Interview with ‘A Clinical Handbook on Child Development Paediatrics’ author Dr Sandra Johnson
Elsevier Australia Medical Student Ambassador Tim Duong recently sat down with Dr Sandra Johnson who is author of recently published A Clinical Handbook on Child Development Paediatrics.
Tim: Could you firstly tell me a bit about yourself and your journey in becoming a paediatrician?
Sandra: My journey started when I was very young. I recall from the age of about five, I used to bandage my dogs and cats pretending that they had injuries. At school when children injured themselves I was the one trying to fix them up. In my mind I knew I always wanted to be a doctor, so there was no question after high school that I wanted to attend medical school.
I completed my medical school training at the University of Cape Town in South Africa and did my internship at the Groote Schuur Hospital, where Christiaan Bernard performed the first cardiac transplant operation. I also worked at the renowned Red Cross Children’s hospital as a young intern. Through my medical training in Africa I had exposure to the extremes of disease. TB, rheumatic heart disease, liver disease and cirrhosis – all the diseases that you tend to see in a developing country. As a final year medical student I worked at a mission hospital in Lesotho, which is a small independent state within the borders of South Africa. There, as a student I was doing tasks expected of a doctor, because of the shortage of medical personnel.
As young interns we had the opportunity to learn technical skills e.g. inserting chest drains, subclavian lines and doing liver and pleural biopsies. I even learned to do breast biopsies and performed three uncomplicated appendectomies under the close supervision of senior surgical registrars. I was surprised to find that as a resident in Australia I was not allowed to do many procedures. I feel that my South African training gave me extraordinary grounding in my career in terms of holistic medicine and technical skills.
After my basic medical school training and internship I worked as a GP locum for 6 months in my brother’s practice in Cape Town before coming to Australia. That was an amazing period – which added to my clinical experience in managing complex medical cases.
In the early years I was very interested in adult medicine. When we moved to Australia, I worked at the Parramatta Hospital as a young resident doing general medicine. I then commenced my residency at the Prince of Wales Hospital in adult wards. During this time I did a term in paediatrics and really loved it. I subsequently decided to do paediatrics. After spending 3 years as a paediatric resident, I worked in a paediatric private practice for 2 years that dealt with learning difficulties, behavioural disorders and ADHD. I spent three months at the Hospital for Sick Children in Toronto, Canada in the Child Development Unit where I was exposed to ADHD and learning disorders and I did a 2 weeks training program in Learning Disorders at the Boston Children’s Hospital. This allowed me to gain knowledge and experience in child development and learning difficulties, specifically.
I did my formal paediatrics training at Prince of Wales Children’s Hospital and after passing the FRACP exams I spent a year as a paediatric registrar in child psychiatry at Avoca Clinic. I subsequently went to the UK to further my training and worked at the St George’s Hospital in London. After spending one year at the Tadworth Brain Injury Rehabilitation Unit in Surrey I worked as a paediatric registrar and lecturer at the St Georges Hospital Medical School.
When I returned to Australia I took up a post as staff specialist at the Royal Alexandra Children’s Hospital and became the paediatrician at the Grosvenor Developmental Disability Unit for six years. I commenced private practice part-time at first, which slowly increased to full time private practice. I retained my position as clinical lecturer for the University of Sydney in Paediatrics and Child Health and have been a lecturer since 1995 – I love teaching and interacting with medical students and paediatric trainees. As a result of working and training in child development in the UK, I attained the FRCPCH.
Having studied legal medicine part time over a 10- year period, subsequent to attaining the FRACP, I did the legal fellowship exams. These exams were rigorous and possibly the hardest exams I have ever done! I then attained fellowship with the Australasian College of Legal Medicine FACLM.
I feel very grateful for my extensive medical training and I have been very fortunate to learn and work with excellent teachers throughout my career.
Tim: Where does child development fit into the rest of paediatrics?
Sandra: Child development spans across all sub-specialities of paediatrics: the child who has a heart problem, the child who has had surgery for his hips, the child with chronic infection, the child who has had treatment for a brain tumour, and the list goes on – development and learning is invariably affected. Then there are children who have no organic disease – but who have behavioural or learning problems, are struggling at school, and/or have self-esteem and mood problems. Child development paediatrics isn’t separate from the rest of paediatrics – it is closely related and integrated into the broader realm of paediatrics.
