This episode is shared from Lab Medicine Rounds.
Guest: Jennifer K. Rodemeyer, M.A., CCLSJustin D. Kreuter, M.D.
Jennifer K. Rodemeyer, M.A., CCLS, manager of the Child Life Program at Mayo Clinic, discusses how to help patients understand laboratory testing during the COVID-19 pandemic.
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This is lab medicine rounds a curated podcasts for physicians, laboratory professionals and students. I'm your host, Justin Kreuger, the bow tie bandit of blood transfusion medicine pathologist at Mayo clinic. It's day we're rounding with Jennifer Rodemeyer, manager of the child life program at Mayo clinic. Thanks for joining us today, jen Oh, thank you so much for having me looking forward to this conversation. Me too. Me too. So uh With the right now, I guess for our audience we should make sure they understand we're recording this during the COVID-19 pandemic. And so one of the things that came up was, there's a lot of discussion about lab testing that's done for patients, different types of lab testing and that's really in the media. And I've been curious about how is this, what is the knowledge of the public or what do patients know? How do they understand the laboratory? And I want to ask your perspective since you're, you know, leading the child life program here at Mayo, why is it important to explain the laboratory to patients? Yeah, well, it's been significantly interesting watching this covid um pandemic unfold and specifically with my practice and pediatrics, how it has affected kids. For example, our oncology population anytime they're hospitalized, they have to have nasal swab testing done. Um anyone going through surgery now has to have nasal swab testing done. And when you get kids to the point where you've built these positive coping strategies and coping plans and they're doing quite well during their treatment. All of a sudden you throw in the covid nasal swab test and that just throws a whole another loop into what people are experiencing through covid. Um Me personally, I think nasal swab testing has been one of the most difficult tests to help prepare the public for because it is not fun um that we hear kids say quite often that they're touching my brain. Um And so the importance of being able to explain and prepare kids families, adults ahead of time is so significant and research backs that up And that actually bases the work that we do as child life specialists. Um why we do what we do. So our role in child life is to help kids cope through medical procedures and I think that there are so many lessons that we teach kids that I wish we had the service for adults because we see the benefits from providing just honest preparation. Um back to the research part of it. 10% of adults abstain from having medical procedures when they're adult because of what they've experienced as a child. And so we've created these moments in pediatrics where kids unfortunately have had unpleasant experiences and the majority that stems back from just vaccines. Well, child checkups, just blood work done. And as a care provider. It's difficult because you may be only seeing that child one time or that patient one time, but whatever is being done affects them for life. And so sometimes you'll hear, oh let's just go in and get it done. This will only take a matter of seconds, but in the end what it does is it unfortunately just builds such a negative um response to future when kids leave the medical environment and haven't had a pleasant experience the next time they come back, they think right back to where they left. And so that's why it is so important to take the time ahead of time. Um there's a quote that we often say it goes against your instincts as a parent to tell your child things that may potentially cause them worry or harm just because you're trying to be protective as a parent. But in the end being open and honest just builds trust and that way kids or even adults aren't surprised what's going to come at them next. So one thing from the very beginning when working with patients as we tell them is there's not gonna be any surprises here. We're going to tell you everything that goes on because we want that patient to feel relaxed during their stay and not worry about who's going to constantly come in and out of their door or ask them of things without being open and honest and telling them that's coming at them. This really resonates with me. My oldest daughter is quite afraid of shots and vaccines and that's something that we're navigating through and it's really interesting this conversation because I it makes sense to me about the idea that the importance of kind of uh you said preparing and having honesty. Um and and how that would lead to somebody that's very that is relaxed. I could see that giving somebody control. I hadn't thought about that component about long term in the consequences that this really can come back in the future. Especially now as we talk about a lot of preventative care medicine that goes on. Yeah. And you know that same study that I was talking about that says 10% of adults abstain from any medical procedures requiring injections. Um the same study reflected that 25 of adults are nervous about the medical environment. And so what can we do? I mean when I think of how many procedures I've been in throughout my career, I feel very comfortable in the study and if things were going to happen to me, I feel comfortable because I know what's going to happen. But if I enter myself into a new situation, I want to know the facts, I want to know what's being done to my body so I can cope and prepare for what's to come and um kids