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Refugee Clinic Podcast

  • SARA LOMAX-REESE: Good afternoon ladies and we are joined with our Einstein docs as they are affectionately referred to. How you all doing today?

    DONEE PATTERSON, MD: We are great. Thank you for having us.

    LOMAX-REESE: It's a pleasure to be here. I am here as a guest, so I guess I am like your guest anyway, right?

    PATTERSON: Absolutely.

    LOMAX-REESE: Why don't we start? Can you both just identify yourselves and tell people what you do, what kind of docs you are? We'll start there.

    PATTERSON: Sure. I am Dr. Donee Patterson. I am the Director of Community Outreach for Einstein. 

    LOMAX-REESE: Medical Community Outreach.

    PATTERSON: Yes, yes, so it is my job to go out in the community and talk to people wherever they'll have me, at high schools, church, mosques, wherever, the mall and high schools, and we go out and we talk about a variety of different topics and just to help people be educated and be healthier. I am also a family physician. I see patients in my office as well and I try to educate people there as well. We are very fortunate today to have one of our really esteemed pediatricians here with us, Dr. Morgan Leafe. She's pretty awesome and we are very thankful to have her here. 

    MORGAN LEAFE, MD:  Thank you. Well, as Dr. Patterson said, my name is Dr. Morgan Leafe. I am a general pediatrician at Einstein Medical Center. I see both inpatient and outpatient pediatric patients. I also have a big role in educating future pediatricians known as our pediatric residents and I am, finally, the Director of the Einstein Refugee Clinic. 

    PATTERSON: Nice.

    LOMAX-REESE: Wow. Now you said you are a general pediatrician.

    LEAFE: That's correct. 

    LOMAX-REESE: That seems to imply some type of specific designation in the field of pediatrics. 

    LEAFE: Sure, that means that I see any type of children. It means that I didn’t go on…all ages and it means that I didn’t go on to do any further speciality training after my residency training.

    LOMAX-REESE: What could those specialties have included?

    LEAFE: Sure, lots of different options, people can be a pediatric infectious disease specialist, a pediatric cardiologist, focused just on the heart. All of the same specialists that you are familiar with in the adult realm, we have the same counterparts in pediatrics. 

    LOMAX-REESE: It's typical, if I am not mistaken, that many of us lay people would automatically think that a pediatrician is a pediatrician and we don’t typically, unless our individual child or some child that's close to us has some specific concern or need, we typically would think just take him to the pediatrician.

    LEAFE: Exactly.

    LOMAX-REESE: We don’t automatically think that it translates to the same kind of speciality needs as adults. 

    LEAFE: Absolutely. A lot of people don’t really know that those specialities exist because thankfully children tend to be a little healthier then adults, so often don’t need this amount of subspecialty care that an adult may need.

    PATTERSON: We have physicians, transpediatricians, and they go on to do a specialty in adolescent medicine, so that's something else that they can do and then if you do have children, your children can either see a family physician, like myself, or they can see a pediatrician and those specialties overlap. 

    LOMAX-REESE: Without causing you all to start fighting and have to separate you, why would I as a parent decide to use a family physician versus a pediatrician for my child?

    PATTERSON: That's a great question.

    LEAFE: That's a really good question.

    PATTERSON: That's a great question. 

    LOMAX-REESE: Y'all going to be okay, I won't have to separate you?

    PATTERSON: No, nope. 

    LOMAX-REESE: Be nice.

    PATTERSON: No, it's a great question. Some people choose a family physician because that's where they take their entire family. It's a place where a mother and father can go. It's a place where they can bring their children as well.

    LOMAX-REESE: Siblings of all ages.

    PATTERSON: Siblings of all ages and then often they'll meet their family physician in the hospital. Some family physicians deliver and then they'll just transition for a lifetime. I actually see generations of families. I see grandchildren and I see the mother, the father. I see great grands. I can actually see people from childhood to geriatrics and some families choose to do that and then some families choose to see a pediatrician. It is totally fine. There is no…

    LOMAX-REESE: …method to the madness.

    PATTERSON: There's no method to the madness necessarily and there is no hard feelings between us. We work well together. Some children who might be more ill and they're in the hospital a lot, they would see their pediatrician, who would often visit them in the hospital as well. 

    LOMAX-REESE: Dr. Leafe, let me ask you, I like Dr. Morgan.

    LEAFE: I would answer to either.

