I Can Tell What's Trending: Pediatrics with Sue

Show Notes

In Episode 8 of No Referral Required, Mandy, Courtney, and Lara are joined by Dr. Sue, a pediatrician of two decades who owns her own practice — and who Mandy has known since med school, where, she notes, the future pediatricians were identifiable within the first two weeks as the kindest people in the class. Dr. Sue took the long way to ownership: four years of newborn care at a county hospital with 50 to 70 babies born a day, seven years working for someone else, then her own doors and a staff of 17 who each have "just a couple of questions" for her. She explains why the well-child visit that feels like nothing is actually the most information-dense appointment your child will have — the growth curve she reads minute to minute, and the developmental exam she runs while the parents brag about their four-year-old and she watches the kid climb the stool. "It's a trick," she says. It also explains the one thing she thinks families undervalue: she takes care of patients from the womb until they graduate high school, and that long view is the instrument.

The conversation gets into the harder parts of a specialty that looks happy from the outside. Dr. Sue puts parent anxiety against genuine pathology at roughly 90/10, traces the shift to social media, and describes reading the day's Instagram trends off the questions she gets asked — mouth breathing, the yogurt thing, and a daily question about autism, a diagnosis she's expected to make despite no training in it. She shares how she handles vaccine refusal by never arguing about the vaccine, only describing the disease. Then there's the 1%: a three-month-old in liver failure, the labs she refreshes all night, and the colleague debriefs and therapy that make it survivable. She makes the case that AI will never measure a baby or feel a rash, tells parents exactly when to skip her and go straight to the ER, and closes with the advice she'd give her just-starting-out self — don't be afraid of failure, be excited about success — and the advice she'd give every new parent: go home and hold that baby.

Transcript

Courtney [00:00:08] Hey, everybody, and welcome to episode number eight of No Referral Required.

Mandy [00:00:13] Hello. Hey, guys. Hi. So we are so excited because we have a pediatrician today, Sue. And I have known Sue since med school. And no, don’t ask her any questions about myself from my mid-20s. I think she’ll tell us later. No, and don’t ask for any photos.

Courtney [00:00:33] Check Instagram, everybody.

Mandy [00:00:35] Thank goodness that was pre-iPhone. AI can do a lot. It can. A little maybe unknown fact, especially to you, Courtney, but pediatricians are generally the nicest people of your med school class. You could pick them out, usually within the first two weeks of starting med school, who might go into PEDS, just because they are the kindest people. You would let them watch your disabled cat for a weekend, if you needed one. This actually, I think, bears out long term. I still know quite a few, and they still are some of the nicest people. So hopefully Sue is taking this into consideration. That’s right. As a compliment. Yes. All right, so tell us, why pediatrics and what was your path to get there?

Sue [00:01:27] Okay. Hey guys. , okay. So I thought I, when I went to med school, I thought I would be a pediatrician, but I wanted to keep an open mind. So I really loved internal medicine. It was the type of medicine where you could think through the processes of the illnesses. And then, , pediatrics was my very last rotation of third year. And then that’s where I was like, okay, this is it. Cause we got to, It’s internal medicine, but for really happy people that want to get better and don’t self-destruct themselves Don’t work out and kids Don’t smoke don’t drink and they play and they’re happy and they want to feel better. So we got I got to use all the stuff that I really loved about internal medicine and then take care of kids. So I kind of always knew I wanted to and then med school confirmed it and then a lot of other specialties also confirmed it. For example, Mandy and I remember our psychiatry rotations, and that was quickly rolled out. So there was a lot about, like, rolling out things and then deciding on things. So some things were definitely rolled out.

Mandy [00:02:48] Now I’m going to have nightmares.

Courtney [00:02:49] Thanks. I know. This is a med school question. How long do you stay in each rotation? Like, how long are you stuck in something that you don’t love?

Mandy [00:02:58] Oh, that’s a great question. So it varies. Some of the more core ones, which everyone has to do a significant amount of, I guess because they really want to drive people to those core things, are longer, like six weeks, maybe eight weeks. Pediatrics was six weeks, is that right? I think, yeah, six weeks. OB-GYN is usually six weeks. Okay. Yeah. Okay. But the like real, real, real specialties are shorter? Like one or two weeks. Oh, yeah. I don’t know if you remember Lara, our anesthesiologist, you said five days is what she had. Oh, God. Yes.

Courtney [00:03:27] I do remember that now. Yeah. Okay.

Lara [00:03:29] And a lot of those are more elective type situations. So you may not get to sample all of them. Whereas everybody has to do generally internal medicine, OBGYN.

Courtney [00:03:38] Yes. Okay. Sorry. Sorry to interrupt.

Mandy [00:03:41] Just want to make sure. And so you do private practice, which is, and you do your own private practice.

Sue [00:03:46] I do. So I didn’t start there. I started at the county hospital right after residency. I did four years at our county hospital. I don’t know what Nashville has, but ours is a very busy place and about 50 to 70 babies born a day. So I just did newborn. care as a general pediatrician. And then after four years of that, I went into private practice in a different area of my city. And then after seven years of working for someone else, I decided to open my own practice.

Mandy [00:04:26] So a business owner and a doctor. Yeah, business owner and a doctor. And did you ever get an MBA or any specific business training? No, but I should have.

Sue [00:04:38] On the job and on the go. I do advise that for anyone listening. I can see that.

Mandy [00:04:46] What does a typical day look like for you now?

Sue [00:04:49] So a typical day is I get to the office around 8.20. We do a team huddle every morning where we meet. The whole office gets together. We just see where everybody is and then start seeing patients at 9. And I typically try to do a well check, a well check, a sick visit. Well check, well check, sick visit. And so I get to see healthy kids mixed in with sick kids. You know, we take a lunch and then we go back and do the same thing in the afternoon. And then I usually end the day around five o’clock. And usually the end of the day is either like ADHD appointment or a like behavioral health. So I tried to end the day with that.