through adults just benefit from knowing. And even though we're so familiar with it and it's really 18 to us, it's so vital and important to take the time to educate your parents, your patients ahead of time just because you're gonna find your patient will become more compliant and like you said, gain more control of the situation and then be able to leave here with a positive experience. Being able to prepare for the next time they have to come. Mm hmm. I'm kind of curious your statement about how adults wish they had a child life programs that we're working for them with your experience talking with Children and then their families. Is it that the your focus is really on the child and then the parents sort of picks up on your efforts that way? Or is there separate? Are you addressing the child and then separately addressing the parent? Yeah, Good question. So first and foremost, when I go and visit a patient, I am going to focus my attention directly on that patient. I think that would be something that I would love for people to leave from. This conversation is when working with pediatrics it's so easy to overlook the child and go directly to the parent because we're just used to having conversations from adults to adults or like even when it comes to making decisions for medical care, we we go to the parent but in the end it's that child that you need to start with. And so first and foremost when I go into a patient's room, obviously I'm gonna knock on their door and if I walk into the room and I see that they're three years old, I'm going to bend down to their eye level and start a conversation just to build the relationship factor with them, you know, probably the majority of the time I'm going to bend down and say hi my name is, jen, can you tell me yours and right away that child is going to look at me like I don't want anything to do with her and maybe we'll snuggle up next to whoever their caregiver is. But I first acknowledge that child and then I'll say something to the effect of I see you brought someone special here today. Who did you bring? Sometimes the kids will tell me sometimes they don't want to talk to me again, but then I turned back to the patient again and I say to them, do you think that whoever you brought with could tell me your name and who they are? I'm giving? I am building that connection with the child that trust with the child and I'm focused on them and their response only and then invite whoever is with to be a part of the plan moving forward. It is important once you make that relationship, you know, maybe that child has mickey mouse shirt run or maybe they're playing a game and maybe I have no clue what the game is that they're even playing. I want to find something that I can connect with them just so they know too that I'm not here strictly to get their blood or get their nasal swab test or whatever I'm asking of them. Um, I am here to form this relationship of trust and also make sure that they feel comfortable being in that environment. And so just um looking around and seeing what can I pull in that they've brought in from their home, um that can help me form this quick relationship. But then from there, I want to make sure that our partnership isn't just between me and the patient, but also between the caregiver that comes. Um it's a team effort and I always acknowledged to the parents right away. Nobody knows your child best than you and so bring your expertise of your child here. We base our success off of these procedures with kids off of what parents have told us what works for their kids. I mean, everybody has past experience. And so maybe there's things that don't work or maybe they know that you know what my child loves to watch. Please let them watch, invite that kind of expertise um into your practice because again, it's only going to make you as the provider, succeed more in how you're able to get this procedure done. You know, I'm interested in um your tips for somebody like myself, a pathologist who likes to go to the bedside and be engaged with patients. There's some of us in pathology. So transfusion medicine docs will with some frequency go to the patient's bedside, but there's other kinds of pathologists that don't do that as much that work more behind the scenes. But there's there's certainly a lot of professional interest in the pathologist being more available to the patient, or more to help navigate some of those questions about what did their biopsy say? What does this lab test mean? And so for those who might be listening, who might find themselves going to the bedside more frequently or would like to what are a couple of tips that you have that maybe the pathologist should think about as they approach those situations. I think any opportunity that you have to go bedside, I would encourage you to do it uh about building that relationship and that trust. I mean, there may be an opportunity for you to build trust even prior to having that pathology taken and knowing what the potential results could be. Can you imagine receiving news um from somebody you've never even met before, and so the more that you can get in build that trust, make those face to face interactions, I strongly strongly encourage it kids up to adults. Um I think for especially for people to be able to process the step and be able to have a clear understanding of what's going on. You know, we talked about the importance of preparation and when I'm sitting down and explaining procedures to kids, I take them step by step and I tell them about all the senses that they're going to experience in that way, when they get to that situation, they can predict what's coming next. All