Hi, this is Dr. S. D. Hess. And I am Dr. Ann Kirsch. And this is on and off the spectrum. Welcome everyone. Tonight we have a very special guest, Dr. Laura Hernandez, who is a pediatrician. And you are the clinicians of the hour, you and all your colleagues, because there's been a lot of confusion. I know that I, uh, in my clinical practice, and Anne, I know for yourself as well, we have parents who just don't know how to navigate with all the changing rules uh associated and that's come down from the federal government. And uh we needed to to speak to someone in your wonderful position. And then I actually sent Ann an article yesterday from the New York Times. I don't know if you if uh Laura, if you had a chance to see it, the confusion that we're gonna be talking about has led to some pediatricians who even have some thoughts about leaving the business because of the uh break and breach in trust between themselves and their patients, themselves and the governing agencies that they have to report to, and just leading to, again, just uh a massive amount of confusion. So let's say good evening and welcome and we'll start the conversation. Yes. Let's ask the I guess the for the first question, which is you know, how did you uh uh how did you decide medicine and how did you decide pediatrics? Which is what I would have done if I had gone to med through med school, it would have been pediatrics. Yeah. So yes. So tell us about that. So um I think my journey in medicine began long ago. I actually didn't initially think I would go into pediatrics. I was, you know, throughout high school, early college. I thought I wanted to go into social work, into being a teacher. So my mind did change a few times. I was like, oh, maybe I want to do this or I want to do that. But I was the general theme of it was that I was attracted to working with families, um, with younger patients. And I liked how, for example, doctors are teachers, we're educators. And um, as an educator, I loved working with um the different populations, but mostly to be able to teach them something, give them a takeaway. Um, there's so much shaping that can be done in the early stages of life. So that was one of the things that um attracted me to, you know, that teacher role. And then um also, and then slowly I started to learn more about the things that I like. I'm like, okay, I like science, I like math. I'm like, I don't really like, you know, writing essays. I love to read, but just for fun. So um I started to become more interested in, you know, the human body, the medicine part of it, and just coming from an immigrant community and a community that doesn't have a lot of access to healthcare and a community that has low health literacy. Um I wanted to help improve that and be a provider for my people. And so that was one of the main things. I think that slowly but surely I started seeing myself in into the medicine role. Um and yeah, when when did I decide? I think I decided in mid-college or later in college. I was like, you know what, I'm gonna commit to this. I'm gonna go into medicine. Um, and I I did think in my head, I'm like, maybe going into the role of a pediatrician were best would best fit me, but I didn't really know because I hadn't done all the rotations. I was open, I was open-minded. I was like, I'm not gonna shut something down, but I'm gonna, you know, consider all my options. And I got into um after after college, I did a post back at UCSF. So I lived there for about a year. Um, because like I said, I did make that decision of going into medicine a little bit later. So I wanted to get mentors, learn more about the application process, about the MCAT. Um, as I had mentioned, I come from a family and community of immigrants. So there I'm the first person in my family that um went to college and finished college. And so I didn't have anybody, I didn't have any role models. I didn't know any doctors that looked like me. So I didn't really have a lot of mentors. And so um, yeah, that's that's sort of a little bit more about my path. But um, yeah, after UCSF, I did medical school at UCLA. Um, and then I also completed my residency there. But during my medical school time, that was a time where I really got to explore the different medical specialties. Um I learned early on that I was like, okay, the OR isn't for me. I love interacting with patients. Um, I learned I really enjoy talking with families, and I really like the sense of, you know, we're all on the same team for this child to help them be the best version of themselves and help them thrive in their health. Um, other fields that attracted me, which are similar to pediatrics, are family medicine. And I had so much fun doing my geriatric rotation as well. And so um, I think the geriatric population is very similar to children. They had a caregiver with them, you know, they they were so like fun telling me the stories, and I really enjoyed just my interactions with them. Um, but eventually I learned that I when I was doing one of my OB rotations, I gravitated more towards let me see how the baby is doing rather than let me see how the mom is doing, you know, because I at that point in time, both the mom and the and the baby are patients, and so that really um uh gave me a sense of like, okay, uh now I know that I'm more gravitated towards, oh, let's make sure we resuscitate baby, make sure we, you know, do all these things. So that's sort of how I got into it, and now I'm a pediatrician, uh uh fully outpatient. Well, you said something so important. You said previously not only did you become the first person in your family to complete your undergraduate and then obviously your graduate work and in and medical school, but you did not previously have any mentor that looked like you. And so I'm wondering now in the community that you're working in, that little girls and boys can come in and they can say, Oh, there is someone who has my color hair and my color skin and my identification with language, and and do you get feedback from the kiddos and