Medical

Q&A with Dr. Perri Klass, Pediatrician and Journalist

Dr. Perri Klass is a pediatrician and journalist for the New York Times, an author, and a professor of Journalism and Pediatrics at New York University. She obtained her BA in biology from Harvard University (1979) before receiving her medical degree from Harvard Medical School (1986). Following this, she completed her residency in pediatrics at Boston Children’s Hospital. Dr. Klass is also the National Medical Director of Reach Out and Read, a national charity that partners with healthcare professionals and organizations to promote early literacy through pediatric primary care visits in all 50 states.

Dr Klass has been writing articles for the New York times for the past 30 years; her most recent column series, “The Checkup”, has covered the topics of possible links between Tylenol use by pregnant women and children with ADHD, childhood obesity, and the current mumps epidemic. She has also written fiction and non-fiction books on subjects ranging from medicine to knitting. Her published work includes Every Mother is a Daughter: the Neverending Quest for Success, Inner Peace, and a Really Clean Kitchen, co-authored with her mother, Sheila Solomon Klass; Quirky Kids: Understanding and Helping Your Child Who Doesn’t Fit In, co-authored with Eileen Costello, MD; Treatment Kind and Fair: Letters to a Young Doctor, and her novels include The Mystery of Breathing and The Mercy Rule. Her short stories have won five O. Henry Awards, and in 2006, she received the Women’s National Book Association Award.

When did you first decide to become a doctor? Why?

When I was in college, I had thought that I might go to medical school, but decided that I wanted to be a biologist. I was interested in the evolutionary biology of parasitic organisms with multi-host life-cycles. I was interested in schistosomes and other multi-cellular parasitic organisms which had evolved these incredibly complicated life cycles which involved moving between hosts, yet somehow evolved and prospered. So I went to graduate school, thinking that I would study the evolutionary biology and ecology of those organisms. If you study parasitic organisms you have a great deal of contact with people in the world of medicine and public health, because that’s where a lot of the expertise is. That’s where the people who understand those organisms and their transmission, and also how to interrupt their transmission, are found. I also realized that, while I found those organisms to be incredibly interesting, I was also very drawn to the people who had a more applied approach in the fields of public health, veterinary science, medicine. It wasn’t just the pure biology that interested me, it was also the clinical problem-solving and applied technology conversations. I ended up deciding that I would transfer out of being a pure biology graduate student and go to medical school. On the one hand, it was a big change in career paths, but on the other hand, I wasn’t making the same leap as someone going into medical school without a background in biology.

How/why did you choose the medical school you attended?

It was in the city that I loved, and it was a place with a good reputation. It’s easy to look back and write much more into the decisions you’ve made than you actually knew when going forward.

What surprised you the most about your medical studies?

I didn’t really know what to expect from medical school. Mind you, my medical school has been through at least two or three complete revisions of the curriculum since 1982, when I started. Hence, the things that I might personally complain about may have been changed several times over.

At least in the pre-clinical years, it didn’t feel like there had been a great deal of thought put into how to teach medicine. The material was clearly really important, and you had to learn, and there were even tests you had to pass. But it didn’t look like they’d resolved the issue of: how do we teach students how to not only handle all the information you have to learn now, but how to go on assimilating new information as it changes? That needs to be addressed so that twenty, thirty years down the line, you are not relying just on what you memorized when you were in medical school; rather, you’re able to update and keep learning. I think we’ve thought about that much more since then.

One of the things that’s very wonderful about this profession is you do have the opportunity to go on learning through your whole life. Nobody ever sits up and says: Oh well, I’ve got it all, there’s not a single additional medical fact that I’m ever going to have to learn. You can always learn more, you can always get better, and the information keeps changing. If you’re going to do well by your patients, you have to find ways of coping with it. How are you going to assimilate the information coming in and keep yourself updated?

I think partly because of the Information Revolution, which allows us to carry all the information in the world in our pockets, I hope people are at least trying to talk about that as part of medical education. Clinical teachers should be talking to you about how are they checking information, and what systems they apply. It’s probably very individualized, but it’s not something which I remember anybody ever discussing with us.

What do you wish you had known when you were beginning your medical studies?

