Faculty Bibliography

Usually, though, it's one of the others: most of our teenage patients are the others, essentially good kids, pushing the envelope no more than adolescents everywhere. Then there are the stars -- the college-bound, the honor society inductees, the athletes, the scholarship winners. The children of immigrants, living out the trajectory that their parents, working nights as hotel housekeepers and nurse's aides, imagine. I have a very small, very sad array of clippings like these -- a house fire, a murder, a car accident. And for every clipping that actually turns out to belong to me, there are dozens I scan quickly -- the abused foster child, the baby who died at day care, the drive-by victim, the kidnapping, the meningitis stories, the flesh-eating bacteria, the drownings -- and then shake my head in relief. I don't think that's one of mine. I suppose there are different kinds of sadness for different kinds of deaths. When an adolescent whom you know is already out there on the edge falls off, when an adolescent who has obviously been circling gangs and drugs and guns ends up dead, there's a certain frustrated fury. Why did it have to be like this? Why wasn't there some way to change the situation? Why did we have to stand by and watch?

Dr. Manish Jain, a third-year neurosurgery resident at Tulane, who spent the days after the hurricane at the Veterans Affairs Hospital in New Orleans, described taking care of intensive care unit patients on ''drips'' -- intravenous hookups meant to deliver tremendously potent drugs at scrupulously measured rates, so that every detail of the patient's heart rate and blood pressure can be monitored and bring about an appropriate adjustment in dosage. Those doctors showed us, over and over, how much you could infer from the appearance of the patient, from what you could palpate, from carefully assessing the different pulses around the body, from listening -- really listening -- with a stethoscope. And they worried that those skills would be lost in an era when you could easily obtain unimaginably sophisticated images of the heart and its blood flow, when you could look to definitive diagnoses by technology that answered every question you had thought to ask, resolved every diagnostic ambiguity. Sometimes it's uncertainty: did I really hear what I thought I heard? Sometimes it's that medicolegal desire to check every box. Suppose the child gets sicker, could I really justify not having gotten an X-ray? And sometimes, I confess, it's just the awareness that the X-ray is possible, the X-ray is there, the X-ray is easy

''Sure,'' I said, thinking, O.K., hit me. ''O.K.,'' he said, and took a deep breath. ''My question is this. My question is, When you have sex with someone '' and then he interrupted himself, horribly embarrassed. ''Oh, I'm so sorry. I didn't mean you personally. I really didn't.'' It's O.K., I told him over and over. It's really O.K. They teach us all this stuff in medical school, I told him. You can ask me anything you want

My mother, [Sheila Solomon Klass], is 77 years old. She believes, I think, that when a doctor finds something wrong, it is partly the doctor's fault and partly your own for going to the doctor in the first place. My father, on the other hand, believed devoutly in preventive medical care. And every time the doctor found an abnormality, my mother was torn between gratitude that they had caught the problem early, and an accusatory impulse. ''What do you expect if you keep letting them draw your blood?'' I imagined her saying -- or thinking. And then when my father died suddenly and unexpectedly, I know that part of her grief was a kind of frustrated anger that all his conscientiousness should have led to this. I do try to avoid going to the doctor if I possibly can, and I do keep my medical problems secret if I possibly can. Earlier this year, my mother and I went on a trip together to India, and on the very first day, a bicycle rickshaw ran over my right little toe. I assured my mother that even if the toe was broken -- which of course it wasn't -- there was no need for me to see a doctor; there's no real treatment for a broken toe. You just buddy-tape it to the next toe with adhesive tape, and wait for it to heal. Dr. [Perri Klass] said she disliked going to the doctor, a trait she inherited from her mother, Sheila Solomon Klass. (Photo by Jamie Rose for The New York Times); FAMILY PORTRAIT -- The Klasses on a 1971 camping trip: back row, from left, Morton, Sheila and Perri; David and Judy, front. (pg. 6)

OBJECTIVE: Failure to read at grade level predicts life-long economic and social disability. Early exposure to reading aloud may prevent reading problems. This study seeks to determine whether institution of Reach Out and Read (ROR) programs is associated with increased reading aloud in a national sample. DESIGN: Before-after intervention study: separate convenience samples were studied before and after institution of ROR programs at multiple sites. PARTICIPANTS AND SETTING: A convenience sample of parents of children age 6-72 months seeking routine health care at 19 clinical sites in 10 states. INTERVENTIONS: The ROR model incorporates anticipatory guidance about reading aloud and distribution of free picture books at health supervision visits from 6 months through 5 years as well as reading aloud in the waiting room. MAIN OUTCOME MEASURES: Parents were interviewed about their attitudes and practices related to reading aloud, using questions drawn from validated instruments. RESULTS: The sample included 1647 subjects (730 intervention, 917 comparison). After controlling for multiple potential confounding factors, significant associations were found between exposure to ROR and reading aloud as a favorite parenting activity (Adjusted Odds Ratio [AOR] 1.6, P < .001); reading aloud at bedtime (Adjusted Odds Ratio [AOR*rsqb; 1.5, P < .001); reading aloud 3 or more days per week (AOR 1.8, P < .001); and ownership of > or = 10 picture books (AOR 1.6, P < .001). CONCLUSIONS: In a national sample, implementation of ROR programs was associated with increased parental support for reading aloud. This study provides evidence of the effectiveness of a primary care intervention strategy to promote reading aloud to young children

Dr. Barry Zuckerman is professor and chairman of the department of pediatrics at Boston University School of Medicine. Dr. Perri Klass is associate professor of pediatrics at Boston University School of Medicine. This policy intervention addresses a major problem: One third of all children in this country are not ready when they enter school. They lack the basic language skills, which are usually acquired at home. In one study, investigators went into children's homes every month for two years, starting at age 8 months, and counted the words children heard in an hour. In professional families, children heard, on average, 2,150 words per hour, while children in working class families heard 1,250 words, and children in families receiving public assistance heard only 620 words. Since children learn language by what they hear; this correlated with vocabulary at age 3: The children from the families on public assistance had vocabularies averaging only 500 words, close to the cutoff for developmental delay. This compares to average vocabularies of 700 and 1,100 words respectively for the working class and professional class children

This wasn't a child who needed to start taking iron drops; all the indices were normal, reflecting a proper number of normally sized and pigmented red blood cells. I couldn't have kept the paper on my desk to remind me to talk to a hematologist because nothing looked out of whack. The numbers would have long ago been entered automatically into the computerized record. Why had I held on to the paper backup record? Was this my clumsy way of reminding myself that this child needed follow-up for some other reason? His name rang no particular bell; common first name, common surname. I looked at his blood count irritably -- what did I need with normal test results? But I clicked my way into the medical record and clicked in his number, and waited for his chart to appear on the screen. So we check the blood count at 9 months and at 18 months, and when it's low, I start the children on iron drops and talk to the parents about adding iron-rich foods to the child's diet. I say, ''Start the children on iron drops,'' as if it were no sooner said than done. The fact is, it's a rare child who likes the taste of any of the available iron preparations, and a rare parent who is up to what is supposed to be a dosing schedule of two or three times a day. And just to make the whole thing more appealing, many children get constipation from the iron supplements. Not this child. His father had told me proudly at the checkup that he had given the iron drops faithfully, day in and day out. That he had decreased the number of daily milk bottles, and started letting the boy feed himself a variety of table foods. And so I sent him off for the more complete blood test, thinking that he had now had a fair trial of iron, and I wanted to see what his hematologic indices looked like

In teaching her son to cook for a school camping trip, Klass learned a lesson in parenting. By learning to take care of one's self, one becomes a grownup.