Interview: Dr. Ann Kellams Pt. 2
In this second part of a two-part interview series, Dr. Kellams speaks on vaccinations, patient interactions, and the resources she provides and refers for her patients.
Dr. Kellams is a pediatrician and lactation consultant at UVA Children’s Hospital. She has served as the Medical Director of the Well Newborn service since 2006, and has served as the Breastfeeding Committee Co-coordinator for the American Academy of Pediatrics, Virginia Chapter for the past ten years.
How do you deal with parents who don’t want to vaccinate their children?
I think there’s some people who say they’re anti-vaccine, but don’t know how vaccines work. Or, they’re worried they’re going to get the flu from the flu shot, which isn’t possible. So I start by asking the patient what they know about vaccines, and what they find concerning. If they’re worried about it causing autism, then I can show them some great data and list some reasons that I know of to explain that there’s no true association. It’s a matter of finding out what the patient knows, telling them what I know, and helping them understand what is or isn’t a serious concern.
Are there any changes that you would like to see in your workplace, or in healthcare in general, to improve the patient-physician interaction, and what each party considers to be an ethical outcome?
The first thing that comes to mind is less reliance on electronic health records. Even though there are some great things about it, it reduces the amount of time we get to spend face to face with a patient. Our whole approach, especially with mothers and babies in the maternity unit, is family-centered care. So anything we can do to get more face time with the patient, put them more at the center, and make them feel more empowered and a part of the team, is better. When we’re sitting at a screen, it makes it more difficult to spend the amount of time with the patient that we’d like to.
What do you find to be the most morally challenging aspect of your job?
For me, it would be when I identify families either with major risk factors, or who I worry are not going to be able to take care of their baby. When there’s nothing so blatant as to prompt a referral or immediate services, it’s challenging to be unsure what’s going to happen. There’s this conflict between respecting a family’s autonomy and giving them the best start you can, and trusting them even if you’re not sure it’s going to go well. So it’s my responsibility to do everything I can do boost them up and give them a chance to succeed, even when I feel like the writing’s already on the wall.
What kind of resources can you provide if you feel a baby won’t be properly cared for?
We have a social worker assigned to our unit, the CHiP program, and a local home-visiting program that we can activate if the family is agreeable to it. In situations where there is something objectively concerning about a family’s ability to care for a baby, child protective services can get involved and we can do a home visit to determine whether or not it really is okay for a baby to go home with the family. Their main job is family preservation. It’s not about being punitive, it’s about the baby’s safety, and what we can do to make the situation safer. But I think some families do fall through the cracks, where there’s nothing that meets that criteria, but they’ve got a lot going against them and you just have to be ready to catch them if something were to go wrong.
What’s the most gratifying part of your career?
Every day feels like an honor, to be with a family at this momentous occasion in their lives, and helping them make this the most amazing, meaningful experience for them. At the same time, I’m also in the background, unobtrusively being that safety net, and making sure everything is okay with the baby, and that they have the resources they need without encroaching on their special moment. It’s just a joy; it’s amazing. Even when it’s busy, I’ll say out loud, ‘”the miracle of life”, and it really is. It’s amazing that families trust us enough that they let us walk that journey with them.
This interview has been lightly edited for length and clarity.