    LOMAX-REESE: This is Dr. Morgan Leafe, she is a general pediatrician at Einstein, and she is joined by Dr. Donee Patterson, who is a medical community outreach and a general…

    PATTERSON: …practitioner. Exactly.

    LOMAX-REESE: …practitioner in the Einstein system. We are entertaining them as our guest here on HealthQuest Live. This is the weekly segment that Einstein is a part of on this program. Dr. Morgan, I wanted to ask you, as a parent, if I have a family physician where our family goes, what would be the kind of consideration that as a parent I would make to say, okay, I want my child, or this particular child, to actually now branch off. I need you to just have a pediatrician. How does that decision take place within the context of a family?

    LEAFE: Sure. I think, to be honest, that's not often how it occurs. I think a lot of people stick with what they're familiar with in their family. So if their family has always gone to a family physician, when they have a new baby, they continue to take that new baby to the family physician and if they've always grown up going to a pediatrician, as I did, you're familiar with taking your child to the pediatrician. That's what you do when you have a child. It is sort of not something I think people tend to switch back and forth between. It is just kind of what you are accustomed to, but I agree with what Dr. Patterson was mentioning. I think sometimes family physicians will refer patients to pediatricians if it is a child who has a more complex medical problem that maybe they don’t feel is familiar with or they feel they don’t see as often because the scope of their practice is so much broader then ours. 

    LOMAX-REESE: What kinds of issues and what kinds of real focal points do you find are critical to the communities that you are typically reaching out to? Where do you find the greatest need in the context of the job that you have?

    PATTERSON: Absolutely. Wherever I go there are people who have at least five to ten questions for their doctor that they don’t necessarily get to ask their doctor when they go to the visit because they have very strict things that they want to talk to their doctor about. I try to make myself available to answer general questions. Of course, I am not examining people necessarily at the churches, but I definitely can give some advice and some education and I really think that it has been helpful. It has been a positive program for Einstein. I am sure there are physicians all over the country that are doing outreach, but Einstein felt that it was important enough to actually send out a physician to answer the questions of the community. I take my job very seriously and I look forward to talking to people about their medical questions.

    LOMAX-REESE: We just got a notification that one of the people did not quite like the end of the answer she gave at one of the events she was at last week so they just called Dr. Patterson here in the studios and text her and said, listen, can you clarify what you were saying when we were at the mall at that event? So she's working that out now. We got another satisfied constituent in the community, who was appreciative of the work you did. I am sure that it is not uncommon that you are constantly being, whether it is within the context of your practice or in the outreach work, that you find that people are going to always need to get more information.

    PATTERSON: Absolutely. One of the things that we wanted to make sure that we would say before we left here today is that it is wintertime and although today is really nice, it is sometimes hard for parents to know what to do when they are home with their children and they don’t have their doctor right on speed dial on their phone. A lot of times parents, I am a mother of four, I totally get it, that they don’t know the difference between their child just having the common cold or whether or not it could be something more serious. We wanted to give some advice to help people through that during this.

    LOMAX-REESE: But once again, what are the kinds of things that you find that are, that many folks may think are common knowledge or that people automatically got it and then throughout the contexts of your practices what are you finding are the kinds of issues or topics that are critically lacking from the capacity of most people who are bring their children, and even themselves, in and out of your offices?

    PATTERSON: Right, that's exactly what I am saying. Thank you for that. We are saying that a lot of times parents don’t recognize when their children are sick and also on the converse side they are very anxious and bring their children within the first hour of them being sick and we want to be able to give parents some clear, concise advice about what to look for, what doctors look for, and when to call us. 

    LOMAX-REESE: Which is very easy for you to say…

    PATTERSON: Exactly.

    LOMAX-REESE: …when you are not home with that child, looking like you know it is not normal for little Johnny to be sitting here like this.

    PATTERSON: That's why we are here today, Glen. 

    LOMAX-REESE: You are telling me I need to wait two hours. Just wait and watch him for a couple hours, so I am just, am I right?

    PATTERSON: You are right. That's why we are here today. We want to be able to explain to people. Let me start. A lot of times people think that children have to have fever for us to consider them to be very ill, but that's not necessarily the case. Sometimes children won't have high fevers. You can't just go on that. A lot of times moms, I do it myself, we feel our child with our hand and we say, oh, they're not warm, but that number means something to us, especially if your baby is three weeks or less. That number means something to us. 

