Delivery of Care

Dr. Tuesday decides to hang up his stethoscope

Personal reflections on value and lessons of 30 years in the clinic

Photo courtesy of Peter Simon

Dr. Peter Simon attending the 2015 Health Equity Summit earlier this year.

By Peter Simon
Posted 7/20/15
Peter Simon, the pediatrician known as Dr. Martes, or Dr. Tuesday, finally hangs up his stethoscope after 30 years of practicing one evening a week at the Providence Community Health Centers, beyond his day job at the R.I. Department of Health.
What is the role that professionals can play in serving communities beyond their own jobs? Is there a way that businesses can encourage that kind of extra-curricular activity? How can the health delivery system build into its evolving practice model the kind of involvement of similar Dr. Martes?
In all the discussions around how to achieve health equity and diminish gaps in health care, one consistent piece of the puzzle remains the act of listening and engagement with the patient. Dr. Doug Eby’s recommendation that providers learn to listen in 10 different ways serves as a worthwhile practice goal, but in the world of electronic health records, engagement with the patient also needs to reflect a way to bring them into a more collaborative process of creating the notes, too. How will these skills be reflected in the new curriculum at medical schools?

PROVIDENCE – Dr. Martes was what they called me.

Since leaving private practice in 1985, I worked as a pediatrician, one night a week, at one or more of the Providence Community Health Centers in the evening, after finishing my daytime job at the R.I. Department of Health, [where I had served most recently as the medical director of the Division of Community, Family Health and Equity, before retiring in 2013].

My first assignment was at the Capitol Hill Center near the state offices, and most recently, at Central Health Center on Cranston Street in the West End of Providence. Over the last 30 years, I think I have worked at all of their facilities.

I will miss being called Dr. Martes. That means “Dr. Tuesday,” for those of you without any Spanish.

Why I continued to practice
There are several reasons for continuing to practice.

Some have to do with the challenges and rewards of practicing medicine cross-culturally.

Others include the pleasure of interacting with so many wonderful health care workers and physicians.

The origins of Dr. Tuesday
Some of you might wonder how I got the name, Dr. Tuesday. It is not as simple as it might seem. Let me explain.

Children that become part of the practices based in these neighborhood centers are assigned to one pediatric provider [and, more recently, to a family physician or a nurse practitioner at some sites].

The rationale is based on some evidence that a primary care provider – someone who knows you and you get to know – will lead to better care and better outcomes.

Since I worked only one night per week, and quite often I was away on travel for the Health Department, I was not considered a primary care provider; rather, I was used to back up the other pediatric practitioners who really did primary care, during the 4-8 p.m. sessions on Tuesdays.

When a dad or a mom called, usually after work, and their child had a problem that needed attention the same day, I was offered as an option if their primary provider was either fully booked or absent.

I shared responsibility for providing comprehensive, continuous, culturally sensitive care that Providence Community Health Centers were committed to providing, under their grant from the U.S. Department of Health and Human Services since their inception almost 30 years ago.

After a while, the nurses and health aides handling these phone calls eventually started to use this “handle” of Dr. Martes with parents, when they tired of explaining who I was and when they knew the child had seen me before. Most parents were pleased to take this option, but not all.

Chicken soup and rest
Some parents chose to wait for a time they could see their primary care provider; some had heard that I practiced in a very conservative manner, and that I resisted the prescribing of antibiotics, which families often wanted to allow their children to continue in day care.

Chicken soup, rest and time might have been all their sick children needed, but as I learned, the family’s economic realities reordered their priorities. Taking time away from work was not possible in their world.

Many families just went to the Emergency Department at the hospital or one of the “urgent” care providers in the Providence area.

This tension is one part of the process I will not miss. Experience had taught me that when pressure was provided to change the management of a patient for reasons external the biomedical condition, I should be wary.

I admit that every so often, I did bend a bit, but it was never a comfortable accommodation for me. The health aides, who all were bilingual and bicultural, used to tease me at times and also called me Dr. Chicken Soup.

They did this, not to make me uncomfortable, but to acknowledge that I was practicing the best medicine I could even when it meant they had lots of explaining to do with our patients’ parents.

Unforgettable moments
There are some moments I will never forget, like the first time I asked a Nigerian mom to describe the process of placing her daughter’s hair into the complicated braids that are commonly worn in their community.

She told me that as a child, her mother spent hours with her hair, simultaneously telling stories that impart the basic knowledge of their tribal beliefs, their family’s history and the strong bonds keeping the family and the tribe strong.

I asked a question about the other tribes and the way Christianity and Islam were embraced within the tribe. Of course, the information was interesting on its own, but what I really learned was how the act of asking such a question, showing an interest in their culture, created between us the beginning of a trusting relationship between a doctor and patient each, with very different ways of seeing the world.

I guess that this complex relationship with the staff and families is what I will miss the most. I will miss hearing the stories about where they came from, what it was like for them to be in Providence now, what the kids liked and disliked about being here, rather than in the Dominican Republic, Guatemala, Haiti, Nigeria, Russia, etc.

Grounded in the work
In addition, these families helped me to keep grounded in the work I was doing during the regular working hours at the Department of Health. I think it contributed to the design of our prevention programs for children, which have been recognized [mostly by knowledgeable folks outside of Rhode Island]as the highest-performing in the U.S.

Some of the parents I met eventually joined the agency’s program called The Parent Consultant Program, started in the mid-1980’s to explore how to improve the community engagement aspects of our home visiting and early intervention programs.

Many of the men and women we recruited and trained to conduct assessments in Central Falls, Pawtucket and Woonsocket were from families I had followed at the health centers.

I think that getting to know them, how intelligent and skilled they were, lead to my belief that they could bridge the social distance between our staff and other immigrant families in valuable ways.

Never say never
This is my way of saying thanks to the innumerable families who helped to enrich my life when I served as Dr. Martes and Dr. Chicken Soup.

I will continue to try to see patients from time to time at the Providence Health Centers, when we’re are not on the road or living away from Providence. At least while I still can.

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