because a series of events that has taken now if I've built that trust and then I come back after the fact I can close that loop and still have that trust built and then be able to prepare that family for whatever that next step maybe. So I appreciate that you do that. Um I love when I return do rounds in the morning and I love the practice when they come into the patient's rooms, they sit down and I understand people don't have time and what we see in our practices, the more time that we take from the beginning, the less time we need to go back and fix things afterwards. And so look at it as kind of a and even investment on both ends. Um Yes, you may be thinking more time pre but post, you don't have to take the time to try to add to what you do maybe should have done pre So um I just yeah, I just can't speak enough for making those face to face interactions. Doable and taking time to do that because I think overall everyone feels better including the provider just knowing that it's just not a name that they're seeing or a clinic number that they're seeing. But it's it's an actual person that has these actual needs and actual questions and it's just great to be able to be that resource. Um I think we've all been on the other end of things when we haven't had the access and we wish that we could, you know, one thing that I do is I encourage families to carry a notebook with them throughout the medical experience and if they think of any questions that they have, write them down, because all of a sudden you get to the provider and you may forget what you really have a question about just because you're so overwhelmed already. So that's another tip that I would encourage um providers to be able to encourage their families, their anyone from pediatrics up to adults to do is to to write these things down. You know, that that's really helpful for me, you know, having been in the mindset of enjoying to take my residents and fellows bedside and a lot of times that's been kind of the focus or in my mind a lot of the bar of wanting to get them that clinical exposure. So they see this way that some pathologists work in this capacity. But I see that you've given me the next bar that I can grow to, which is think about how can I make this relationship a little bit more of a long term relationship so that really everybody can grow from that experience. I wanted to flip it around if I could really quickly that because we have clinicians who are bedside all the time and uh long term relationships or at least longer term relationships are more than norm. What are your tips for them for explaining the laboratory as a provider at times. Let's let's go back to the scenario of not being able to be present ahead of time. Whatever message is being sent to, whoever is going to help you get the procedure done. So let's just take something simple as a blood draw with a child and you, the provider have ordered it. It's in the system. You might know that this child is anxious ahead of time and could benefit from some topical cream or L. A. Mix cream or whatever is available in the lab. If that hasn't been clearly communicated and passed down, it might not be on whoever is giving the procedures mind um to even think that that I don't know, I guess I as a provider would want what's best for each one of my patients. And so if there's an opportunity for you to share what you think could be done to help this patient have a positive experience. Don't assume that it automatically gets shared. Pass that information down, put it in the chart. You would be amazed when I help kids with immunizations. And I speak with the provider afterwards. And I say, you know, in the future, I think that child really would benefit from having um cold spray. The provider will say you mean that wasn't offered to them because sometimes there's just a gap in the system and here at Mayo, you know, pediatrics has seen all throughout adult areas. And so maybe in the lab that they're visiting. They're not used to seeing a lot of Pete's patients. And so they don't think about what could be done to help that child. Um they do more. Let's just get it in and get it done. So if there's specific ways that you can communicate about your individual patients do so and have that, make that phone call ahead of time, put it in the chart and have it tagged just because it's so important and vital for those positive coping plans. I mean our goal when we are working with individual, individual patients should be what coping plan does this patient need And how am I going to aid in seeing that that coping plan gets fulfilled. So some of these patients will come in and they'll have a beautiful coping plan already established and we'll get it into play. And then all of a sudden just one thing just sets them off. If you can just pause, break, restart again, remind those patients. Hey, in the past, I noticed that while you were doing this we played a game of I spy and that really seemed to work. Is that something you would still like to do? Let's give it a try this time. You know, and try to get patients to be able to divert their mind away um from what is actually taking place. We also find that research supports 50% of people like to watch and being engaged in whatever procedure is happening. And so sometimes I end up battling the parent more than I do the child because the child wants to watch the parents saying no, no johnny turn away, you don't want to see this from happening. But in the end, that's just how that child copes. And so if you know specifically how your patient copes help them succeed at fulfilling their coping plan to make that happen. That's brilliant. I