    LOMAX-REESE: By number you mean…

    PATTERSON: The actual temperature. We are encouraging people to invest in a thermometer. The digital ones are fine. We are kind of moving away from the glass ones. Some of the ones that you may stick on the forehead, they may not be as accurate. So we are encouraging the oral digital ones. What do you say about that, doctor?

    LEAFE: Yeah, absolutely. I would completely agree with that. I think that's something I always review at newborn visits with my families. Very, very important to have a thermometer at home and know how to measure the baby's temperature. When you were asking before about common misconceptions with patients and families, I think, I don’t know if you agree with this, Dr. Patterson, but that fever. There are just so many myths related to fever. What is a fever? How dangerous is a fever? What does it mean when my baby has a fever? There is a lot of confusion related to that. We certainly field a lot of questions about fever. 

    PATTERSON: You want to talk a little bit about that?

    LEAFE: Yeah, absolutely. Like Dr. Patterson mentioned, it is very important to know the number of the baby's temperature. An actual fever is a temperature of 100.4 or higher. Some people think because 98.6 is considered a normal temperature, my baby's temperature is 99, that's a fever. It's not really what we would consider to be a fever in the medical realm, 100.4, and fever, I always like to tell my patients, is your body's way of fighting infection. So people think, oh my gosh, my baby has a fever, that's so dangerous. I need to fight it right away, but that's not always the case. Sometimes it is a good thing to have a fever because that means whatever infection is going on your body is fighting it. You certainly don’t need to rush to the emergency room the minute that your baby has a fever, unless your baby is young. If your baby is eight weeks or younger, and has a fever, that is an emergency and you should certainly call your doctor right away or go to the emergency room. 

    LOMAX-REESE: May I just jump in? I want to ask a couple questions about that.

    LEAFE: Sure. 

    LOMAX-REESE: In the context of that, I know of situations where people will be in that type of scenario and they will do one of two things at least. They will either say my baby clearly is experiencing a fever, so I am going to start giving them children's Tylenol and then see what happens and then I will wait until tomorrow and if they still have the fever then I will take him or her to the pediatrician or they may say I am going to give them some catnip tea or whatever, any number of…

    PATTERSON: …home remedy.

    LEAFE: Absolutely.

    REESE: Well, home remedy, natural remedy…

    LEAFE: That's a great point.

    LOMAX-REESE: How do you factor those kinds of things in terms of patient education and patient care? These are realities. These aren't just like hypothetical. These are realities.

    PATTERSON: That's exactly why we are here. That’s a perfect question.

    LEAFE: Absolutely right and that's why I said fever is a topic that I always cover at the newborn visit so that when it does come up parents feel prepared, but I tell families that Tylenol or Motrin for the baby is fine to give them, but I would encourage you only to do it if the child has a fever and is kind of miserable with their fever. I have a lot of parents say, oh, yeah, he was sound asleep and I took the temperature and it was high so I woke him up and gave him Tylenol. 

    PATTERSON: Or he was playing around and bouncing around and he had a fever and I gave it to him anyway.

    LEAFE: In that case, kind of why bother?  Certainly Tylenol is a medication that if you dose it wrong it can be a dangerous overdose. Don't overuse it if there is nothing wrong with your child because of the fever, but if they're absolutely miserable with their fever, sure, and a little Tylenol or Motrin might make them feel better, that's fine. I would encourage anybody who wants to use any type of natural remedy or homeopathic remedy to discuss that with their pediatrician. 

    PATTERSON: I just want to add something to that. This is very important. A lot of times you see the word children's Tylenol and we think that it is okay to give infants. There is a very different dose for infants and children and adults. You can't just have adult Tylenol and cut it in half and assume that that's the right dose. You can literally, really hurt a child if you are giving the wrong dose. Infant, child, adult, very different doses, and you have to go by weight. You really do need to know your child's weight.

    LEAFE: Absolutely and always keep that pediatrician or family medicine doctor's phone number close at hand or in your phone. Almost all doctors these days have somebody answering phones 24 hours. If you are not sure what to do folks would much rather get a call from you then hear about a bad situation later on.

    PATTERSON: Absolutely. Yes, that's a key point. 

    LOMAX-REESE: You said if you are not sure about this herb or whatever, call your doctor and you know…most of the people that I know would say my doctor doesn’t believe in that. We just, we do this and they don’t even know because they don’t believe in it so I just keep that over here and I keep this over there.

