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Interview with paediatrician, Dr Emily Whitehouse

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Interview with paediatrician, Dr Emily Whitehouse

April Prendergast

Emily qualified as a doctor in 2008 after studying medicine and psychology at Edinburgh University.  She now works in Manchester Children's Hospital and has 18 months left before completing training to become a consultant in paediatrics.  She enjoys sleeping, eating and trying to find time to read, play the piano and see friends and family in her spare time.

We would love you to read our interview with Emily, in which she shares her advice for preparing a child for a visit to hospital, tells us where parents and carers can go for more help, provides book recommendations and much more!

What do you enjoy most about working in paediatrics?

Working with children!  No matter how busy, upsetting or stressful a day is, children can always be counted on to make us laugh, tell a joke, do something silly, or simply show us how strong they are.  They more often than not bounce back from illness more quickly than their adult counterparts - such that at the beginning of a shift, a child can look very poorly, and at the end they can be waving and smiling as I walk out of the door.  You never forget the relief when a little face wakes up suddenly to a room of concerned onlookers and breaks the tension with, ‘oi, that hurt!’.  

Of course this is not true for all patients who face some terribly difficult times, and prolonged suffering, but seeing these patients come through and getting to know their families makes it all the more rewarding when they manage to weather the storms sent to them.  These little humans are truly inspirational as are their families, and the colleagues that I have the chance to work with.

What is the hardest part of your job?

There are many challenges which I have faced in the years since starting work as doctor.  Physically it has been hard to change frequently from night to day and back again, to travel long distances because of the training requirements of moving hospital every six months for the past nine years, and to keep up to date with training requirements beyond the hours of work. 

Emotionally it is difficult as it sometimes feels that we are being stretched beyond what is possible, and it often feels that there is no control over your own family life.  I find it personally very difficult when faced with anger or disappointment by relatives, but what is probably most difficult of all is finding a way to explain to parents that no further treatment is possible to save their child.   

I must never forget however, that no matter how hard this is for us as doctors nothing will ever be more difficult than for the parent and child going through this experience.

What advice would you give to parents or carers who are trying to prepare their child for a stay in hospital?

A stay in hospital can be a very scary time for both parent/carer and child, particularly at a time when there can be uncertainty for the whole family, and there often isn’t much time to prepare in an emergency.  It is not always easy to arm yourself with information in a rapidly changing situation, or when more time is needed by the medical team to try to work out a diagnosis and treatment plan.  This can be very unsettling for both parents and children, and the most important thing for children is to know that they will have their parents alongside them during the scary times.  All hospitals I have worked in allow at least one parent to stay with their child overnight, and although it can be tough for parents to see their child going through pain and discomfort, parents should feel part of the team rather than excluded from the experience

In general terms, I think when children know what to expect they can often cope better.  This is particularly true for children with certain conditions such as autism.  Unfortunately the huge change in routine that comes from an admission to hospital, the long waits and meeting numerous new people may make this a particular challenge for these children.  Questions children may have will depend on their age and developmental stage , but might include ‘how long will I stay in hospital?’, ‘what will I miss at school?’, ‘can my mum stay with me?’, ‘will there be any nice food’, ‘will it hurt?’, ‘will I be put to sleep’ etc.  They may even have questions which they are too frightened to express, such as ‘is it serious’, or even ‘will I die?’, and of course how we answer depends on the situation, and how much we feel informed as parents, but it is possible to pre-empt this anxiety by being reassuring about the purpose of their visit.  Try to explain things as honestly as you can in practical terms about what will happen, and if you don’t know the answer, there should be opportunity for you to ask the medical team what you need to know when you actually get to hospital.  If you think of questions, write them down as a list as it may often feel rushed when you finally get to speak to the doctor.  If in doubt, ask the nurses: they know almost everything or they should offer to find out. 

When in hospital, I think children can often deal with the situation better if their own parents seem like it is normal, but this must be easier said than done!  I am full of admiration for parents that manage to exude calmness and apparent lack of anxiety in these situations, but it is normal not to feel calm at all.  For example, when it comes to doing blood tests, a child who has never had the experience before will often pick up on their own parent’s anxieties about the situation, and be much more uncomfortable and difficult to reassure if their parents are overtly upset.  This obviously depends on the age of the child.   Often in this situation, with play distraction and the help of some ‘magic cream’, this horrible process can be made a little easier for the child.  Speak to the play team or nurses separately about your own anxieties or needle phobia, because the team should be experienced in how to make this easier so that it doesn’t appear such a big deal to the child.

Another general observation I have is that if children are given false promises, this can make things very difficult for the child to deal with at a later date.  For example, if a parent tells a child that something won’t hurt at all, and then it does, the child will not want to go through with this again if needed at a later date.  If a parent says that a blood test will be done at the first attempt and will never have to be done again, this makes it difficult as we can never be 100% successful when performing procedures.  Promises of going home are often given to persuade children to do things, but this can make children (particularly teenagers) upset if this does not happen.    

General tips for parents on how to cope would be to remember to look after yourself, prepare for lack of sleep, waiting around, the noise of other upset children, and that it is perfectly normal to ask for and need help.  Work out where to park, how much it will cost and which ward you will be going to.  Don’t worry if you forget basics such as nappies and milk-there should be spare on the ward in an emergency.  What is particularly difficult for parents is when they have more than one child, because it may feel as if having to choose between the child at home and the child in hospital.  This is normal.  Try to listen to the nurses when they tell you to go home and get some rest, and do accept the help of friends and family when you simply need a break or when they want to bring you some nice food in hospital.  