Mandy [00:05:36] Something that you might think needs a little bit more time.

Sue [00:05:39] Needs more time, yeah. Just so if it’s a 4.30 appointment and I go past 5, I feel like I’m not making anyone else wait.

Mandy [00:05:45] You are, sure. Yeah. That’s great. That’s a smart way to schedule. Yeah, it’s very smart. You can do that when you schedule your… I was just about to say, when you’re the one who schedules it, yeah.

Lara [00:05:56] One of the advantages of private practice, you know what works best for your patients and you, and you can make it happen. Right.

Sue [00:06:05] You’re not dealing with… But I will tell you, when you own the practice, in the middle of all that, you have, you know, your M.A. who called in sick, and then you have the M.A.s who maybe got in a fistfight. Oh, no. And then you’ve got your front desk lady, you know, that needs to go to her eye exam. And then, you know, you’ve got, you know, the phone bill that needs to be paid. Like the owner part is like in between all that. And it’s all day. Yeah. And then you’re the one that has the answers to it. So I have a staff of 17 people, and some days it feels like all 17 have a couple of questions each for me.

Courtney [00:06:52] And that’s how they say it. I have a couple of questions. Just for me. Just for me. Times 17.

Sue [00:06:58] Times 17. So I didn’t know if y’all wanted me to be a little salty, because I feel like

Mandy [00:07:03] We want you to be real. Sometimes the salty gets out. Don’t hold back. You know, we imagine that at some point medical students will listen to this repertoire, this collection of interviews we have, and it will help them decide and think about, you know, with real intention going forward about what they want to do with their lives and how they want to structure their practices. So we hope everyone is very candid with us.

Sue [00:07:28] Sure. Sure. I hope everyone except the new pediatrician I just hired. It’s awesome. My goal for her is to take over this business in the next 10 years, and she probably shouldn’t listen. I’m not going to share it.

Mandy [00:07:44] Okay, we won’t tell her. What’s the most common misconception people have about pediatrics as a specialty?

Sue [00:07:54] Oh, that’s a good question. Probably because I loved your intro saying like, we’re pretty happy people. And we totally are like our jobs are amazing. But I think like everyone has a bad day, you know, or everybody’s like, just got in a fight with their husband right before work. Everybody, you know, like, their dad’s in the hospital or whatever. You still, I mean, I guess you don’t have to, but I feel like you go in and you have to be like, oh my gosh, you’re four-year-old’s four now. This is so amazing. And brag about your four-year-old. You have to be on. And I know most, I mean, everything. If you wait tables, you have to do that. I understand that, but it’s a little extra special when you have a family that’s super excited to be there to brag about their four-year-old, and then you have to be excited about the four-year-old. So a lot of, I think that was the answer to your question. Yeah. Yeah, sometimes it’s hard to fake it and sometimes it comes natural. You know, I don’t know. I mean, that’s right. You’re a human. Yes. Right. But you’re right.

Mandy [00:09:07] I’m a human. Yeah. Because you’ve put off that persona. And so now people expect it from you. Sure. Yes. Yes. Yeah. And so it might. So where all doctors are expected at some point to have a big chasm between their home life or their personal life and their professional life and be able to turn it on. You probably have that more than most.

Sue [00:09:27] Yeah, I mean, yeah, I think so. Because you just have to, I think the patient in the room probably doesn’t care. Because I have a patient, you know, who’s two months old. But you have two parents and maybe a grandparent that you have a lot of eyes on you during, I don’t know. I was thinking, like, I don’t know if there’s any other specialty that brings multi-generations to a checkup. Plus they’re all their children. It is a circus. And most of the time the circus is sticky and snotty. And I was also thinking no other practice where there’s a the patient like poops to your face. Like I had one yesterday that just like stood in front of me and just like bared down and pooped. And I was like, I think you’re pooping. I think you’re pooping. You made them feel so comfortable. I know. I know. Good job. So lots of eyes, lots of eyes, and everyone brings their mom, their dad, their grandparent, there are sometimes aunts in there, you’ve got all the kids, so it’s a big audience, a big circus audience. That’s interesting.

Courtney [00:10:42] Our pediatric clinic, Orego, is like, you can have one adult with you at all times. That’s what they say, so they have that as a rule. Too late for you. Like the new policy in your clinic. They ask you to only bring the child who is being seen at that moment.

Sue [00:11:01] That’s a salty pediatric thing to say. That’ll be me in five years.

Courtney [00:11:06] Someone close to retirement. So talking about those well-child visits. All of us sitting at this table have kids, and we’ve taken our kids to these. Most people who are listening have taken their kids to a pediatrician. How important are those well-child visits?

Sue [00:11:24] Very important. So it doesn’t feel like we’re doing a lot. You know, but we are, first of all, we always weigh and measure your kid. So growth really is a big indicator of health. so when kids don’t grow we start looking for chronic illnesses or Malnutrition or something like that. So just weighing and measuring your kid I know it feels like like just the what you do every time but that gives us a ton of information and then as I usually start the checkup by going like brag about you know, we talked about the four-year-old like about your four-year-old. Tell me what he does.” That is all development. And so while the parents are talking, I’m watching the kid and I’m watching the kid climb up on the stool and climb up on the table. So I’m evaluating strength and coordination. And so it feels like we’re not doing a lot, but That’s the trick. It’s a trick. Yeah, it’s a trick. And we try to make it fun. Yes. So the kids want to come. Right. And then when they’re, you know, if there are issues, this is the time most people in my practice bring up everything, right? Yeah. Like, our asthma is not acting, you know, we’re not getting good relief and he’s got a runny nose all the time. And, you know, so they’re bringing up some problems in addition to the well stuff.

Courtney [00:12:46] What are the most common ones that they bring up? Like, what’s the most talked about?