their parents when they meet, you know, this is Dr. Hernandez. And I do, yeah. I get I get comments um a lot, often from patients who come from a similar background, or you know, sometimes I share a my last name is so common. Sometimes I share a last name with with one of my patients, and they're like, oh my god, that you have the same last name. Or sometimes I get families that tell me, we've never met a doctor who spoke Spanish, who really fully explained this to me. I never understood, you know, what that means. So thank you so much for explaining that to me. And those moments I really try to carry them with me because sometimes in in medicine in my field, sometimes it can go both ways. You can have wonderful experiences and you can have um other experiences that aren't the best. So I really do try to take that with me. And I need to do a better job at this, to be honest, because sometimes at the end of the day, I come home and I just focus on the negative. And I think that's just human nature sometimes to do that. Yeah. Um, you're like nodding yes, because you know, we we've all experienced this in the in the field. You know, we remind each other that by and large, our day has been remarkable and positive. And the the kiddos, to quote Dr. SD, that we have worked with, and their parents that we have worked with, because they're all like you said, they're all our patients, they have come away enlightened and happier, and they have more tools for their life. And so, yes, you gotta remember both. Yeah, you you said actually another very pointed point I've never heard a doctor who can speak Spanish to us who can explain things so well. So now you have an extremely arduous task. How do you explain the change that has come down from the federal government in regards to vaccinations where we as parents, you know, many years ago that we just performa? We knew we had to get our kids vaccinated, we knew more or less the vaccination schedule, we just did it, didn't question it. And now there are a lot of scary thoughts. Do my kids need the vaccinations or not? Uh does the vaccination cause autism or not? Is there a pill that is going to cure autism or not? Uh and even parents have been so fearful that there is an injection, a vitamin K injection, which has to do with making sure that a child uh has a proper capacity, infant, you're right, a proper capacity in terms of uh that they are uh that their blood can clot a particularly healthy, positive way. And parents aren't doing that because now all injections appear to be scary vaccinations, and how now, whether it's in English or Spanish or any other language that you're proficient in, how do you go ahead and share the help your parents traverse all these different pieces of information so that ultimately everybody walks out with a healthy baby? Yeah, such good questions. What do you I know? And I'm gonna add one more thing. What I started to notice about when all of this started to happen was that I became, and I'm sure this happened with you too, that that therapists became the first line of questioning my patient who had young kids or newborn kids, because I specialize in pre-imperinatal psychology, and so they would call me and ask me what they should do, and that told me that there might be a breakdown in how they feel in terms of communicating with their pediatrician or communicating with their own doctors, but as a therapist, that's where they felt connected. So it really made me sit up and take notice. So please answer all of that. Yeah, I'll do my if I don't do my best. If I'm missing anything, just just let me know. We will definitely worry your Yeah. So one of the things I try to do when there's vaccine hesitancy or questions about that is to really explore where this hesitancy is coming from. What I often leave it open-ended. What are your thoughts about it? Or tell me what you hear, or tell me what your fears are. Um, I try not to come from a place of judgment because we are like we are the information we are given. So if someone is, you know, only on social media and that's their only source of information and they're on an algorithm that feeds them anti-vaccine information, you're just digging yourself deeper and deeper into a hole. And your feed will feed you what you're clicking on and interacting with. So I try not to like pass judgment. Um, as you know, from my background, my family wasn't um very um uh literate in terms of medical terminology and medical things like that. So I also try to come to them from a place of, okay, let me let me see what you know, and hopefully we can like tease out all the different little parts of it because part of it is like parents are afraid that we're causing harm to their kids. And I I let them know, you know, I am part of your care team. We are both on the same team here to help your child thrive and help your child be as healthy as possible. I did not become a pediatrician to harm kids because, as you know, pediatricians are the lowest paid in the medical specialty and we do a lot of work and we treat kids from birth up until sometimes I have patients who are in their mid-20s, like full adults. And so we have to, you know, know a lot of uh a lot of information and um and sometimes we don't know it all. And so sometimes when parents do have information, I'm like, tell me where you got this from. I really I'm interested. Can you send me the article so that I can look through it and review it with you or email it to me so that I myself can look into it and I'll let you know what my thoughts are. Um, and yeah, the uh to touch on some on the autism part of it too. Um unfortunately, um there was an article that came out that you know said that vaccines cause autism and that has been debunked. So I do let patients know that this piece of information has been debunked. It has been proven. Even kids who don't get vaccinated do get autism. So um I try to explain to them that correlation does not mean causation, that we we screen for autism at 18 months and 24 months using the