Tim: What lead you to write ‘A Clinical Handbook on Child Development Paediatrics’, and what was involved in the process?
Sandra: When I started my training in child development back in 1984, I remember thinking that there were so many wonderful textbooks – but no one book with easily accessible information that I could use for study. I thought then that I would write a simple handbook on the topic for trainees. Busy doctors don’t have the time to work through complex textbooks and young medical students can find the subject daunting. What I want with my book is for people to be able to read it from cover to cover – with accessible and readily available information. Beneath the simplistic style of the book there is a vast amount of detail, which required a lot of background research when this book was written. I read many books, journals and included knowledge from my own clinical experience – to give the reader a clinical overview of the subject whilst providing the ability to explore the tabled references in order to obtain more detailed information.
The book could not be written without the support of many colleagues that are acknowledged in the foreword to the book and also the commitment of several experienced colleagues wrote chapters for the handbook. These contributing authors generously gave their time and expertise to share their knowledge and experience with the reader.
When I approached Elsevier I was asked to write a book proposal and only once the proposal was accepted, did the writing commence – and I spent a lot of time researching and writing! I wrote every single day, except for the days when I was working in my clinic. I enjoy writing, and did not find the task particularly onerous, but very time consuming.
Tim: Have you written other books before?
I have written another book prior to commencing this handbook, but it hasn’t been published yet – and hopefully it will be someday! It is specifically written for parents about child development.
Tim: How long did it take you to write from start to finish?
Sandra: It took twelve months from start to finish. I started in July 2010 and I submitted the final manuscript (which included the manuscripts of all my colleagues who contributed to the book) at the end of July 2011.
Tim: How did you decide what topics to put in your book?
Sandra: The topics in the book are precisely the issues that I encounter in my work: the problems that I deal with on a day- to- day basis in clinical practice. Issues like learning disabilities, ADHD, language disorders and behavioural problems occupy a lot of the work that paediatricians do in private practice. My previous experience in working with children with cerebral palsy and intellectual disability was included, because these are essential subjects of developmental paediatrics. I included a chapter on child abuse because I believe that this is an important aspect in this field of work. I also included a chapter on law because having studied law I wanted to share some of that knowledge with the reader.
I decided on a handbook style because I wanted the book to be portable enough to be carried by the reader for quick referencing. As a student and young doctor I enjoyed studying while sitting in coffee shops – of course studying at the library or quietly at home was preferable for the majority of medical subjects, but I love the outdoors and found that carrying a small book to read was a good way to learn “on the run”.
Tim: During your training in paediatrics, which aspects did you find most difficult?
Sandra: Oncology was difficult – particularly with children dying. When you know that a child with cancer might die you can’t help feeling emotionally affected. In paediatrics you become very involved with your patients, especially because children are so vulnerable. It is hard to detach emotionally.
Tim: What would you say is the best part of paediatrics?
Sandra: I love the freshness, the honesty and the spontaneity of children! It is the spontaneity with which they relate to each other, their parents and also with you, the doctor, that I enjoy the most. In general, adults tend to be much more reserved and measured in their responses.
Tim: What do you think are the key aspects of paediatrics that all medical students should know by the end of their paediatrics term?
Sandra: They must know about child development (read A Clinical Handbook on Child Development!). There are many common disease entities that form essential core knowledge, and these subjects must be studied well. But it is also important to understand children’s behaviour and their vulnerabilities – how they grow and develop within the family. We must consider the big picture and think about all the influences and persons in the child’s life e.g. family, friends, school, culture and society.
Tim: What advice would you give students who are considering a career in paediatrics?
I believe that it is important to have a good grounding in general adult medicine first, because it is advantageous when you study paediatrics. Even within paediatrics, I recommend starting out in general paediatrics before focussing on a particular field of specialty.
Dr Sandra Johnson was interviewed in October 2012 by Tim Duong, Elsevier Australia Medical Student Ambassador. Tim is currently in his 2nd year of medicine at The University of Sydney.