And finally, even if you don’t have time to prepare, the reassuring thing is that children are surprisingly resilient, and cope with change much better than adults on the whole.  They can be so much stronger than we expect.

For general information, there is a great article on the Great Ormond Street Hospital website and another on the NHS website.

Which children's books are good for helping to get a child ready for a trip to hospital?

I must confess, I asked for advice about this one!  I have a friend who works as a play specialist and her role is, among many other things, to prepare children for radiotherapy before they come into hospital.  She has lots of magic ways of engaging children and making them feel more comfortable in the hospital environment, and without people like her we would not be able to do half of the things that we do. 

Play and also reading are a huge part of a child’s life, and we should not deprive them of this just because they are in hospital.  My friend’s recommendation was from the Usborne First Experiences series called ‘Going to the Hospital’ by Anna Civardi for ages 0-5.   There is also a website called monkeywellbeing.com which has a range of resources including individual books like ‘monkey has a blood test’, and ‘monkey has an injection’ which can be individually bought.  

If parents/carers are concerned that their child isn't well but don't feel like they are being taken seriously by their doctor, what should they do?

This is a difficult scenario for parents to encounter, and one which I expect is probably not that uncommon given how good children are at making us worry.  It is extremely stressful for parents and carers to experience any illness of a child, and having to trust a complete stranger to give them advice can be difficult.  There can also be very confusing and scary advice to find about medical problems in the media and on the internet.  My advice would simply be honest and open.  If you are worried, say so. 

Doctors may often come across as being defensive if they feel that their own knowledge is being questioned, and dismissive if they feel that a problem is minor, and this may lead to confrontation if parents feel that they are not being listened to, or if doctors feel that they are being questioned aggressively.  I find that most parents come on board with a plan for treatment or even non-treatment if the doctor explains the reasoning behind their decision making process.  I am sure that some doctors do this better than others naturally, so perhaps questions that parents can ask to help guide this process might include: ‘please could you explain your reasoning for that?’, or ‘what would make you concerned in this situation?’.  A really good question would be ‘have you seen this before?’, and a good doctor should always be honest about the experience that they have had with that particular scenario. 

As I gain more experience, I now feel more comfortable to tell parents when I am not sure what is going on.  If doctors don’t have the answers, they should be happy to seek advice from a colleague.  This often happens in the hospital setting, where there is access to a wide range of specialist opinion, and where different types of doctor will inevitably have different experiences of life and illness.  

At the end of the day, always trust your own instinct as a parent and if you are not happy, ask for a second opinion: you are entitled to this, and do not be afraid to ask.  We are taught as paediatricians that we should always listen to parents, as they know their own children the best, and I do believe that parents often know when something is wrong even if it takes time before this becomes obvious to others.  The phrase ‘mum knows best’ is often true (and dad of course!)

If parents/carers want to learn first aid, where or who can they go to for help?

The UK resuscitation council provides training for healthcare professionals, but learning these skills can often be intimidating for parents and carers, so it is important to choose a course where you will feel comfortable.  There are a number of courses which you can try and again I asked some advice from a friend who works as an advanced paediatric nurse practitioner and she recommended:

Millie’s Trust provides different types of courses including those for training for people who work with children in settings such as nurseries, and is family friendly.  This includes training about how to deal with choking which is often a fear for parents, and was the whole reason that the charity was set up. 

There is also St John Ambulance.

Finally, a new charity has recently been set up by medical professionals to teach basic life support to children in schools called Little Life Savers.  This is a great initiative given that basic life support is not yet part of the national curriculum, but can teach children how to save a life.

Hopefully we can set up more courses like this in the future to help spread the message.

If you could change one thing about the NHS, what would it be?

The NHS is a complicated beast, and it is hard for people (including those who work in it!) to understand how it works fully.  My main wish would be that those who are put in charge of it, would have some experience of working in the medical field, because I do believe that this would add huge understanding to what is needed for the delivery of healthcare to the individual: patients as humans should be put first, and I think this is sometimes forgotten at a higher level.

What is your favourite children's book?

Wow, this is a really difficult one.  My favourite book as a child was Peter Rabbit and I learnt the words by heart.  My favourite author was Roald Dahl, and I used to love scaring myself by reading The Witches.  My mum used to pretend to be a witch and this terrified me, but I loved it!  Later at school, I read the diary of Anne Frank over and over: I kept hoping that the ending would change, because it wasn’t fair that a child with so much to give was taken away from the world in such a terrible way.    

If you could do something else for the day, what would it be?

I would like to travel to a place where I could see elephants in the wild.  I would then like to know how it feels to dance a beautiful waltz wearing a dress like they have on strictly come dancing.  This would be followed by witnessing a conversation with world leaders which resulted in creation of peace throughout the world.  The day would end by having some nice food with family and then having the time to sit down and read a really good book.  

If you could spend a day with one of the PrenderPals, who would it be and why?

It took me a while to decide between Gabriel the Giraffe and Ted the Turtle because Ted looks so wise and like he could teach lots of things, but I eventually decided on Gabriel because he is so tall.  I would love to spend a day sitting in a special chair on his back so that I could see a bird’s eye view of the world while reading a story as he walks along eating leaves from the trees.  He could also help me at the supermarket to try to reach things on the top shelf without me having to ask!  

Thank you to Prenderland Books for giving me the opportunity to answer these questions-they have really made me think hard!

We would like to say a huge thank you to Emily for doing this interview.  We hope you have enjoyed reading her answers and have found them as informative as we have.  We especially love that Emily has spoken from the heart and the image of her riding on Gabriel the Giraffe in the supermarket so that she can reach the top shelf!