MChat. Um, however, that's also around the same time where kids are getting a lot of their vaccines. The MMR Vericella is given at one year, and we have some boosters at 15 and 18 months, um, and other stuff at the two-year mark. So some parents will associate, well, they got their vaccines at this time, and this is when I started noticing changes. Right. And so I emphasize to them that just because your kid is developing and we start noticing things, because parents can tell when they're something is off with their kid, and sometimes even before we do the MTAS screens, at one year or maybe even earlier than one year, parents start noticing, oh, my kid is not acting like other kids. Um, and so I try to also uh answer that question in that way of like this is you know, this is how their development is, and we we it's correlated, but doesn't mean that vaccines cause autism. Um and then I'm trying to think what other parts of the question, what else am I missing? No, I I I think you know, you mentioned about the fact that the uh pay scale for pediatricians themselves are at the lowest at the end of what physicians uh generally make. But um the article in the New York Times reflected that there were pediatricians who because of the fact that to be a successful pediatrician specifically, you need to have trust between yourself and the certainly the the parents, your pay and your patients or the kiddos. But at the same time, you also want to trust the agencies, the federal agencies, which are uh prescribing or dictating the drugs that you are recommending, uh the directions of care. And when this seems to be in conflict, as I said, some physicians were or have expressed a thought about leaving the business because it's just too hard to navigate this general sense of confusion, if not chaos. So I'm I I heard with such loving admiration your desire to go into medicine and and for all the the wonderful reasons that you shared. Um how has this shift that's come down from the federal governments and the various uh you know food and drug administrations uh agencies, how has that impacted your particular practice and your thinking about medicine in general and specifically your pediatric practice? Yeah, no, this is a really great and loaded question. It some days are so difficult, so difficult, and it can be really draining. Um, and I do have these hard conversations with patients, and we do talk about it and how there is a disconnect between the information that we're getting. You probably um are aware that some of the the guidelines with the CDC are not um aligning with the American Academy of Pediatrics. Um I I know it's really difficult because how do you tell a family, well, this is the way I feel about the policies that the government is putting out? Um I try to um handle that with care. Because also, as you know, being a minority in minorities, there have been so many experiments done on people of color. Um, and there's so much history to that. So let's not forget that part. And that sometimes can cause people to be distrusting. And I don't blame them as someone who comes from a minority community and people of color, like I don't blame them. How can you trust, you know, the government sometimes when um these experiments have been done on your people and this, you know, um certain things in medicine are not research. For example, we know that maternal morbidity for people of color is higher than um people that are that are white women. Um, and so why hasn't there been, I literally just had a conversation with someone, why hasn't there been more research done on that when there's a clear disconnect? Um, so I do, like I said, I try to handle it with care and just let them know, you know, I I let them know my my opinions and sort of my takes on it. And I tell them, you know, the CDC is making some changes. However, I, as your pediatrician, I do follow the guidelines for the American Academy of Pediatrics because um not only are they backed by the American Academy of Pediatrics, but there's the um Academy of Family Medicine, other big agencies that are supportive of the AAP. Um I let them know that, you know, these we are the frontline people. We are the people that are seeing the patients. People in government are not, they're not, may or may not be doctors, not sure, but they are not the ones that are currently in the front lines working in the ER, working these shifts where they see all these vaccine preventable, preventable illness. Um, so you know, that's where I try to explain to them where currently I am a provider seeing in the front lines seeing some of these diseases. So I do trust these agencies like the AAP who have doctors guiding making these guidelines, um, versus another agency who might just be doing it for political reasons. Um, such an important thing you just said, because that's like like throwing uh you know a grenade into a conversation sometimes, and I can see how hard that that would be to have that kind of conversation, to try not to keep it, you don't want it to be a political conversation, but I know just from my experience that politics is in almost every conversation that I have. And I'm not a pediatrician, and so I'm it's like tiptoeing around that, but what you just said, I think is brilliant about going away from the political aspect of it and and relying on the American Academy to be able to say, yes, we hear a lot about this and this person and this voice, but here's another way that pediatricians get information, and we get this information from medical doctors, and you emphasize that from medical doctors, from people who have had the same training and sometimes more than what than other doctors or that I may have had. So when I tell you that this. Is on the level that you can trust this and and I trust it, that is the key right there. It doesn't always, you know, mean someone changes their mind, but I love how you said that. So important. I want to add one more thing. I didn't hear you negate another family's position. What you said is bring me your