Sue [00:12:51] Well, I live in an area that is, we are probably the number one, and I might give my area away, number one allergic city in the whole United States. So allergies is probably the number. I would not think that, because I know where you are, and I would not think that. Yeah. I don’t know why. Well, then we must be number 1.5. I know. It’s pretty bad here. Yeah. Y’all are number two. I did see the top five list and I remember Nashville being in it. So y’all are in there. But I would say allergies, constipation, picky eating, kind of thing. Behavior issues is always one. This day and age, especially, like in the last probably 10 years, behavioral issues are, or just like normal questions like, when do I potty train?

Courtney [00:13:45] Or, you know, all the advice, parenting advice kind of stuff.

Sue [00:13:48] Parenting advice.

Courtney [00:13:49] Yes. Okay, so you talked about parents bringing up things that may be going on with their kid or whatever and I personally chose a pediatrician based on how chill they were because I knew that or I just was gonna assume that I could be one of those that would be like oh my gosh even though I’m not really an anxious person I just wasn’t sure how I was going to act once I had a kid and I wanted somebody who was very calm like that was literally why I chose them and I love him he’s fantastic how much of like the patient care that you do for your patients is actually like parent anxiety and stressing about something versus like a real issue that you’re actually having to treat. 9010.

Lara [00:14:41] We are. Yes. Okay. Do you feel like that’s getting worse? I know such an interesting question. Yeah. What’s the driver doing this a minute?

Sue [00:14:48] So what do you think is driving? Yeah, I have. I mean, we can blame everything on social media. However, however, I do have a mom. She had chatted. Her first baby 15 years ago had her second baby in the last year. But she was so anxious this time around and I just sat with her and talked to her and I was like, what is different? You’re more experienced, you’re older, you realize kids are so resilient and you just have to love them and feed them. And she said she thought it was social media. She didn’t have Instagram first 15 years ago. And Facebook was around, but it was more like, you know, posting what you had for lunch, stuff like that. So you didn’t have all the all the noise of the influence of the like your kid should be doing this or watch out for this or whatever and so she came off of it and she came back and Like the next month and she was like I got off Instagram and I’m not as anxious and I was like, wow Yeah, so We do these meet and greets once a month, and it’s pregnant women. And they come in and basically interview us to see if they want us to be their pediatrician. And they’re talking about this block or something now that they put their phone on.

Courtney [00:16:21] Bricks.

Sue [00:16:22] It’s called the BRIC. Yes. So I think the next generation of moms, like the pregnant women now, are going to be better about it. But then they want to be on there and post their baby’s picture. It’s like this fine line of… the most anxious. And this is why that growth curve. I know, Mandy, you remember the growth curve from like pediatrics and endocrine. Yeah. I mean, I use that on a minute to minute basis. Yeah, sure. Me too. They’re so anxious. And I’m like, your kid is so normal. Your kid is beautiful. Yeah. But I loved the question about like choosing chill versus you know, not an anxious doctor, but somebody who’s gonna feed into that. But I feel like over the years, because I’ve been a pediatrician for two decades now, but I feel like I started like, let’s run that test, let’s do the thing, let’s do the thing. And now I’m like, totally normal, normal, normal, totally fine, totally normal, totally normal. Yeah, exactly.

Courtney [00:17:33] Yeah. What are the, I can only imagine that it is difficult because you are a parent right yourself personally and then you’re giving all this advice to parents. Do you ever feel I have a similar my husband has a similar he’s not a he’s not medical but it’s a it’s a place where you’re giving people advice and then at the same time you’re thinking am I doing this Like, am I actually doing these things also? How does that, how do you live with that? Like, do you, do you ever have like, what is that, imposter syndrome or, you know, where you’re like.

Mandy [00:18:09] I think it’s just hypocrisy, just good old garden variety. And all doctors are really good at this, you know, giving advice, but then totally ignoring it. Okay.

Sue [00:18:18] So it’s not meaning that. 100%. OK. No. And I often will do my whole spiel, blah, blah, blah, blah, blah. You know, I talk about sleep a lot and how important, blah, blah, blah. And I was like, and honestly do as I say, not as I do. Because half of my patients also know my children. And they’re like, you never did that. I saw your kids without a helmet, on their bikes. Your kids get in my car and don’t put their seatbelts on. And I’m like, I know. I do a lot of do as I say, not as I do. If you see me out in public and I’m spanking my kid in the grocery store, I tell you not to spank.

Courtney [00:19:03] Look away, look away, keep moving. So are there good parenting books or references that you recommend frequently? Like what’s your top two that you’re like, this is what I want you to do. I know it’s developmental, like you don’t give a newborn parent the same thing you give an 11 year old parent or whatever.

Sue [00:19:23] Yeah. So I typically, so my kids never, my own children, didn’t read the books. So it caused a lot of anxiety in me. So the books were the pre-social media, right? Like, your baby should be sleeping through the night by eight weeks. And I was like, none of mine did that. So I wanted to, like, shake my baby, but what I really did was burn the book, right? Yeah, so I tell people all the time, I kind of guide them. I’m like, do you like books? Are you going to get mad at your baby if they don’t do what the book says? And they’re like, you learn to read people. And I’m like, don’t read any books. Trust your gut. And then there are people that are like, I mean, using for guidance, but I’m not going to do everything they say. I’m like, good, read this one. This one’s really good. So they’re not written by any type of pediatrician. My favorite books these days, and Mandy, you may know this one, it is written by an economist, and she looks at data. And it’s called Crib Sheets. So she wrote maybe a pregnancy version, and then she wrote Crib Sheets about the newborn phase, and then she wrote one about the toddler phase, and I can’t think of it right now. But she is wonderful because all she does is look at data and then put the data to the page and then just says, like, do what you want to do. So crib sheets for the little, but whoever, I can look it up, but whoever wrote the crib sheets, she has a pregnancy one and a toddler one. And as her kids grow, she’ll probably do like an adolescent one too. But I don’t, let’s see, the one for adolescents, I like the adolescents to read. So there’s like the, the puberty books, like Guy Stuff is the boy one, and then the American Girl. So they’re simple and they don’t get too much into the weeds and the parents and the kids can read them together. So those are the ones I typically go to. But I like to tell parents to like, I mean, really my newest, because I’ve had two decades of being a pediatrician, You can’t harm them too much. They survive. Just love them and feed them and put them to bed occasionally. And if they don’t go to bed one night, that’s okay. And if they don’t eat one day, which all toddlers have days where they don’t eat, it’s okay. They survive. They do. They’re just little survivalists and they make it.