    LEAFE: Hopefully you can establish a relationship with your doctor as such that you can sort of have an open discussion about it. Sometimes my patients come to me and say, you know I want to give this remedy or this medication or herb or something that I haven’t heard of and I have to look it up myself and I feel that it is my job, as a physician, to let people know whether something is safe or it's dangerous or we just don’t know anything about it based on studies that have been done and then it is up to families from there to make their own decisions. I am there to be your advisor, but I would much rather know what you are doing and have you be honest with me, even if you say, no, I really want to give my child this herb, even though I know your studies say it's dangerous. Honesty is really important in your relationship with your physician so I think that it is important just to keep them informed, even if you may not agree about what's best.

    LOMAX-REESE: Before Dr. Patterson jumps in, how has your experience been in that regard? What kind of experiences overall do you have? Do you have a lot of resistance? Do you find that there are some difficulties in relationships at certain periods or just in general?

    LEAFE: I haven’t had a lot of issues with that. It's not in my practice, something that patients come to me about commonly, although in the refugee patients that I have seen that have come from other countries, certainly often they have the other remedies that I have not heard of before. Again, to me, if something is known to be safe, even if it not been shown to be effective, if it is not going to harm the child, then probably I would just let the family know that and let them make their own decision. 

    LOMAX-REESE: Dr. Patterson?

    PATTERSON: I have a lot of patients that use herbal remedies and remedies that have been passed down to them and, as Dr. Leafe said, if it is not harmful to them then we work well as a team. I consider my doctor/patient relationship as a team. What is important is that they share all the herbal and over-the-counter medications with us so that if we are ever making recommendations to them that we don’t give them something that's going to interact or mix improperly with what they are taking. That's a big part of the communication. Even if you are not sure how your doctor is going to feel about it, it is very important to keep those lines of dialogue open so that the things that they are recommending to you don’t interact. 

    LOMAX-REESE: Yeah, you know, I do, just personally, I am involved, I do some complimentary and alternative medical consults at some FQHCs around the city and I just broached this and I'm kind of like probably weighing a little too heavily on it because it is a critical issue, particularly in a lot of the communities that I know that are important to Einstein's system and I was just curious how this plays out. I don’t have any pediatric. Generally I deal with an adult population so I know how resolute those kinds of practices and beliefs and other kinds of considerations are and I know the degree to which people will go to think that it is appropriate to delineate like by saying, well, I don’t even talk about that with them. I keep all my appointments and I do this and get my prescriptions filled, but they don’t know that I am doing this. So for that reason I kind of play this traffic cop kind of thing.

    LEAFE: Sure, right.

    LOMAX-REESE: In fact, I just had a woman who had some abnormally high blood pressure and her provider, her primary care physician determined that she needed to be on the appropriate hypertensive medication and she's like, oh, I don’t want to take any medication and blah, blah, blah. I want to do the natural way. I said, hey, listen, let's do this to get this out of this area. 

    PATTERSON: Sure.

    LOMAX-REESE: Then you can have that other conversation and so 30 days later her numbers dropped significantly because she did, in a very compliant way, do what's necessary to take the medication to get it. So it is a very difficult thing and I am seeing that more and more children are being impacted by these types of adult decisions so I was just curious how you all see those types of things playing out.

    PATTERSON:  I think it is so important for people to work as a team. If you have a homeopathic doctor we all should be working as a team and communicate and send consult letters and e-mails, whatever it takes. 

    LOMAX-REESE: Once again, this is also something that I think had less to do with these particular entities deciding they wanted to make alternative medicine available, but the lack of compliance and how that impacts both patient outcomes, as well as patient costs. The cost of care is just you know, so it just made sense on so many different levels to say most importantly the message is how do we at least acknowledge that this is a problem or it has the potential to become an even bigger problem.

    PATTERSON: Absolutely.

    LOMAX-REESE: Can we take a call? Do you mind?

    PATTERSON: Absolutely.

    LEAFE: Absolutely.

    LOMAX-REESE: We want to say good afternoon, Jean. Thank you for calling from Center City and welcome to HealthQuest Live.

    LEAFE: Good afternoon to all.

    LOMAX-REESE: How are you?

    JEAN:   I am good. And you? I have a great grandson, who will be three in February.

    LOMAX-REESE: Have you spoiled this boy yet?

    JEAN:   Definite.

    LOMAX-REESE: I could just hear that. I could hear that when she said I have a great grandson, okay, go ahead. I just wanted to expose you, Jean.