information, bring me your fears, bring me your concerns, bring me what you the research or whatever you believe that you have that is accurate. Let's explore together. And I think that reestablishes the trusting element that we're talking about. So that at the end of the day, as difficult as our days can be, you have re-established the the basic fiber and fabric of what a clinical alliance is to their patient. And I think that ultimately, ultimately, when then a a new parent, for example, can come in and say, I'm really not sure, and you can offer guidance and a thoughtful guidance, taking in consideration current understandings, current fears, current misunderstandings, and looking for clarity. Fear. Just when you have a new child, a baby, there's a huge amount. I remember there's a huge amount of fear in what do I do now? You know, they give you this baby, you put it in a car seat, you go home, and then I now I'm a mom, and what do I do? They come to you and what do I do? And instead of being able to just do what you used to be able to do, now you have to be tiptoe through the minefield that politics has brought into a medical field that is none of their business. If they don't have the background that makes it their business. How to feed their kids. That the uh pyramid, the food pyramid that we knew and appreciated, has seemingly been turned up on its head again. And and I have families who come in and say, I, you know, I I wasn't sure to begin with, now for sure I'm confused. How do I, I mean, I I do appreciate, I know there is a very strong message to reduce the number of processed foods, and I think that's probably healthy across the board. But the amount of um uh of of carbs versus protein, I mean, I think it's just a general confusion. What do you also talk to your patients about in terms of uh, you know, older kiddos? You said you had individuals up to the age of their mid-twenties, how to eat. We have a chronic issue of obesity in children, partly because I think of the the honest addiction to technology, so the kids are not getting out and playing that they are, you know, we're raising a generation of children behind a wall. What kind of guidance do you offer parents, both in terms of exercise, both in terms of uh food and direction and uh and continuity of care? Yeah, good question. So, with every child, um agree that processed foods are not recommended or recommended to be the least amount, because who doesn't indulge in like a cookie or two? I mean, I do it myself. And so, um, but you know, limiting the amount of processed foods, I tell the parents, you know, whenever you have a plate in front of them, um half of it or you know, at least the majority of it should be some type of vegetables. And I describe it as because we don't have the pyramid, um, you know, we don't use the graphic in in our office. I don't know the last time that I saw it be put in an office, to be honest, but um, I let them know, you know, make sure you are including all the colors of the rainbow and that you are including some kind of protein, if you, whether it's chicken, fish, meat, um, or if they're vegetarian, tofu, I offer a wide variety of protein. Um, and I let them know, you know, don't be afraid of carbs. But when you are eating carbohydrates, make sure that they're um the healthier carbohydrate. You're not eating like crackers from a processed food. You know, you're for example, whole wheat is is fine, and that you're not doing it excessively. And um, especially with beverages too, I let patients know water, water, water, water. There is really no need to do juice unless it's maybe a little bit of orange juice after you eat some um some iron-rich foods to help absorption, um, or like, you know, oranges have enough vitamin C. So, and then the cow's milk. But really, the main thing I think that is an issue in kiddos sometimes in school-aged kids is that they're drinking Ghetterate, powerate all day long, uh, these juice pouches that are just full of sugar. And I yeah, I sit down with people, or sometimes um, even you know, I ask them, Do you have you read a nutrition label and do you know what it is? And um, sometimes it just takes a few minutes to make that comparison. And I'm like, look at the amount of added sugars in it. There's the total sugar and then the added sugar. You want the added sugar to be the least as possible because those are additives that are being added. You know, there's the difference between like the natural sugar and fruits. Um, and so I I talk about it in that sense of more of the variety of food that they're getting throughout the day rather than the food pyramid, because yeah, we don't use that as much. I I appreciate that because you end with educating your parents and educating your kiddos, which also moves us to creating and firming up that alliance that we're talking about. I want you to know it's been such a pleasure to sit and get an education for both of us. It's really true. It gives me many ideas of ways to approach things. So I appreciate that. Absolutely. So I want to thank Dr. Laura Hernandez for coming and giving us from a both a pediatric perspective but as a sensitive humanistic perspective between you know between herself and her patients. It's really been a pleasure. I want to just share this is Dr. Estee Hess. And I am Dr. Ann Kirsch. And this has been on and off the the spectrum. If you enjoyed tonight's uh episode, and then please subscribe, follow us. We are on a variety of different social media uh platforms, including Instagram and YouTube, uh Spotify, Apple Music. And by the way, if you think that you have a conversation that you would like to share with our audience, please reach out to us uh and uh and let us know that you think that you would like to be a guest and uh and expand on our education as well as our audience. Again, Dr. Hernandez, thank you for the evening and for for really spending the time with us, and it's really been such a truly special, special time and a special evening for all of us. Yes, take care. Thank you.