Courtney [00:22:06] Okay, great.

Sue [00:22:07] Yeah, put it put a helmet on him. I mean, that’s probably the biggest thing. Yeah, and watch him watch him around water. Yeah. Yeah.

Lara [00:22:14] Good. Good. Good advice. Yeah. So when I am in my pediatrician’s office with my children, and I see the signs that are up about vaccines, whoo. I know. Hot topic. I never, never envy your field of having to have these conversations, which I am sure are so difficult. But how do you approach parents, because it’s usually the parents, who decline interventions that we know are very evidence-based and are very helpful for preventing serious illness?

Sue [00:22:55] Yes, it’s one I have daily and one of the hardest and one of my most, I like having this conversation, honestly. So I get, I take the approach of not talking about the vaccine. I take the approach about talking about the disease. Oh, smart. So for example, the rotavirus is one that we give at two, four, and six months. It’s the oral vaccine. No injection. It is a live vaccine, but not a lot of preservatives. But parents decline that one often. And I’m like, oh, my gosh, you guys, have y’all ever had, you know, norovirus? And everyone has now these days, right? And they’re like, yeah, that was the most awful week of my life. And like, rotavirus is norovirus on steroids. It’s like a thousand times that bad. So just just so you know what you’re like declining. So I try to tell, and then I, you know, I tell my stories about like the patient in our own practice who The mom declined a bit. She got rotavirus as a 12-month-old and ended up in kidney failure because she was so dehydrated and needed dialysis. So I try to tell stories of, like, tell about the disease, stories of, like, real-life people so they know what they’re declining. I think they only know, like, to decline the vaccine. And I don’t think they know the other half of it. So I describe meningitis because I’ve seen it with my eyeballs. I’m like, OK, let me. Yes. And I never push anybody, but I’m like, OK, so you want to decline Prevnar today, which is the pneumococcal meningitis, pneumococcal vaccine. And I’m like, so let me tell you what meningitis is. And if you’re OK with that, we’ll sign the decline paper. And, you know, and so I try not to push. Everyone is entitled to their opinions, but I feel like it’s my job to educate. and educate them on what they’re saying no to.

Lara [00:24:56] That’s great. You mentioned a little bit already about what social media, what it has done in your field. Other thoughts or other areas where you’ve seen an impact?

Sue [00:25:12] I think y’all touched on it, the parent anxiety, the expectations of children, I think is a big one because I don’t know, I came off social media in the last 18 months probably, but I don’t know what’s floating. You know what, I can tell what’s floating around because it’ll be that same question all day long. They’ll say like, There was a recent one about one of the yogurt lines or something, and I was like, oh, is Instagram talking about this? Medically, I haven’t heard about this, but Instagram may be talking about this. So you can almost tell the trends by the questions that are asked. So mouth breathing is a really big Instagram hot topic right now. Mouth breathing.

Lara [00:26:02] Interesting, tell us more. Oh, I thought you were saying breeding.

Sue [00:26:08] I don’t think I want to talk about this.

Courtney [00:26:14] Wow, we’re no longer family friendly.

Sue [00:26:16] Oh, you mean like mouth tape and all that stuff, the taping of your… Yeah, like kids that breathe through their mouths. Like, you know, So mouth breathing is a big one. Let’s see. The yogurt thing was a big one recently. The cryptosporidiasis is a big one right now. Let’s see. So I can almost tell. I’m not on Instagram, but I know what’s trending by the things they come in. I mean, autism is huge. So I’ll have, you know, every in the spectrums wide, so I you know, like we, we are gonna, you know, we’re getting better at diagnosis and stuff, but autism, like every every day will have a question if their child is autistic. Every day.

Courtney [00:27:08] Do you feel like it’s fair? I’m sorry. Whatever. Do you feel like it’s fair? I want to pause on autism for one second. My mom was an autistic preschool teacher, like in the public school system for 40 years. She worked in special ed for 40 years. And at the end it was like autistic preschoolers. So she can tell someone with autism like a mile away, but I, she’s always had kind of a, , I don’t want to say soft spot, I don’t know, a pity, I don’t know what the right word is for a pediatrician who sees a child like for 15 minutes once maybe once a year and they’re expected to, they’re the only ones who legally can diagnose a child with autism and it’s like, Because then the kid will come back to school, and the teachers will ask, well, what did the pediatrician say? And they’ll be like, well, nothing. And you’re like, well, yeah, because they were only around them for 15 minutes. And I’m sure in extreme cases, there’s lots of obvious signs. But you said it’s a spectrum. So do you feel like that’s an unfair expectation of pediatricians? Or do you feel like that’s, yes, you got it, or what? What is that?

Sue [00:28:16] No, I don’t feel like I got it. I do not feel like I got it at all. I’m with your mom. I think like, there are some very obvious nonverbal, you know.

Courtney [00:28:29] Yeah.

Sue [00:28:31] Yeah. And the beautiful thing about being a pediatrician is you’ve known the kid their whole life. Like you, I mean, typically I take care of someone from the womb till they graduate high school, and you can watch development. You can watch, like, yeah, he was not smiling, even at six months. I did not see a smile from this kid. And I didn’t diagnose him with autism at six months, but it’s very clear at three, you know, that I’ve watched this kid. But it’s, yeah, it is not my most fun part of my job, because I don’t feel fully equipped to do that. Because I, we weren’t trained on it at all. This is something I’ve had to do post training. And then we are we’re having to do it. We have to do it. I’ve taken as many CME classes as I can, but it’s very different than feeling equipped.