    JEAN:   He has a problem with constipation. His bowels doesn’t move every day. When it do, he has like these one or two hard balls. He goes in the corner and hide or on the chair, something like that when he getting ready to pass his bowels. I tell his mother that's not normal. She need to go see about him because he drinks water, he will have a bottle of water, like the regular kids will have soda, juice. He loves water. I think he drinks too much water to be constipated like that. 

    PATTERSON: Constipation is pretty common in children. I don’t know if he is on medications and I don’t know what his diet is.

    JEAN:   No medications and he doesn’t drink milk like he used to.

    PATTERSON: That could be one of the reasons. Sometimes milk constipates kids, but then other times it helps kids to have more loose stools, but a diet of high fruits and vegetables often helps. The fruits where you can eat the skin often has a lot of fiber. One of my four children actually has a slightly similar issue. She eats lots of fruits and vegetables, and she drinks lots of water, it's just her makeup, but we use things like aloe juice and we mix smoothies. Whenever I increase her fruits and vegetables I add a little bran to whatever her cereal is. She doesn’t even know it. Nobody tell her. It has totally correct the problem, but I know that it is something that you should look into and if it continues then definitely talk to their doctor about it. 

    JEAN:   Because you know what he loves broccoli. He gets real proper, he says, grandmom, can I have some broccoli? 

    PATTERSON: That's good. Keep encouraging those fruits and vegetables.

    LEAFE: Yeah, you have a wonderful great grandson there that likes water and broccoli. We love to hear that.

    JEAN:    Grandmom, we have broccoli. He gets proper with it. 

    PATTERSON: I would avoid overusing laxatives though. Overusing laxatives in children can be a problem and I would just try to do it in a more natural way and then talk to the doctor if it continues. Do you agree, Dr. Leafe?

    LEAFE: I agree. This is a problem that we hear about commonly in our office. It certainly wouldn’t be out of the ordinary at all to make an appointment with the pediatrician to discuss this issue. They would be happy to discuss it and follow it with you.

    PATTERSON: And if there is blood, especially a lot of blood, or mucous, that would be something that you would want to talk to your family doctor or pediatrician about.

    JEAN:   The balls are hard, but we don’t see blood or mucous or anything. I say it's painful to him. That's why he go in the corner and hide. 

    LEAFE: Yeah, it is good to address it at this age, too, because he is probably at the age where he is going through potty training and it certainly makes that a little bit harder if they're having constipation issues. 

    JEAN:   Thank you very much.

    LOMAX-REESE: Jean, thank you for your call.

    PATTERSON:  Good luck with that.

    LOMAX-REESE: Absolutely. 634-8065 is the number. 215 is the area code. 215-634-8065. We've got some great docs here. We've got some great information. Dr. Donee Patterson and Dr. Morgan Leafe, both from the Einstein system, and this is good stuff.

    PATTERSON:  You had mentioned my community outreach, but I'd be remiss if I didn’t mention Dr. Morgan Leafe's community outreach. She has this pretty unique, very important refugee program that she does for Einstein and I think that there is a misconception about what a refugee is and what an immigrant is, but her clinic is doing some groundbreaking work and I was hoping that she would be able to inform our listeners a little bit about it today. 

    LOMAX-REESE: Well, I think because you have basically taken initiative, I say why not.

    LEAFE: I would be happy to give you a really quick summary of what we do at Einstein. We are really proud that the hospital that we work for is really dedicated to serving our community in North Philadelphia and part of our community includes some refugee patients. These are folks…

    LOMAX-REESE: Where?

    LEAFE: Refugee patients in North Philadelphia.

    LOMAX-REESE: Where?

    LEAFE: Where are they from?

    LOMAX-REESE: Where in North Philadelphia?

    LEAFE:  Oh, we are right on North Broad Street.

    LOMAX-REESE: Broad and…

    LEAFE: Broad and Olney. 

    LOMAX-REESE: So the refugee center is at Einstein.

    LEAFE: At the main hospital, yes.

    LOMAX-REESE: That's what I am trying to get to. 

    LEAFE: I got you. Yup. 

    LOMAX-REESE: I know I am a little slow, but work with me please, Dr. Leafe.

    LEAFE: We see adult and pediatric patients in our refugee clinic and these are folks who, not necessarily, sometimes people are confused by who is a refugee and who is maybe somebody who is the country in an undocumented fashion. Refugees are folks who have all been registered through the UN. They are from places that you are familiar with from the news, war-torn places, like Syria for instance right now, where they are unable to stay in their home country because of political unrest or other issues for which they're being persecuted against and so through the UN they register and they're able to be resettled in a more stable country. A lot of them end up in the end in the United States, in Australia and Great Britain and every year we get between 800 and 1,000 refugees resettled right here in Philadelphia.  We see a number of different ethnic groups, people from Burma, Bhutan and also Iraq, and we are now expecting an influx of folks from the Congo in Africa.

