that just because your wife is happy doesn’t mean that you are going to be happy. However, the converse is true, which is unhappy wife unhappy life. So if your wife is not happy, then it’s going to be very difficult for you to be happy. Her happiness doesn’t necessarily guarantee that you’re going to be happy. It puts you in an arena where it is much more likely and much more probable. And it works through that way. I know that you have a fiance. Take that as advice for the road.

Nicholas Smith: I will.

Rob Oliver: You’ve kind of given me an example already. But can you think of any other examples of quality health care?

Nicholas Smith: Yeah. One of the things that I really love about my job is my work, and I do this as a resident at the University of Miami and then now at Johns Hopkins. I really like specialty clinic work. And the reason I love specialty clinic work is because you get to address a lot of times in my cases, it was children with cystic fibrosis and then with type one and type two diabetes, and they really get the whole gambit. I know the appointments might go along sometimes for patients and that’s sort of acceptability and feasibility thing they were always trying to address. But I really love when everything just flows so smoothly. For example, tomorrow is Tuesday morning, I’ll walk in the diabetes clinic. The nurse practitioner will see the patient, and then our social worker will see them and I’ll see them and do a psychosocial screening with them. And then we kind of meet as a team after for each patient and in between. And we might say, oh, they need more education if you go to one of our dark classes or, hey, they could really benefit from some counseling to help them facilitate adherence. And I just really think that team approach is something that I really value, and I really find it in the specialty clinics, not only because you have capacities and systems in place to support, but everyone just sort of has a routine and a role, and we know what has worked before with similar patients. Obviously, we tailor care to make sure that it meets the individual needs of the patient and family. But that’s just a time where I’ve really seen great quality health care. As in the specialty clinics, everyone’s involved.

Rob Oliver: Wonderful quick definition for me. You said a DART class?

Nicholas Smith: Yeah, it’s a diabetes Reeducation class. So it would just be sometimes the American Diabetes Association, for that example, recommends, like, annual or biannual education for families, even if they’ve been thriving, it’s just important as kids age, they maybe go back and be like, oh, you’re getting ready to go through puberty. How’s that going to affect your blood sugar levels or your diet and everything? So Dart is just a Reeducation class, which is something that I do as a pediatric psychologist is a lot of education about illness.

Rob Oliver No problem. We swim in the sea of Alphabet soup, and I just was trying to make sure that I understood what we’re talking about. What do you wish people understood about your role in health care?

Nicholas Smith: Yeah, that’s a really good question. I don’t want to lean on the old adage that people think psychology is just talking about your feelings, but that really is a component of it. One thing that I really was trying to emphasize is that I’m a behavioral health provider during my graduate training and even some of my outpatient cases, I do a lot of parent management training and psychology shifting behaviors for I always say, to parents, shifting your kid’s behavior is not necessarily hard, but the consistency is hard. Changing a habit is hard. Having their ability to catch themselves the way they’re talking to their kids, the way they’re directing their kids to engage in some medical treatment is really difficult. I sometimes think there are some professionals or disciplines you might say, oh, this psychologist is here. They’re just going to try to make them feel better, whereas I look at it as a behavioral health provider. What I can do to make it easier for you. Back to the specialty clinic example, I always say to all my patients, I’m here to see if we can talk about one behavior today. That’s one thing that we can tweak and twist and make it that it’s easier for you and you have less distress over managing your illness. And I’m doing my job. That’s sort of what I like to think of.

Rob Oliver: In that case, I think what I’m hearing you say is that a lot of people have the mistaken understanding that it’s just about feelings and what you’re talking about is not necessarily feelings. You’re talking about actual behaviors, which makes a whole lot of sense and is very helpful. I think I might know the answer to this based on the grant that you’re looking at with kids with their initial diagnosis of diabetes. But what excites you about the future of health care?

Nicholas Smith: A lot of things, particularly, I think the pandemic has made it that people are starting to recognize the impact of mental health not only on the functioning of our patients with various illnesses, but also on providers. Compassion fatigue is a real thing. Burnout and burnout can be not only for caregivers, but also for people with various illnesses. I am excited about the application of telemedicine. It’s interesting, too, how when you’re kind of living in the moment, you see how things can be altered based on your circumstances. And the example I have is I do a lot of parent training, like I said, parent management training. And when I was a resident, I came in and already certified as a therapist in something called Parent Child Interaction Therapy, and it’s for kids with disruptive behavior. So again, some of that behavioral shaping piece. But when I was on internship, I was able to get a level up. I’m a trainer. Now I can train people in this type of therapy. And when the pandemic happened before that, we’d always done it in a lab setting. But then we had to kind of shift to an online telehealth modality, and we were all really apprehensive and anxious about what’s this going to look like. It’s in the people’s homes. My goodness, what if something happens and so many parents had so much more enjoyment and acceptability of it because they were at their home. It wasn’t in a lab setting. They’re like, hey, I can implement these interventions when I’m at home, we can problem solve it here, like, hey, this didn’t work in this room or the setup we have here doesn’t facilitate it here for that behavior. So to me, I really enjoy the telemedicine component of things as well, ensuring accessibility to our risk populations. And then finally, just from a research perspective, I also really am fascinated just in the research being done about social determinants of health and how we know where you sleep matters and what the food you eat really matters. And all those compiled effects of various risk and protective factors can really contribute to the overall health long term.

Rob Oliver: Yeah. When you’re talking about telehealth and even meeting in people’s homes, there is a territorial element to it that when they’re coming into the office, they’re coming into your environment. When you’re going into the home, making a home visit, you’re in their environment and with the telehealth, it allows you both to somehow kind of be in your own environments, which is very interesting. Dynamic. Last question for you is what is one thing that medical professionals can start doing today to improve the quality of healthcare?

Nicholas Smith: One thing I noticed with medical professionals in particular is sometimes they want to jump right to the meat and potatoes of the situation. Like I said, I work a lot with kids with oncology, and sometimes pediatric leukemia is very treatable. There’s a 98% success rate, I believe survival rate. And I sometimes think medical professionals jump right to that, like kid has cancer, but they’re also going to be fine. It’s going to be okay. Whereas in psychology, we always talk about the importance of validating people’s emotions. I always think it’s important to just I know that the healthcare system is very strict right now at the pandemic, but even just taking a moment and sitting with a patient or validating their distress, and it’s really hard to know that you’re going to have to go through all this. It’s a really distressful circumstance, or your heart must have just fallen out of your chest the last couple of days when you see your baby, get all these tests. So I just like to think of that kind of pause and really having patient centered care always be the center of your actions is something that we have psychologists always try and evoke. And I know that there are many providers who do that, but that’s just one thing that I really recognize that sometimes it’s always about the outcomes as opposed to the moment, just taking the moment to give up those emotions with people, to deal with the emotions and to basically meet people where they are instead of pushing to where they’re going to be at some point in the future.

Rob Oliver: Very Sage advice. I love it. Nicholas, thank you so much for being here. I really appreciate your perspective on healthcare.

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