Courtney [00:29:35] And your word gets them services in the public school system, which is like, that’s so much weight. I don’t know. I’ve always felt bad for y’all being thrown into the deep end of something like that. So anyway. Yes. Thank you.

Sue [00:29:51] I feel so seen. It’s like a therapy. That’s the goal.

Lara [00:30:00] Let people know what it’s like. I think you brought up a really interesting point just now. I just sort of made a note to myself. I think a lot of families may not realize how important that temporal relationship is. over time and they think, oh, I do see you just once a year. What can you do in once a year? But if you have known someone since birth, you know, you pick up on a lot more, I’m sure. And I don’t know if parents realize the value of that, of sticking with one and letting you see them over time.

Sue [00:30:30] Yes, and I think that’s super important. We call it continuity of care. But the area I live in, that is the number one allergy thing in the whole United States. Also, we have probably so many pediatricians, we do get a lot of hopper hopping around, which I’m a loyalist. So I my kids have been with the same pediatrician, but there are people that like come and go and hop around. And, and that’s where I mean, you’re losing that continuity, but also we have weird things in the city I live in where some people go to one pediatrician for their well visit and one pediatrician for their sick visit, and they do this hop around situation, and it’s so weird to me. We do it all. Come to us. We can do it. I think there’s too many choices here, honestly. They can almost cherry pick what they want. And what they want to hear.

Mandy [00:31:31] Which can happen, yeah.

Lara [00:31:35] Any threat to your field with AI? This is the hot topic in medicine.

Sue [00:31:40] Oh, I, I, you know, I don’t think so. , I have in the last week I’ve had, you know, they all come in, they’re like, well, chat GPT said this and has got it right 50% of the time, but when they’re right, I’m like, hey, you know, you got it right. Roseola. But I think not in pediatrics, because we have to, I mean, like, AI can’t measure a baby. They can’t feel a rash. They, whoever these people are. I mean, you know, like, there’s things like, you have to touch, you have to touch your patients. You have to, like, look in ears and look in throats and, you know, like, I just, I don’t, I think the, the, like, touching of the patient, it just can’t, can it give you some good information about, like, rosella is just a virus? Yes, you know, but it’s, it’s been wrong 50% of the time, too, this week.

Mandy [00:32:40] So flip a coin, essentially.

Sue [00:32:41] Yeah. Yeah.

Lara [00:32:42] I could imagine pediatrics being one of the last Vestiges of holdout.

Mandy [00:32:50] We decided it’s never going to do a speculum exam either, so we’re probably completely saved. We’re good until the end of time.

Lara [00:33:02] So I imagine a lot of pediatrics, I think in some ways similar to OBGYN in that you often get the highest of the highs, the really fun times with healthy patients, but you also can get some really sad lows. So it’s like a little bit of both of that. How often do you have to give difficult news to families?

Sue [00:33:25] I do, I mean, lately, and this might be why I’m a little salty, too, because I’m really tired, because I’ve had a couple of little, little babies I’ve had to give some bad news on. So, you know, I think that, you know, in medicine, things come in threes, so I’m due for one more. Yeah. So you described it well, like a healthy child is beautiful. And then a kiddo that you just gave really bad news that they have a chronic disease or like, I just have a three month old and liver failure, you know, you’re just like, golly, I just can’t. You know, you become so attached because by three months old, I’ve seen that baby probably five times by three months old. And that’s just regular visits. That’s not including the phone calls and the, you know, rash and the, you know, the extras in between. So you kind of, you kind of like become part of their family and And I don’t know, I take it hard. I stay up all night sometimes refreshing labs. I’m like, oh gosh, please. Let this baby live. And it’s just, because I know OB-GYN, y’all get that, because y’all are like, this is supposed to be a healthy mom and a healthy baby. What is happening? These babies are supposed to be healthy. They’re just starting. So it’s really, really sad.

Lara [00:34:54] But you touched on this a little.

Sue [00:34:56] Yeah, the bad news is, it’s mostly, it’s like, you know, we said 90%, 10%, it’s probably 99% all really good, healthy children, and 1% some really bad stuff.

Lara [00:35:07] Something’s devastating, yeah. You touched on this just a little bit, but one of the questions we’ve enjoyed, or not enjoyed, but feel like is important to ask our guests is, how much of your How much of your mental load do you take home? And you just sort of talked about, you know, I’ve stayed up late refreshing labs. I think we’ve all done that. How often does that happen and how do you manage it?

Sue [00:35:30] Yeah, a lot. It happens a lot. So I bring home, I mean, I bring home like the parent that got mad at me for like, you know, you know, I bring home that, I mean, obviously the sick kids, I bring those home. And it will affect the, you know, like, I’ll cry at dinner. Like, you know, like, you know, not be present with my family. I’ll be like, you know, like, shut up. You’re not in love or failure. I like, I like try to bring perspective to my very, you know, whatever. I don’t tell my kids to shut up. This is what’s in my head when I’m hearing a baby and liver failure. And I’m like, so you didn’t get to play video games today. I’m so sorry. So yeah, I think I bring it home probably more than I should. And I bring home a lot. And then, I mean, we all know how sleep, how important sleep is right now. I lose sleep when there’s somebody not doing well, for sure.

Courtney [00:36:41] Have you found a healthy way handle all of this yet? What do you think you do?

Sue [00:36:47] I go to therapy. That’s great. That’s good. I mean, I talk to other, I employ, let’s see how many pediatricians, four pediatricians and two nurse practitioners. So I debrief with them a lot. If we have something that happened in the office, we are cheerleaders for each other. We’ll kind of, we’ll be like, yeah, you did everything right. Yeah, that’s how it goes. So I think having other people in the same practice, in the same building, in the same, they know the patients, it feels better to debrief with them. So I think colleagues plus therapy. That’s good. Yeah.