In clinical practice, I repeatedly had moments of thinking: I wish I could go back and take haematology now that I understand what the ten most common pediatric questions are going to be. It’s what all med students know: you can’t do clinical work before you know some of this basic physiology, but once you’ve done some clinical work, your understanding of pathophysiology, and also why you might want to know it, is so much more profound.

Why did you decide to specialize in pediatrics?

I just liked it. When I was rotating through it, it was clear to me that this was where I belonged, and what I most enjoyed. It was the rotation in which I was happy to come to the hospital, happy to be told there were patients waiting for me. I just liked it.

Has being a pediatrician met your expectations? Why?

The strange thing about our training, which was probably more true when I trained than it is now, is that the training was heavily hospital-based, inpatient-based, and involved a lot of time in newborn intensive care. But, of course, most pediatric practice is not. So on the one hand, I thought the training was really interesting and I loved it, aside from the fact that it was exhausting and difficult and stressful, and all that. But on the whole, I really liked the training. A lot of it, however, was fairly far from what you do in primary care. I trained at a tertiary care children’s hospital, and had the benefit of seeing lots of cases of some syndrome for which only seven cases exist in the literature! But that’s not necessarily going to come up every day in regular primary care. I’m not opposed to my earlier experience; I think it was really interesting and I see the value. But there wasn’t a direct link to what you do in primary care.

What do you like most about being a pediatrician? Explain.

What I like most about it is watching the kids change and grow up over time. Watching families change and evolve.

What do you like least about being a pediatrician? Explain.

I probably dislike the same things that other people dislike: The paperwork, the charting, and the electronic medical record.

What’s your typical work week like?

I have a very anomalous job. I am in two departments at New York University: the Journalism Department, and the Department of Pediatrics. My typical work week depends a lot on whether it’s a semester in which I’m teaching; if I am, then I’m teaching a class or two in the journalism department. I see patients on Wednesday mornings, and I precept residents in the pediatric clinic on Wednesday afternoons.

Tell me more about how you started in journalism.

I’ve been writing fiction all my life. My mother was a writer and teacher, and believed strongly that everybody should be a writer. I sold my first short story through a magazine right as I was starting medical school, and the editor at that magazine asked me to write about my experiences as a woman in medical school. After I did that in my first year of medical school, I was pregnant in my second year of medical school, and I wrote a letter to the editor of The New York Times magazine, saying, essentially: “I’m a second-year medical student and I’m taking reproductive pathophysiology, and in the evenings I’m taking a childbirth class, and there’s no overlap. Everything we learned about pregnancy and childbirth in medical school completely differed from evening classes’ content. Do you think it would be an interesting article to have a medical students’ perspective on pregnancy and childbirth?”

I ended up writing that article, and after I had written those first two, people were more interested and I started getting the opportunity to write mostly personal essays at first. I wrote about my training and my experience of learning to be a pediatrician right through medical school and residency. Gradually over time, I got some opportunities to write stories about the medical world which were not necessarily so personal. So I learned how to do some serious reporting, where I could go to another hospital and make an appointment with somebody and say: “Tell me about this work that you’re doing. Can I see what it looks like?” I ended up doing a fair amount of both of those kinds of writing: the first person memoir-style writing, and more reporting. I was using my position as a medical student and resident to get myself through the door to report, but it was really interesting and fun.

I write a column every week in the New York Times. For that, I usually base what I’m doing off of a research study, and I’m usually trying to communicate to parents. For instance, this is a research study that came out in a journal, but here’s why you might be interested. It might help them understand their child’s development, or explain why practices are changing. I did a story on the resurgence of mumps in the US, even in vaccinated children. It turned out to be a story about waning immunity and the fact that mumps spreads in closed communities like college dormitories or close religious communities. But the fact that you’ve been vaccinated does not necessarily protect you.

In those situations, I’ll usually call one or two of the authors of the study and ask if they will speak to me, then I will look for other experts in this field who have done related research, to add context. Depending on the subject, I will sometimes look for either a clinical practitioner or, in the case of mumps, the state epidemiologist in Iowa, who had dealt with a huge outbreak at the University of Iowa. I wanted to get a real world perspective on the challenging, scary, and practical parts of tackling this problem.