think, you know, that it's been my experience to this, the communication and there's a lot of things, a lot of assumptions that everybody is making in health care. You know, we see our area in our domain and we make a lot of assumptions up and down the line and speaking as a laboratory in, I will never get tired of phone calls with somebody wanting to double check something or to touch base about something. And and I think for that patient that really translates into a huge, huge difference. I wonder for our students that are listening, kind of curious about, we've been talking about what can pathologists kind of think about and what can clinicians, the healthcare providers think about for our students, those that are in training to become physicians, nurses, medical laboratory scientists, uh what, what's your message for the learners where they're probably getting to see snippets of their mentors engaged in this way. Um, but you have quite a lot of experience to share. Yeah. So I always talk to our students to is every day is a learning opportunity and never stop learning. I think there's an opportunity, I always remind them think about a pie and all the pieces that put together the pie. You may learn from different providers, things that work, things that don't and include them in part of your pie and who you are. I love being able to observe others. Like that's the I think that's probably the best part of our role is in pediatrics. I think in health care in general, you are living in the world of unexpected. And I love that about our job because I love being able to observe new situations. I love being able to interact in new situations. But if you don't take the time to stop and process what just happened and the good things that happened about it and maybe the opportunities for potential growth, I think then you've stopped learning and that is not a model that I like to live by. I think you need to be a lifelong learner because things are changing so often and if we can learn from somebody's experience in order to make the next person's experience even a better experience, continue to do that. So as a student keep an open mind and keep learning never stops. And I like I said, II I'll this will probably date me, but it became a certified child life specialist in 2001. So for close to 20 years now I want to keep learning to keep elevating my practice and who I am and in the end who wins? It's the patients and the families because then we can continue to provide even more strategies and techniques to make their visits successful. It's a brilliant message. And in the spirit of continuous learning and maybe this is a premature unfair question. But as we were talking before we started recording, you were dropping some gems and and one of the things that you were sharing is that you're actually at least started planning to create a video to show kids and their families what's happening in the lab kind of behind the scenes, where does their sample go? I was just curious about uh, you know, is this, this is something I'm assuming that that's kind of new. You haven't done one of these before. Uh how are you approaching this? Yeah, so we just recently have, have been given this male kids channel and child life has the right as of now to what is being broadcasted on the system. So through covid. Um, because we're no longer able to provide group programming opportunities, we've been going on live Child Life live at least two times a day and just offering opportunities for kids to um either do like a craft project, play bingo will have pet therapy, music therapy. But part of what we're doing is providing educational opportunities and through this we are hoping to be able to educate kids a little bit more about what takes place while they're experiencing these medical situations. So for example you brought up the lab work. We are going to be planning on putting together a film that um you know, video is a patient in their room, the lab, the phlebotomist come in, take their lab. And then what what happens? I mean from the kid's perspective, the next thing that happens is someone turns on the computer in their room and the lab results are brought up on that screen. But in the end, look at all the steps that they're Singapore goes through in order to get there. And so we want to take it even one step further. You talk about preparing kids and the importance for them to be able to understand what's happening, why they're here even behind the scenes is so important for them. So we've even talked about taking a GoPro and sending it through our tube system. So then when it opens up it ends up in the lab and then it can go through all the steps there blood can go through all the steps to get that result that's on the computer screen. You know, when we're preparing kids for surgery, especially teens. Their number one concern for them is what happens, why I'm sleeping. They want to know how their body stays asleep? Who will see their body? Some kids even want to go into detail on how things are done, but it's just how it so supports what our minds are capable of doing, especially from teens and older. Being able to actually think in concrete terms and understand. It gives people peace and ease to be able to understand how some of this stuff works. And so for kids to, we want to just be open and honest and show them so then they can understand a little bit more about these processes, even if they're not physically there. So we hope to be able to start the series and then just extend it to things like laundry. How does laundry work here at the hospital? You know, as far as they know, they put it in a bag and then