Mandy [00:37:34] The colleague debrief is vital.

Courtney [00:37:36] Yeah. It’s huge. It’s huge.

Mandy [00:37:39] I got out of the car yesterday, pulled in the garage, got out of the car, I was getting my backpack out of the back, and I was like, I can’t imagine what it’d be like to be like, and done for the whole weekend, and not have to think about work. To have a job where you literally didn’t carry anything home with you, mentally, physically, nothing, that you just like, I can’t even imagine what that’s like.

Sue [00:38:03] I can’t either. I don’t know what that is. I don’t know what you’re talking about.

Lara [00:38:07] We don’t have those jobs.

Mandy [00:38:08] You’re speaking French right now. All right. Sue, if my children only eat goldfish, buttered noodles and chocolate muffins for years on end, is there going to be a long term impact?

Courtney [00:38:20] It’s an if.

Sue [00:38:20] She’s not asking anybody. Yeah, not having anybody. Long-term impact. I would tell you to throw them a vitamin. Okay, good. We did that in the last two years, so we’re getting a vitamin in there. Sneak in some spinach and that chocolate muffin. And if they’re growing, you know that growth pattern I talked about, if they’re growing and thriving and doing well in school, just keep offering the good stuff. And they will, I have the pickiest of my, in my own home, the pickiest of pickiest eaters, and he had sushi last night. Like, they get there, they get there, it just, it just, and he grew, you know, it just, like, I always tell people, like, in the 1800s, when you just ate what came out of your farm, it wasn’t better noodles than goldfish and chocolate. Like, there was a lot more malnutrition back then than there is now, you know? Or the Holocaust, you know? I’m like, we’re resilient people. We’re gonna be okay. We’re getting vitamin D from Skittles, but that’s fine.

Mandy [00:39:29] There’s a lot in this, okay? Wow, that’s funny. I didn’t know that. It’s like 200 times the ADA or something. Anyway, what’s the biggest change you’ve seen in the last 20 years in your specialty?

Sue [00:39:43] Oh, I think parents having a semi-medical degree. An honorary medical degree from their Google searches. I think when I started, I started at a large children’s hospital as a resident and then a county hospital, which when you walked in the room and you said, I’m Dr. Sue and I am here to, this is the plan. people would shake their head and say yes, you know, and now there is questioning, distrust.

Courtney [00:40:37] You’ve been giving us percentages. What percentage of people do this? I may ask a question, but it’s never in a like, oh, I thought this was the right answer. It’s more like, explain that more to me. And that’s great. But yes, sir, I’ll do what you say. That’s how I feel. But what percentage actually is like, , no.

Sue [00:40:59] Yeah, okay, so it’s gonna feel bigger than it is, right? You two over here, right? You’re like 99%, but it’s like 10%, but they are like so frustrating. They’re loud and they’re so frustrating because they You just spend all this time, y’all, and as a pediatrician, I have words that by Friday, I have no words. Like my words are, I’m like, I’ve already used all the words. My word quota for the week is gone. No more explaining. After all day. Yeah. All day. You’ll use all these words to educate and answer questions and do the things and they’ll look at you and they’ll be like, yeah, I’m not doing that. And I’m like, okay. So glad, so glad we talked. You have an alert now.

Mandy [00:41:57] You got in your car, you drove here, you parked, you got out of the car, you walked in. So weird that it went off the rails at this point.

Sue [00:42:06] Yeah. I just, I, yeah, I, it, they, it feels, it feels like a lot of, but I would say 10% are distrustful of doctors right now. So 90% of people are very, I mean, and it’s, that feels like I’m saying like, I’m, I know it all and I should do it, you know, but that’s the shift I’ve seen. Okay, over time. I worked at a hospital where I’m like, we need a CT to roll out a head bleed. And parents would say, do the CT. Let’s do it. And then now they’re like, do we need a CT? I read online that the CTs aren’t good. And I’m like, oh, OK, OK. Yeah. So that’s the shift, I think. Kids are kids, you know, like. They haven’t changed. The kids have not changed. But even, like, the hot topic of vaccines, those haven’t changed a lot. Like, everyone’s like, there’s so many more. And I’m like, in 20 years, there’s not. maybe one more in the last 20 years. So everything, my daughter’s 21 and she got everything the kids are getting now. So like 21 years ago, same exact vaccine schedule. So, so not a lot has changed except Google and AI.

Mandy [00:43:28] What’s most likely to change in the next 10 years?

Sue [00:43:36] Oh, golly. I don’t know. I’m hoping for not another pandemic. That was rough in pediatrics. So I’m hoping to make it through that. I don’t know. Do you guys do virtual care? Does pediatrics jump into that? We do some. We started in the pandemic and that actually, I was really against it because I was like, in pediatrics, you have to see and touch your patients. But I realized quickly that half of my job is advice and behavioral health. And I was like, we can do all that. Online or virtually so I do a lot more than I did prior. So probably that I mean I’ve seen those little devices where the parents can stick things in ears and like show me a picture and like that’s kind of cool and not that I Want to do that, but you know I don’t know I Hope not a lot. Honestly, I hope charting gets a little bit easier, and that should help. I mean, AI might help with that, but I don’t know.

Mandy [00:44:55] I don’t know. We had a question that I’m going to kind of circle back to, and it kind of goes with them. So I was going to ask you what scares you the most in your field, but then I also wanted to ask at some point, when should parents just go straight to the ER instead of waiting on a pediatric visit? So then those probably are the same thing, but maybe they’re not. Yeah.

Sue [00:45:19] I really want you to come to me. Because I feel like 90% of the people that end up in the ER could have come to me. Let’s see. So the things that have to go straight to the ER is like. People unconscious. So like, you know, I get, I get, I get called a lot with head injuries. Like my baby fell off the couch and you don’t have to go straight to the ER, you know, like call us, let’s talk about it. Bring them in. , , laceration that cannot. We, you know, that you can’t stop the bleeding, a bone sticking out of an arm. I did have, I did have someone walk through my door with door with like a Like the humorous like sticking out and I was like Turn around.