These columns aren’t very long. One of the things that worries me is that you talk to people about something they care about passionately, but you have to boil it down to one or two quotes because of your space limitation. Sometimes, I apologise to people upfront: “You spent your whole life on this issue; I’m going to try and do it justice in 800 words”. Often, there are issues which are complicated and really interesting, but you’re not necessarily going to have room to cover it all.

How has your journalism work informed your clinical practice?

I think they feed into each other. There are these parallels in interviewing and in understanding people’s lives and other people’s forms of expertise. I also use my work in journalism to give me a way to investigate some of the medical topics that I find most interesting or most perplexing. Writing about them and trying to explain them to the general public make me think more deeply about medical uncertainty and medical decision making.

What do you like most about being in journalism?

What I like most is this whole experience of reporting and letting other people do the talking. I like finding out about things I don’t know so that I can write and speak with confidence about areas beyond my own immediate knowledge. Reporting and going outside your own narrow experience is a really important, interesting skill. It’s what we teach in journalism education, and I think it’s quite related to what you learn in medical school, when you learn how to do a clinical interview.

What do you like least about being in journalism?

In terms of what I like least, it’s the moments when you feel like people are only interested in having you tell the same story that’s already been told. Back when I was a medical student, I wrote an article about being in medical school. The editor thought it was much too light-hearted. In my article about medical school, the medical students were having friendships and relationships and having fun together, and she felt that medical schools were supposed to be a much more miserable experience, much more competitive, much less friendly, and a much harsher environment. She thought I was falsifying the experience, I was prettying it up. But I wasn’t, I was just telling my story, and my medical school class was perfectly sociable, and people were friends, and they were also working hard!

On average: How many hours a week do you work? How many weeks of vacation do you take?

It varies tremendously from week to week with deadlines and projects and coverage. I’m on an academic schedule because I teach in the faculty of Arts and Science. When I’m in town, I try to keep up the clinical responsibilities, but my basic schedule is an academic one, with the holiday time that comes with it.

How do you balance work and life outside of work?

I spend time with friends and family, I read a lot, I knit, I travel.

What types of outreach/volunteer work do you do, if any?

I am the National Medical Director of an organization called Reach Out and Read, which has been a very big part of my life for more than twenty years now. One of the founding pediatricians asked if I would take over, as he left. It really resonated with me, what I believe, and what I find important. It’s been pretty wonderful experience.

Reach Out and Read is the national literacy organization in the United States which works through pediatric primary care professionals to encourage parents to read aloud with their young children, and to encourage lots of parental responsive interaction around children’s books. We have a training curriculum, we talk with parents about the importance of reading with children, and we give a children’s book at Well Child visits in the first five years of life. I started working with this program when it was only one program in one hospital. There are now programs in every one of the 50 states. We are reaching almost 5 million children a year now, and we have more than 5,800 clinical sites. I spend a great deal of time working on advocacy, education, and helping the National Center serve the needs of more than 35,000 primary care providers who have been through our training.

From your perspective, what is the biggest problem in healthcare today?

As you can imagine, the biggest problem in the United States today has to do with trying to keep our families covered, and making sure that people continue to have access to the healthcare that they need. In particular, I worry about children, but I also worry about parents and adults, and what’s going to happen to healthcare access for the people who need it most.

Where do you see medicine at large in five years?

We clinicians are going to have to keep struggling with this issue of coverage. I think we’re all learning that, in the world at large, one of the ways that widening inequalities play out is in access to healthcare, and in receiving both preventive care and the care people need when they are the sick or hurting.

Where do you see pediatrics in five years?

I don’t think it will surprise you to hear that, for a lot of us in the US, especially those of us who treat underserved populations, we are really hoping that we can continue to take care of people, and that inequalities begin to narrow. We want to be part of that change.

What is your final piece of advice for students interested in pursuing a career like yours?

The clinical skills you learned in medical school and residency training are incredibly important. Learn to talk to a range of people with whom you have nothing OBVIOUS in common. Learn to listen to them, learn to understand them, learn to figure out what they’re saying, what’s behind what they’re saying. Those skills will be tremendously important in your life.

When you asked me “why pediatrics?”, I said “I loved it”. You really do get an opportunity in medical training to try out a bunch of different things. When you find the field where you are fascinated, where you love talking to patients and caring for the patients, where you like the people who will be your colleagues, you have to pay attention to that, even if it’s not what you thought you would end up doing.