    LOMAX-REESE: I was just getting ready, I got a sensitivity on that part and I was just curious because, which is a bigger issue, where refugees are actually allowed to come from. I know from my own travels, Central Africa and even in Sierra Leone, Ivory Côte d’Ivoire, Somalia.

    LEAFE: It's interesting. I wish I knew more about how that's decided. It is very much at the federal level. Each year President Obama signs a bill that says we will take this many thousand people from this country and that country and this country.

    LOMAX-REESE: Exactly.

    LEAFE: And that's where the quota comes from, but I don’t really know the political workings behind that. It certainly changes from year to year, which is really fascinating as a physician because there's always something new to learn.

    LOMAX-REESE: But typically, and we don't want to belabor this point, but it changes from year to year, but there are some countries that never change. It always remains at very low numbers so some of the other countries seem to get better flexibility.

    LEAFE: Yeah and why that happens I don’t know.

    LOMAX-REESE: In terms of the scope of services that you are offering and making available at this center, what is encompassed and included in those kinds of, what kinds of services are you offering?

    LEAFE: Sure. We like to think of ourselves as a multidisciplinary, very comprehensive center for refugee healthcare.

    LOMAX-REESE: You cannot use big words like that. You have to break it down.

    LEAFE: We see folks for their initial medical exam, which as you can imagine with most of them not speaking English, can be a pretty long exam. We talk to them through an interpreter phone. For their initial medical exam there is a lot of bloodwork and testing that folks who are not from the United States may need so we take care of all of that. Very important that we get everybody immunized. Refugees are actually required to be fully immunized in order to apply for a green card, which they are eligible for once they've been in the United States for one year. Any sort of forms we are really adamant about getting children enrolled in school very quickly. Most kids when they land in the United States, within a month or so, are actually enrolled in the Philadelphia public school system, which is great.

    LOMAX-REESE: What are the criteria to be able to be, is it just the fact that you, if you have refugee status you can come and get the services at Einstein?

    LEAFE: Exactly.

    LOMAX-REESE: There's no other kind of criteria required.

    LEAFE: What we are really proud of in Philadelphia as a whole, certainly lots of states and cities and counties see refugees across the United States. We are very proud of our system in Philadelphia because we have developed a system such that the resettlement agencies have a very close relationship with a number of academic medical centers in the city and actually the resettlement agencies that are taking care of housing and basic needs for the refugees arrange their health care appointments with us, go to the families home and bring them to us. It is not up to this refugee, who is completely disoriented in a new country not speaking the language, to seek us out for medical care. 

    LOMAX-REESE: However, there are extended fellow country people, men and women, who originate from some of those same regions who will know that there are refugees from their homeland who are here.

    PATTERSON:  Word of mouth.

    LOMAX-REESE: Some of whom are listening to this program. 

    LEAFE: Absolutely. 

    LOMAX-REESE: I am trying to make sure that they are empowered to know that they can have the ability to help, to make sure that those kinds of things are not falling through the cracks, availability of service and care.

    PATTERSON: I want to emphasize that the word clinic does not in any way mean that there is any less care or that everybody is just a number. Dr. Leafe takes this very seriously. Everybody is very important. Everybody is an individual and they get the same care that you and I would go to if we went to our physician, but we just are reaching out to them because they are new. They are visitors.

    LEAFE: We have special services available. We have our own social worker dedicated just to the refugee patients. We have a patient navigator, who continues to help families make appointments, get to their appointments, arrange transportation, a lot of extra bells and whistles that this patient population really needs to get the care that they deserve. 

    LOMAX-REESE: Are you seeing a significant pediatric base in that population or is it mostly adult?

    LEAFE: We are. Right now it is a little bit more skewed toward adults. Iraqi families sometimes just are adults, tend to just have a couple of kids, and that's our main population in North Philadelphia. However, we are expecting with the influx of Congolese families, that their family structure is a little bit different and they tend to have more children to a single or maybe two adults. It is going to change a little bit in the coming years. 

    PATTERSON: I was just going to say that we take this very seriously, our community outreach. We hope that the years that we've been spending giving outreach to the community make a difference. If you have suggestions about topics that you would like to hear, you can e-mail the station and I am sure that they will get that to us. 