Mandy [00:46:13] Go back. Yeah. 180, 180.

Sue [00:46:15] No, yeah, yeah, no, do not even come straight here. You know, like any respiratory distress, so I always tell people to call first. I’m like, call first, because I can actually, on the phone, triage.

Mandy [00:46:26] Oh, sure.

Sue [00:46:27] And get you where you need to be. So I think the most is like a bone sticking out or respiratory distress or unconscious, you know? Yeah. And the rest we could, more than likely at least get you seen and triaged and say, like, go straight there or come back or we’ll draw labs or something, so. Good, good, good advice.

Courtney [00:46:50] What’s the most- And then- Oh, go ahead. No, go ahead.

Sue [00:46:52] I don’t know, I forgot the first part of that question.

Courtney [00:46:54] Oh, what scares you the most?

Sue [00:46:55] Yeah. Oh, scares me. Probably, probably, like, not knowing what I don’t know. Like I still have, it’s probably back to that imposter syndrome. Like, what am I missing? What have I not seen? You know, just, that’s what keeps me up at night too, like gives me a tummy ache. Like, is there something going on? And that’s hard in pediatrics because you’ve got an anxious parent. that doesn’t trust you, that questions, and then you start questioning yourself. And then you’ve got the, like, oh, gosh, am I missing something? And then a history that, I’m not saying exaggerated, but, like, you know, like, it’s, I don’t know. So I think scary to me is missing something big or not knowing what I don’t know. And we all have that in our line of work still, even with decades of, of experience under our belt. Yes.

Courtney [00:48:00] What’s the most rewarding part of being a pediatrician?

Sue [00:48:04] Oh, I mean, like, sell it. You got to sell it. Okay, I’m trying to remember y’all are like residents, maybe or med school people, maybe. I love, like, when kids are in my office, and they tell me they want to be a doctor when they grow up. And that means that means they like had a good experience. We don’t scare them. They think my job’s cool. They like, I don’t know, like they, they, I don’t know. So I have like the kids that show up with their doctor bag and their doctor coat from their dress up thing. I mean. Extra stickers for you. And then they bring me a piece of paper with the drawing of me and them holding hands with a rainbow and a heart. And it’s just like, who? And then a hug at the end. I give them a shot, and then they give me a hug. I’m like, oh my gosh, y’all are amazing. So those are my favorite days. I just, I don’t know. I’m like, okay, this is all worth it. And then we do this big flu shot clinic every year where we like vaccinate 500 people in a two-hour window. And we just like churn people through the building. But we do like balloons and cookies. And one little kid walked out and he goes, Dr. Sue has the best birthday parties ever. And I was like, ooh.

Lara [00:49:39] Do you have a funny patient story that you can share with us that people won’t believe like that’ll be like

Courtney [00:50:01] Unbelievable.

Sue [00:50:03] Okay. Okay. Well, I don’t know if it’s funny, but it, okay. , when I just started my practice, , we get a, you know, you get like the phone call, the chief complaint, and then we schedule the appointment. And I look on the, on my schedule and it said patient allergic to clothes was my complaint. That’s good. Yes. Real good. So I walk in and I’m like, You know, and the patient is wearing like the mom’s coat with nothing on. She’s allergic to clothes. But this smart little cookie didn’t want to go to school. And so she told her parents. She couldn’t wear clothes. And they were like, we can’t send her to school because she’s naked. She wrote it out. And I was like, you guys, I looked at the parents. I was like, you have the smartest kid on the planet. And they got you. She’s not allergic to clothes.

Courtney [00:51:15] That’s so funny.

Sue [00:51:16] No one on the planet is allergic to clothes, but I get lots of like, I’m allergic to broccoli and things that aren’t real. That was one of my very first private practice stories. That’s funny.

Courtney [00:51:30] She’s probably grown and a lawyer. She should be a lawyer.

Sue [00:51:34] She is.

Courtney [00:51:34] She’s really smart. That’s funny. Do you have a favorite children’s book? You’re around kids all the time. I love children’s books, it’s like my lane.

Sue [00:51:45] Yeah, yeah, yeah. I have my own that I read my kids, that were my favorite. And our office is just full of books. Do you have the Sandra Boynton books?

Courtney [00:52:02] The little, those are so funny.

Sue [00:52:05] Those are hysterical, so funny to read as an adult, yes. Yes, yes, I love those books. Yeah, I don’t know. I’m just a book lover. I think in my secret life, if I weren’t a doctor, I’d work at a quiet bookstore without screaming children or be a librarian that didn’t allow children to come. An adult librarian. Or you could come, but you only could bring one kid.

Courtney [00:52:38] We’re interviewing her, we should say. We’re interviewing you at the end of a week. Rough week. That’s our bad.

Lara [00:52:49] That’s funny. That’s good. OK, well that is the perfect launch into our next section, which is our speed rounds. So we have a series of questions that we ask everybody. They’re supposed to be just sort of short, punchy, whatever comes to your mind first. OK? OK. Are you superstitious?

Sue [00:53:10] Yes.

Lara [00:53:10] Okay, we’ve got one.

Mandy [00:53:11] You have already said, things come in threes. And I was like, yeah, so she’s like waiting.

Sue [00:53:16] That’s right. And I’m married to somebody who is in the line of work that’s very superstitious.

Lara [00:53:22] Oh, yes. That is true. What other specialty do you have to ask for help the most from?

Sue [00:53:32] Mmm, probably dermatology.

Lara [00:53:37] Oh, the rashes.

Courtney [00:53:38] Oh, gosh. Okay. He was like, if one more person throws some steroids on it every time.

Lara [00:53:57] What’s a word or phrase you end up saying multiple times per day?

