Decidedly Academic. Distinctively Christian.
Written By Michael G Madanat, MD, MBA, MS, FAAP
Dr. Madanat practices general pediatrics in San Dimas, CA and is the president of Foothill Pediatric and Adolescent Clinic. He completed his Bachelor’s Degree in Psychology at UC San Diego and his Master’s Degree in Physiology and Biophysics at Georgetown University in Washington, DC. He then went on to earn his MD and his MBA from Tufts University School of Medicine in Boston, MA. Dr. Madanat completed his internship and residency training in pediatrics at UCLA Medical Center. In addition to his role in his private practice, Dr. Madanat has served in multiple leadership capacities including Chairman of Pediatrics at Foothill Presbyterian Hospital, Pediatric Subject Matter Expert for the new Martin Luther King Hospital, and founding Board Member for Heal, a start-up physician-on-demand company. He is currently a Pod Lead for HealthCare Partners Medical Group, a Physician Coach for Citrus Valley Health Partners, and serves on the National Speaker Panel for Mead Johnson. Outside of his professional life, Dr. Madanat enjoys spending most of his time with his wife and two young sons.
We live in a beautiful world, but beneath this beauty lurks cruelty and sin. A recent patient encounter reminded me of this. As a pediatrician I am honored to have the opportunity to help my adolescent patients manage and cope with crisis. At the same time, I have the misfortune of seeing the world’s cruelty through their eyes.
A 15 year old male presents to my office for his annual wellness exam. He is accompanied by his mother, Lucy. She is tearful. He does not make eye contact with me as I greet him. His name is Matt and I have known him for many years. I previously saw him last year for his routine physical. He seems different now.
Matt appears less well groomed than usual. He has gained weight. He appears withdrawn. I quickly recognize the situation and I respectfully ask his mother to leave us alone to speak. I learn that he nearly failed 9th grade. In years past, he had always been a stellar student. He no longer plays soccer. He was once considered one of the finest defensive midfielders in his league. Matt spends most of his time alone now.
I bluntly ask him if he is getting high on any substances. He denies this. I then ask him if he has had any inclination of self-harm. After a pause, he says “No”, but endorses that he questions the value of his life. He says that he feels worthless and that his future is hopeless. My heart hurts listening to him. I reflect on my own young boys and ponder how I can prevent them from becoming like Matt.
With Matt’s permission, I ask for his mother to join us. Matt accepts this proposal. I immediately ask how John, his father, is doing. Lucy tells me that he has not been around as much recently due to work-related travel and regular evening meetings. Matt’s older siblings are grown and have moved out of the home. I acknowledge that I sense her concern and I ask her how long Matt has felt this way. Lucy answers “two or three weeks.” Matt is initially quiet, then responds “four or five months.” His mother appears shocked. She has no clue. Dad has been unavailable. Matt then opens up about his experience in his first year of high school. Lucy and I learn that he
is being bullied – daily! The harassment started during orientation and has persisted. He has not been physically harmed, but the intimidation is always there. A familiar story unfolds – a group of older kids picking on a kid for being “different.” To make matters worse, Matt has not sought help from anybody until today.
This story conveys one of the most serious problems amongst adolescents. Bullying is virtually ubiquitous in middle schools and high schools. While it is well known that school bullying is associated with depression and suicidality among adolescents, the risk has been seemingly compounded by the digital age. With social media, the bullying follows our children home and pervades their life. Matt was a victim of bullying and was certainly starting to show classic signs of depression.
While physicians should routinely screen their adolescent patients for depression, the onus is on us as parents to detect problems and to initiate the evaluation. Parents should be vigilant for rapid changes in their adolescent’s appearance, interests, academic performance, friends and acquaintances, diet and behavior. The treatment ultimately involves close collaboration with the physician, the parents, the school, and sometimes the whole community.
So, how do we as parents intervene both to prevent bullying and to manage the consequences? At every phase of the crisis that Lucy, John and Matt face together, the following are some parenting fundamentals that I believe address both sides. Please feel free to rank these according to your discretion.
We obtained help for Matt. We spoke to his school principal. We connected him with a counselor and a therapist. We set up a meeting with the bullies’ parents. We even hard wired family dinners whenever John was at home and planned a weekend getaway for his whole family. I followed up with Matt three months later and I was relieved to see his improvement. He physically looked better, projected a healthier attitude, and had a more positive outlook. John came with Lucy to this office visit. Through a team-based approach, we averted disaster. Perhaps some kids are not so lucky. I know many of you have heard the stories about young teens taking their own lives due to the effects of psychosocial stress, particularly cyber-bullying. Matt was fortunate to have great resources and positive forces all around him. He and his family just needed direction. Through early identification and management we brought back the beauty to his life. I hope we as a community can keep Matt’s story in mind as we collectively seek the best for the younger generations.
Disclosure: While John, Lucy and Matt represent real life characters, their names and the exact details of the events have been modified to protect patient privacy.