Česky
Two years have passed since your arrival to the hospital in Hořovice. How would you evaluate this period?
In the two years of my stay at the hospital in Hořovice, we have managed to increase the number of patients by half of the existing records! We are still accepting new patients and the plan is to expand the children's district by one more outpatient clinic with new medical staff. However, it's not that I only see patients, it also happens occasionally that someone is referred from me to someone else. There has been, is and will be a fluctuation of patients between centres. The reason for this trend is clear, and Božena Němcová wrote about it in her Grandmother: "There is no man in the world who can please everyone".
At the time when you started, you said that you preferred an individual approach to patients. Are you succeeding in fulfilling this resolution?
This question would be more for my patients. I hope that I am succeeding in fulfilling this resolution, although it is difficult to evaluate oneself objectively. I can say with certainty, however, that I do not recognize a paternalistic doctor-patient relationship and you really won't see it in our office. Unfortunately, it has its pitfalls. I also see patients in my practice who might be labelled by my colleagues as problematic, and so, for example, it happens that I have more non-standardly vaccinated children in my practice than I would like, because I am a great advocate of vaccination and I like things to be done in a standard way. I try to explain things to parents, I don't mind discussing things with them, and I'm especially not angry with them if they have a different opinion, but of course I'm sorry when they prefer the internet to my recommendations. Every relationship has to be built, the patient's trust in the doctor is not a given and the doctor's actions and attitude should win the patient over to his side. Coercion and threats are not the appropriate means of communicating with a non-vaccinating parent.
I also said two years ago that I would like children and their parents to feel comfortable in my office. Recently, a mother with a small infant from another doctor came to my office and brought her infant to my office already completely naked at our first appointment. I was surprised and received the explanation that this was how she was forced to undress the baby in the waiting room of the previous doctor, so as not to distract the doctor from his work by undressing and dressing. I definitely object to this kind of treatment of a pediatric patient, and although the infant won't tell us, it certainly isn't pleasant for him to be undressed for 10-20 minutes in a drafty hallway somewhere. And there are a lot of other little things like that that I try to avoid in my office.
There is a lot of talk about the shortage of pediatricians in the country or their aging. Why do you think medics are not interested in this field?
Unfortunately, paediatrics is not very attractive to male medics, who mainly choose between surgical fields. Otherwise, what you described is not just a problem for paediatrics, but for all medical disciplines. The shortage of doctors in the Czech Republic is a well-known thing. After studying medicine, which takes 6 years, you have to undergo specialty training, which takes 5 years at best. The starting salary of a medical graduate who is not yet serving inpatient emergency services is comparable to that of a clerk in a chain store or a tram driver. So if you want to get an apartment, take out a mortgage, save up, or just start a family, you have to work several times a week, even at night, and you have to work weekends and holidays, and again, that's not exactly a convenient system for personal life. In fact, night services are not really based on volunteering, so if you don't want to earn money, you have to serve anyway. If you are then offered better working conditions or more time for your personal life and family in a completely different industry or country, which option will you choose?
What illnesses do children face during this period?
In the autumn months, when children return to the collective after the holidays, most patients come down with respiratory illnesses. The vast majority are viral upper respiratory tract infections. However, bronchitis and, in young patients, acute laryngitis, which may be accompanied by breathlessness, are also relatively common during this period. Exceptionally, bacterial pneumonia is seen. The winter period is also typical for viral infections of the digestive tract, especially of rotavirus aetiology. Children with urinary tract infections and children with functional abdominal pain or other psychosomatic difficulties are another large group.
You mentioned psychosomatic difficulties... Are they common in children? How can a pediatrician help such patients with psychosomatic illness?
Children are better at communicating with their bodies than adults, and they can figuratively benefit from their illness in terms of secondary gains (e.g., increased care from parents, not having to go to school or sports, parents addressing their illness and not fighting...). Psychosomatic disorder therefore occurs more frequently in children than in adults. Typical psychosomatic disorders are most often various pains (headaches, abdominal pain), sometimes also vomiting, fatigue, lack of appetite, psychogenic cough, collapse states, fever. In adolescents, various eating disorders are not rare. The paediatrician has the task of ruling out the organicity of the difficulties and explaining to the parents and the child that the primary problem is not in the body but in the soul and suggesting further solutions in terms of psychological care. In the hospital in Horovice we have 2 psychologists who also take care of paediatric patients.
How do problems of a civilising nature manifest themselves in children, e.g. spending long periods of time in front of a television screen or on a computer, mobile phone or tablet?
In principle, very similarly to adults, but of course it has its specifics. It is now becoming clear that children who spend a lot of time from a young age with entertainment electronics of all kinds are, in addition to the obvious and at first sight visible problems such as being overweight or having poor posture, also more prone to many psychological problems - namely ADHD ('hyperactivity') or depression. Some studies have even suggested that children who are used to only receiving stimuli from the external environment (excessive screen viewing) have lower imagination and creativity than other children, which can have immeasurable consequences and completely change their potential in adulthood.
Moreover, with few exceptions, children are not to blame for their difficulties but are dependent on the influence of their parents. And if they do not set a good example, it is difficult for them to break their own habits and difficulties.
Overworking children is a chapter in itself. This is a problem from the opposite spectrum, where children are put under abnormal pressure from their parents to perform- at school, in clubs, in sports... Children then often end up hospitalised in a ward with polyvalent difficulties because they "just can't go on" at the pace set. But this has already been discussed above. In all cases, you need to work ideally with the whole family, without the parents the children can't do it on their own. But that's the problem of paediatrics as a whole.