Sue [00:54:05] You might need context, but put the cream on like you’re icing a birthday cake. That’s good. I talk about diaper cream most days.

Lara [00:54:18] Okay. Okay. That’s a good one. Who in your inner work circle could you not live without? Oh, I would say my nurse. Okay. That’s a good one. Okay, so our next question is, if you could ask your boss or chair for one thing, what would it be?

Courtney [00:54:36] But you’re the boss.

Lara [00:54:39] I do want to ask her for more vacations.

Sue [00:54:41] She always tells me no. She tells you no. She says no.

Lara [00:54:49] What other medical specialties gross you out? Do you have one that you were like, I just could not do this? Podiatry. Oh, yes. That’s the first one we’ve had of that.

Sue [00:54:59] That’s been said, yes… Toes are gross.

Lara [00:55:06] Would you encourage your children to pursue a career in medicine? Yes. All right, a little bit of a mixed response. Care to elaborate a little bit?

Sue [00:55:21] Well, yeah, okay, so my third born says he wants to be an orthopedic surgeon, and I’m like, let’s do it, dude. Let’s go for it. Because he has a very, he likes the finer things in life. I’m like, he might want to go way more than her. , but then, , my daughter is, , she’s a senior in college right now and she is a artist and a economy major. And she’s like, I think I might take the MCAT. And I was like, okay. And I was like, you go girl. And I, you go. You know what, though? She would probably ace it. And then I would be like, okay, here we go. You know, there’s some part of me when I hear people in their 20s that brunched, I’m like, what? that brunched, like did we brunch? I don’t even know what brunch is. I’m like, what do you do at brunch? We hospital caffed, that’s what we did. Peanut butter and graham crackers. Yeah, exactly. So I’m like, I just, I feel like we did, our 20s, I mean, and it was mostly med school, I mean residency, you know, like there’s just, it’s a hard couple years and it’s just, you know, I’m like, it’s not for the weak of heart, so.

Mandy [00:56:49] No.

Sue [00:56:50] You know, so the finer things in life, go for it. The daughter who like adores education, I’m like, you would do great. Go to med school. That’s awesome. Because she just is like, she wants to learn forever. I’m like, go for it. You know. That’s a good start.

Lara [00:57:06] If you feel to do it, yeah. Yeah. Do you have a joke about your area of medicine?

Sue [00:57:14] Oh. I don’t have a ready-to-go punchline joke, but I do have… Pediatricians are always there with lollipops. We aren’t great in emergencies, but we can give hugs and lollipops all the time. You do want us around, you know, because we’re going to like take, you know, take, you know, get everybody calm and, and be kind and then give you a lollipop at the end. But I don’t, I don’t think I have a specific joke. That’s all right.

Courtney [00:57:51] Well, you stole the last question already. Oh, okay. But the last question is that we typically ask everybody, if you can do any job in the world outside of medicine, still support yourself, just wake up and it’s all set up. Like you don’t have to start a business. You just get magically put into one or whatever. And you said a librarian or a bookstore, somebody working at a quiet bookstore. Quiet.

Mandy [00:58:15] Yeah, but she said adults only. But not dirty.

Sue [00:58:21] Not like an adult bookstore. Just not sticky. Yeah, nothing can be sticky. The surfaces are clean and there’s no screaming. I hear a lot of screaming a lot of the day. Between sick and shots. It’s just not wanting to get weighed and getting their diapers changed. It’s just a lot. as screaming.

Courtney [00:58:49] So somewhere really quiet. I was trying to think of what else I could ask you. What would you tell your just-starting-out self? So you’re out of residency, out of all that. You’re just starting out, pediatrician, first day, all that. Knowing now what you didn’t know then, what would you say to her?

Sue [00:59:14] I think I would say, don’t be afraid of failure, be excited about success.

Sue [00:59:26] Because I think I was super like, I’m like, Oh my gosh, I don’t know anything. Oh my gosh, I have whatever I do, you know, I think I just was, like, very timid and didn’t I mean you just you are as trained as you’re gonna be and you’re still just not a hundred percent confident that you’re You are a doctor Wait, I’m in charge here If you could tell your patients parents

Courtney [01:00:04] Starting out, first time you’re seeing that mom has a baby or whatever it is, what’s the one thing you would tell them?

Sue [01:00:16] God, it sounds so cheesy, but I always want to be like, just go home and hold that baby. Like, I just, you know, I was the one that like, wanted to go home and put the baby on the schedule and like, they need to be like fed every three hours and sleep. And, you know, like I read the books and blah, blah, blah. And I’m like, Oh my gosh, if someone would have told me to like, go home and put that baby like, just on your chest and go watch your favorite TV show. Like, you will never, they will never just lay on your chest and be cozy. You know, it just goes so fast. I feel like those little ladies at church where they’re like, it goes so fast and, you know, enjoy the moments and all that. And I really, I would just say like, just go home and love that baby, like just love that baby and just hold them and love them and you cannot spoil them and just, you know.

Courtney [01:01:07] It’s very sweet. It’s very sweet. Well, Sue, thank you so much for being with us today.

Sue [01:01:12] Yes, Sue, so great. That was so fun. It did feel like therapy for me. I feel like I’m all good. Oh, good. I’m glad. I’m glad. Which you needed. I don’t even need to have you guys back for the weekend. Yes, you needed it.

Courtney [01:01:22] You can pass over to your family that are shut up.

Sue [01:01:28] Yep. All right.

Courtney [01:01:29] You can delete that out. Well, thank you so much again for being here. Thank you all for listening. Make sure you’re following us on Instagram and all the socials and listening wherever you listen to all your favorite podcasts. And we’ll be back soon.

Lara [01:01:44] Bye, guys. Bye. This podcast is intended for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The views and opinions expressed by the hosts and guests are their own and do not constitute medical guidance for any individual case. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or health concern. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast. By listening to this podcast, you acknowledge that the host, guests, and producers are not responsible for any decisions or actions you take based on the information discussed.