    LOMAX-REESE: Can they e-mail you?

    PATTERSON: Umm.

    LOMAX-REESE: If you really are serious about this work there's got to be some way that they can e-mail and contact you.

    PATTERSON: You know what? That's true. I am going to give you…

    LOMAX-REESE: Before we leave we will get somebody…

    PATTERSON: No, I am going to give you one right now. I am going to give you…

    LOMAX-REESE: Wow, you are reluctant, too.

    PATTERSON: No, I am reluctant because sometimes when people e-mail a doctor they e-mail me medical questions and they may be saying I am having chest pain, but I may be with my children and I don’t get back to that and I don’t want…

    LOMAX-REESE: No, I mean just in terms of community outreach, is there a way for people to contact the office or that sort of thing?

    PATTERSON: Absolutely.

    LOMAX-REESE: I would not put you in…

    PATTERSON: That's what I thought that you were asking so that's why I seemed a little hesitant, but if you have questions about Einstein and how to find a doctor there, there is 1-800-EINSTEIN and if you have any suggestions or comments about the show we encourage you to go to Einstein's Facebook page. That's Einstein Health and you can go there and put in any suggestions that you have about future topics or comments about any of the shows that we have done. You can also go to Einstein.edu and if you look up on the podcast library there is a whole year of last year's shows that we've done on asthma and COPD and different health topics that you can go to and for free listen to the old topics. 

    LOMAX-REESE: My grandmother told me lunch is never free. I always see to remember. When people say things are free I always think about grandmom, but anyway, furthermore, what about people who have community organizations, events, activities and they want to have some health education added. How would they reach out to Einstein, I mean, see if Einstein would provide you or someone on your behalf to bring some information to some community event? I am assuming that's the kind of way that you would have to…

    PATTERSON: Absolutely. If you are looking to have a health event and you need someone to come or you are looking to setup maybe blood pressure screens or things like that, you can call my office, which is 215-456-8220 and you can leave Dr. Patterson a message. You can also e-mail Leroy Howell. He's going to get me for this, but it is totally fine. You can e-mail Leroy Howell, it's howellleroy@einstein.edu and he is our constituency director and he helps coordinate things with the community.

    LOMAX-REESE: He may get you, but his boss will be happy that there's…

    PATTERSON: Absolutely. 

    LOMAX-REESE: …you have to do the job. Hey, listen, I want to go back. If we could just finish and talk some more about these issues with children. 

    PATTERSON: Sure.

    LOMAX-REESE: I just want to frame that we are coming up on it, but we have a little bit of time to talk about it. I want to frame this part of the conversation by looking at the context of basically the state of children in Philadelphia, the state of children's health, which is not good. We've got high asthma rates. We've got hunger. We've got poverty. We've got housing issues. Clearly, we have got educational issues. Children are in many ways very, very vulnerable as a general population in Philadelphia and for the most part we are seeing these children of parents who have the same kinds of socioeconomic kind of conditions for the most part, so how, you know, you can't just, I would assume rather, because I am certainly not a doctor, but I would assume you can't just kind of apply your skills so to speak, there have to be some kind of dynamics or some type of innovative, creative kinds of approaches that you have to be aware of and to apply. I don’t know if this question makes sense or not.

    PATTERSON: It does. It makes sense. I want to encourage people that if your children do not have health insurance, they can get free health insurance through multiple programs. There is Obama Care now, but there is also the CHIP program. I am not trying to be political, but they can get insurance. Also to bring your child for health maintenance exams. We often remember to do it when the child is very young, but then when they start to be toddlers and the pre-teens, those years start to skip in between. Make sure that you think about bringing your child at least once a year and if they have more medical issues they may have asthma or diabetes or high blood pressure, they're certainly going to have to come more frequently, but at least once a year make sure that you come in and get a physical exam for your child. Make sure that their health status is updated if they need lab work or immunizations, whatever it is and be in touch with your doctor. Make sure you have someone that you feel like you can communicate to. I have no problem with you putting it in your speed dial on your phone or the refrigerator, any sitter should have your doctor's number available. See us as part of the team in raising that village. We are part of that team and we have a vested interest in helping your child be healthy.

    LOMAX-REESE: So what about healthy literacy for parents? I always site an example of a situation where a mother had a little baby, an infant, who had developed a very terrible earache, ear infection, child screaming uncontrollably, you know what that looks like, right? 

    PATTERSON: Sure.

