Pulse
A Voice for Kids
A pediatrics resident believes one of the best things she can do to improve the health of children
is to speak out on their behalf.
Bubbly, blonde, and blue-eyed, Tracie Newman, M.D., looks as if she could still belt out one of the cheers she led at her high school in Arlington, Texas. Actually, the second-year pediatrics resident still does raise her voice—but in a different arena. Rather than sports, her passion these days is children.
Newman spent the better part of February doing a self-styled advocacy elective as part of her residency training at the University of Minnesota. The idea was to spend time learning about how laws get passed in the state and trying her hand at influencing the people who make them.
Newman, who served as president of the Physicians for Human Rights chapter at the University of North Dakota where she attended medical school, had considered doing an advocacy elective with the American Academy of Pediatrics (AAP), which brings residents from around the country to Washington, D.C., to learn about policy making on the national level. But with a 2-year-old son at home, she didn’t want to leave Minneapolis for a whole month. Then it occurred to her, why not try something similar in Minnesota? “I thought, there are so many opportunities right here in the Twin Cities: The Capitol is here, so many hospitals are here, the state legislative session was coming up. I felt very strongly that I could fill a month working on issues.”
She pitched the idea to her program director, John Andrews, M.D., who agreed that she could devote a month to advocacy work and was excited about the possibility. Andrews pointed her to Megan Jennings, M.D., chair of the Minnesota AAP chapter’s public policy committee and a pediatrician at Partners in Pediatrics’ Plymouth office, who helped her establish goals for the elective. The guidelines they wrote state that the resident would, among other things, participate in lobbying efforts, attend sessions of the state Legislature including hearings and briefings, and research child health issues.
Still, it was up to Newman to organize her time. She decided she would do behind-the-scenes work such as writing letters and creating fact sheets on medical home, booster-seat legislation, and the importance of breastfeeding. She also attended the AAP’s National Pediatrics Advocacy Day in Washington, D.C., as well as Pediatrics Day at the Capitol in St. Paul, spoke to other residents about getting involved in advocacy issues, and attended town hall meetings regarding the restructuring of state funding for children’s health care.
One Issue at a Time
Newman says her interest in policy grew while doing a rotation at Hennepin County Medical Center (HCMC). “I saw frustrating things. I saw kids without access to care, hospitalizations that could have been prevented,” she says.
One of those was the hospitalization of Brynn Duncan, now 8, a Moorhead child who was admitted to HCMC last year after her spinal cord was severed in a car accident. On the day of the accident, the girl was riding with her grandmother, who did not have a booster seat in her car. Brynn was severely injured when the car crashed. Newman was involved in her care for a month.
To Newman, Duncan was more than a patient. She was a vivid example of how public policy could affect a young life. “Had we had simple legislation, the whole thing would have been prevented,” she says. By February, when Newman started her advocacy elective, Duncan and her mother were telling their story before legislators and pushing for a new child restraint law.
Duncan’s case isn’t the only one that has shown Newman how public policy manifests in the lives of patients. She recalls a child she admitted at 3 a.m. with a tooth abscess that hadn’t been treated because the child had no access to dental care. “It all could have been prevented. It costs so much more [to provide health care] farther down stream,” she says. “To be honest, providing preventive health care for children is cheap, and it’s not hard.”
Newman thinks health care is a human right and that current policy in this country is counter-intuitive. “We take extreme measures to universally insure the elderly, but we don’t really insure our children. If you think of that from any logical perspective, it’s way more expensive. The elderly have many more problems … It seems backwards to me.”
Her passion about expanding access to care is evident. Yet Newman says she had more anger—and energy—10 years ago when she first encountered the issue. “I wanted a revolution,” she says. Since then, she’s taken to heart Margaret Mead’s famous quote “Never underestimate the power of a small group of committed people to change the world” and has become more willing to accept small gains. “It doesn’t have to be universal health care for children. I’m OK with that. I’ve learned to take small victories in stride.” Paraphrasing Mead, she now says, “It only takes a few people one issue at a time, and you really can change the world.”
Shifting Gears
Newman is grateful for having had some time to work on causes she cares about. “You know, as a resident, we work 70 to 80 hours a week. It’s a very demanding and selfish time. There isn’t a lot of time to think about issues.” Taking that time seems to have given her a fresh understanding of the relationship between and importance of both practicing medicine and working on public policy. “In medicine, we do change lives. But it’s on an individual basis,” she says. “Advocacy is a gear shift. Now, I’m thinking, What if we made small changes not just for one patient but for all children in Minneapolis? If you think about it that way, even a small change has a big impact.”
Andrews says Newman deserves credit for seeing beyond her own clinical interests and demands and for having the drive to put together an experience that he hopes will be replicated. “I certainly would love it if it were a required part of our residency in pediatrics,” he says. He’s asked Newman to document her experiences so that other residents might use what she’s done as a model.
He thinks an advocacy elective has educational value because it provides a broader context for the clinical work that residents do. He explains that pediatricians need to understand that improving children’s health involves more than treating a fever. It’s addressing the things that have a larger influence on kids—safety, nutrition, education. He also notes that pediatricians generally tend to be more aware of the need for advocacy because their patients—children—are less capable of taking care of themselves.
As Newman puts it, “There’s no voice for children in the Legislature. It’s really up to parents, pediatricians, and teachers to speak up for children. If we don’t, then no one will.” —Carmen Peota