Research Assessment #3

Date: ​October 12, 2018

Subject: ​Pediatrics

Source: ​Thomas, Paul. ​RARE POLYDACTYLY (Newborn) | Dr. Paul.​ ​YouTube,​ YouTube, 23

May 2017, www.youtube.com/watch?v=GXsytmwGk8g.

Research:

Recently I have been following Dr. Thomas Paul, a Pediatrician based in Oregon, on

YouTube. Dr. Paul always treats his patients and their families with compassion. In this video,

he examines a newborn with polydactyly, a rare condition in which one is born with an extra

finger. Dr. Paul begins by asking the parents questions about the patient’s age, birth weight, and

home birth. He proceeds to give the child a full body examination and inform the mother of the

expected number of wet diapers the child should produce daily and weight gain while making

light jokes.

After watching several of the videos on Dr. Paul’s channel, I have begun to view him as a

role model of the medical field. Dr. Paul goes beyond the responsibilities of the average

Pediatrician by establishing meaningful relationships with his patients through his kind words,

jokes, and most importantly his empathy. I admire how he greets his patients with a warm smile

and engages in conversation with the parents outside of the wellbeing of the patient. In addition,

Dr. Paul commends the patient’s mother for giving birth at home, fostering trust towards the

physician in the mother. This reminds me of instances when my teachers provide me with

positive feedback on my work, as it motivates me to work harder in the class and creates a
positive perception of the teacher in my mind. This trust helps create a positive environment in

the clinic and should allow for better care for the child in the future. Furthermore, I was

appreciative of Dr.Paul’s decision to offer weight checks free of charge in his clinic, it shows

that he is not trying to make a profit from parents worried about the health of their children.

Throughout the visit Dr.Paul asked the mother of the patient several questions about her

nursing and well being, I began to wonder if these questions were standard procedure or a kind

gesture on his behalf. I assume that the latter is correct, as I could not find any articles detailing

questions pediatricians are required to ask mothers.

In the future, I hope to establish a practice similar to Dr. Paul’s as he is able to connect

with his patients and leave a meaningful impact on their lives, something I wish to do as part of

my career. As of recently, it is becoming more common for Pediatricians to see thirty to forty

patients a day, creating rushed and meaningless doctor-patient interactions. While I am unaware

of the number of patients Dr. Paul sees a day, I admire his dedication to taking the time actually

speak to his patients and their families rather than rush in and out of the door. These videos have

provided me with a unique insight into the Pediatric field and a better awareness of my capability

to prosper as a Pediatrician.

(See transcript attached below)

00:00 ​Dr. Paul here I am going in to see a new baby and this baby has a surprise on their hand

I'm told let's go see something we've never seen on this channel.

00:10 [​Music and Dr. Paul enters the room] Hello!

00:19-00:51 ​[Dr. Paul Introduces himself to the patient’s mother]

00:52-00:54 ​[Dr Paul asks] How many days old now? [Mother responds] She was born

Saturday evening.

00:57-01:03 ​[Dr.Paul briefly engages the infant] So three days, great remind me what was the

birth weight?

01:04-01:08 ​[Mother responds] Well we've had it at eight but we just weighed her now and she

was seven - so eight seems a little high.

01:09-01:16 ​[Dr.Paul asks] Okay where​ ​was she born? [Mother explains it was a home birth

and Dr.Paul responds] Awesome. Did you have all your kids at home? [Mother nods in

agreement]

01:19- 01:35 ​[Dr. Paul explains] Fantastic. Less intervention right less chance of being

colonized with hospital bacteria and the microbiome the good bacteria that we have in our gut

comes from mom and your environment so your child has a better chance of being healthy

and in that regard of having a good microbiome.

01:36-01:57 ​[Dr.Paul examines the child] I'm gonna grab some gloves and then just take a

little look at this one nice reflex there and there's the light the lights shining nice and even on

those pupils newborns. Sometimes their eyes don't track perfectly yeah I don't get too excited

about that one until year three.

02:01-02:10 ​ [Dr.Paul opens the child’s mouth] Nice to see little tiny white dots on the roof of

the mouth they're called epstein pearls probably named after Dr. Epstein, not probably, for

sure [laughs].

02:11-02:22 ​It's a little bit tight down at the base they call that a posterior tongue tie. [Dr.Paul

inserts his finger into the infant’s mouth and asks the mother] How's your latch right now?

[Mother responds] Its good.

02:23 ​[Dr.Paul notes the child’s irritation and jokes] I don't like you don't like the flavor. [To

the mother] Oh

02:25-02:38 ​Yeah, we've got a good latch yeah she's pretty strong yeah and she's able to take

my finger right to the back of her throat no problem. So you'll probably have really good luck

with nursing.

02:39-03:07​ [Examines the child’s finger] Okay he's a good got good little hand here, this

hand's got a little extra kind of finger. The nice thing about this one is that because this one is

little it is what we call a bridge.

03:08-03:39 ​[Music Dr. Paul continues to show the patient’s extra finger] This will be a first

for our channels history, yeah you can see the nail because it's got such a tiny little bridge the

specialists are gonna be able to just tie that off.

03:40-04:05: ​[Dr.Paul explains] Our fingers are developed around week six or seven in the

womb and you know if you look at images of babies at that stage they have paddles and then

the division happens between the fingers and sometimes you can just get an extra little

division that happens. It's kind of no big deal mostly we don't know what causes it and in this

case, we're gonna have totally normal function.

04:06-04:12 ​I don't think people you never know, usually you wait until they're one or two

years old but I think we can refer right away.

04:13-04:45 ​[Dr.Paul moves to examine the child's lower half] We have got good femoral

pulses and the reason we​ ​check for femoral pulse those of you who who​ ​you can't feel a

femoral pulse then you probably or might have an complication with the aorta which is just a

narrowing of that biggest vessel that goes from the left heart to the body. And that's not a

good thing, you don't want to miss that.

04:46-04:48 ​So your child has a good suck, now are you sore? [Mother responds] Yeah.

04:49-05:00 ​[Dr.Paul continues] Then we check for hip dysplasia by just doing these

maneuvers here, hips are great. Now I am checking for leg creases in the feet toes. Yeah you

have the perfect baby.

05:01-05:12​ Here, I'll flip you over and look at your back for a deep sacral dimple, which there is

none that's all normal. Sometimes you'll have a deep deep hole that you can't see the end of and

then you have make sure that's okay.

05:13-0:5:16 ​Perfect perfect you are ready to go back​ ​to mama [Dr.Paul returns the patient to

the mother]

05:17- 05:21 ​[Dr.Paul asks] How many wet diapers are you getting at this point per

twenty-four hours?

05:22-05:31 [​Mother responds] Probably three or four. [Dr.Paul states]] Okay perfect, normal

is one wet diaper on day one, two on day two, three on day three, four on day four, and when

you get to day six you should be having at least six wet diapers.

05:32-05:46 ​We should be seeing an ounce a day weight gain from here on out okay. You're

kind of at the probably the lowest weight and takes three to four days for the milk to come in.

And if you're worried and you want to come in and just get a weight check, before them

there's no charge for a weight check okay.

05:47-05:57 ​But otherwise let's see where you are at two weeks, since you're an experienced

mom I'm not too worried if you were a brand-new mom I would probably bring you back in

two three days but I think you're gonna be good.