    LOMAX-REESE: The mother takes this kid to the emergency room. They treat her. Give the mother a prescription for some medication. The directions for the use says to use two dropperfuls daily and the mother gave it to the child orally by not knowing. That's a health literacy issue, right?

    PATTERSON: Sure.

    LOMAX-REESE: A man I just heard about from a friend of mine in Oakland was telling me about it, a gentleman out there who was a Latino man, who had some hypertensive issues that was forced to not be allowed to come to work until he got them addresses. He goes and gets treated, prescription, take two tablets once a day and in Spanish once looks like the word once so he took two tablets 11 times a day and died. Health literacy is kind of like a big kind of like 800-pound gorilla in the room a lot of times because so much of what you learn clinically and what you know is the appropriate kind of standards of care and all those kinds of things is kind of like…

    PATTERSON: Sure. It is hard. We do try to make sure that we talk to our patients and that we are clear and we give them the opportunity to ask questions. We highly encourage people if you go home, no matter what literacy level you are, if you go home and you are overwhelmed or you can't remember, I am not sure what the doctor said, call us back. That's what we are here for. We would so much rather you call us back and say I am sorry, I can't remember how you told us to take this or what that over-the-counter medicine you told us to get, can you please clarify and we are more then happy to do that. We would so much rather that. We encourage people, if you know that you have some problems reading prescriptions or reading in general, any of the instructions or literature that's given then ask your doctor, call us back, as your pharmacist. The pharmacist is part of the team as well and often helps to educate patients as well.

    LEAFE: Absolutely. You can always, sometimes people may not be comfortable asking questions back to the doctor. I am not sure why they are not comfortable or they think the doctor is in a rush.

    LOMAX-REESE: That's a whole other program.

    LEAFE: Find somebody else in the office. A lot of people in our office feel like they have a very close relationship with our nurses. We have wonderful nurses. They are in the office all the time. They know a lot of the patients really well. Ask the nurse if you feel more comfortable doing that. The nurse can explain it to you.

    LOMAX-REESE: I am doing some research on a book I am writing, Mercy Douglas Hospital, which no longer exists, was preceded by Mercy Hospital back in the early 1900's, 1903 or something like that and they started a hospital to develop a school for colored nurses and so these nurses because of the growing needs of the expanding population and blah, blah, blah. These nurses were well-trained nurses and they started to be found in all these places all over the city and they had this little distinctive way that they would like wear their hats and they had a little pin and people would go into the doctor's office and they would look for those particular, they knew that nurse. That nurse represented something in terms of that they had like a conduit, it was a level of comfort. It provided those kinds of things. To your point, there is something that about us, we live in a society where clearly there is a whole mystique about…

    PATTERSON: Hierarchy.

    LOMAX-REESE: Hierarchy of doctors and don’t question them. This is a lot of stuff is being undone that has been previously established.

    PATTERSON: Glen, to that point, the Einstein doc showcase was my brainchild because I really felt that when do people get to meet their cardiothoracic surgeon so we will bring them in.

    LOMAX-REESE: Hopefully never.

    PATTERSON: But you bring them into the studio and you get to know what that is or the radiologist and we can bring them in the studio or any number of specialties, the oncologist, etcetera, etcetera. I am hoping that it kind of demystifies the hierarchy that we are up here and other people don’t know us. We don’t feel that way. We want to demystify that. We want to show you that we are common people, too. We have children. I have questions about my children. You may be interested to know that my children have a pediatrician. It is just we are normal people, too, and so we want to educate people, but we want to demystify the concept that you can't ask your doctor questions. I also wanted to mention that if you do have a language barrier, every hospital in the city, especially Einstein, we will have translators and so you can ask for a translator. We have translator lines that if we are caught off guard and a person walks in then we can call for any language, whether it be Cambodian, whatever. We have people who will translate for us and that helps to bridge the gap a little bit and that's very important in our care for the patient.

    LEAFE: Not only, Einstein I like to think is great with our interpretation services, but I think a lot of families with low English proficiency may not be aware that that's actually a legal mandate. The owness is on the healthcare provider to always provide somebody to interpret so if somebody isn't providing you with proper interpretation; it's your legal right to ask for that.

    LOMAX-REESE: Well, thank you, Dr. Donee Patterson and Dr. Morgan Leafe.

    PATTERSON: Thank you for having us.

    LEAFE:  Thanks for having us.

    LOMAX-REESE: Both Einstein docs and this has been the Einstein docs showcase as part of this week's HealthQuest Live.