they get clean sheets, but there's so many steps in between and so stay tuned because this is going to be something something we're really excited about. Um, we'll have to think of a clever title or chapter series for what we're about to endeavor, but we're really excited about it. You know, it's funny, I often explain the the lab as a black box to, to most people and, and um, I think uh, laundry at the hospital for me is definitely a black box. So I'll be watching that as well. So, last question I'm curious about, um, you know, given how different patients can be when you produce that information, do you, do you envision it's going to be kind of um, you know, some material, you know, down the line, would it be some material that's for kind of K through five, Grade 5 and then like the teenagers, would there be different content? Or is there one content that you think how how differentiated does the education get? And I'm gonna respond to ways to that one in reference to making that video content. What we find is we gear it more towards that young school age group, but we find the teens still like to watch it. If we created it to the team level, we might not be able to capture as much of an audience, but we also want to make sure what we're introducing isn't scaring kids that can't understand. And so that's kind of why we choose that age group when we're producing these things to kind of be geared towards that younger school age group. But when it comes to preparing, So here's the second part of the question that you brought up. Each patient needs to be treated at a clean sleep and individually assessed because there's no way to come in with one script that's going to work, I may start preparing a child? Well, first of all, I always ask ahead of time if this is something they'd like to know, Some kids say absolutely not. I'm going to turn my head, I'm not going to watch. Please tell me when it's over, there'll be some nights I work in the emergency department and with the overhead light I'll take a gown and we'll drape it around the child and the light and we'll hide underneath that tent until it's over. And again, that's the child's choice. They have said, I don't want to see this, please help me become removed from it and we'll make that happen. If the child wants to know more or the teen wants to know more. We'll start by just asking them basic questions. Tell me what brought here, What brings you here today? That's always the question. Even though I know the answer to it, I want to know what that child's understanding is. You'd be amazed at the amount of kids that come here and they don't know why they're here or you'll see the parents in the background going, don't tell them I've said nothing. And then we're like, what? Like how then are we going to build trust with these kids and then how are we going to explain? And then you are the one who has to take them home and explain what just happened. So in order for us to be able to just provide some education to parents on the importance of allowing this preparation to happen is so key to, but know that sometimes it becomes so overwhelming and you'll see it. I mean you've got to not only um pay attention to words that are being said, but people's body language. You know, if I'm preparing a child for surgery and the child as a teen and we talk about the breathing tube because when they wake up they want to know why their throat is scratch and if we don't tell them ahead of time, then they're gonna again lose trust in the fact that we're being honest with them. Not all kids can handle hearing about that. And so I use that assessment piece when I'm working with them to see, you know, how far am I able to go on the preparation? Sometimes it's not, I can't even get beyond getting an ivy. Then we stop there and we just helped them cope through that ivy and then we're still thankful for our anesthesiologists that come help us get through the rest of it. Um, so again, we gotta be careful because you can't take a script and read it. You've got to individualize whatever you're sharing with your patients according to what their needs are and then just pay attention to their body language and how receptive that they are to what's coming at them because you'll know when too much is too much. Um, terminology wise. I always encourage families to use real medical terms at least one or two times in front of that child because they're going to hear the medical environment talking that way. You know, we had a young child that was recently diagnosed with leukemia and the parents said, you can call it leukemia, but whatever you say, don't call it cancer to the child. So I go in, I asked the child, tell me what brings you here today and the child said, well my parents brought me here because I'm not feeling well. Can you tell me a little bit more about what you think is happening to your body? And the kids said you mean that I have cancer? And the parents eyes were just enlarge like how do they know kids are so smart, they're going to hear absolutely every conversation that's taking place in the room and so it's so important and to make sure that you are not only speaking the medical terms, but then explaining them at a child's level. Um, just so they have a little bit more understanding and then from that point on whatever they choose to call it, that's what you stick with and you call it that. But at least they understand that Yes, it is leukemia, it is a form of cancer and here's what it means, you know, according to whatever their age level is, wow, jen, thank you so much. I think this conversation for me has really kind of hit that highlight of, you know, preparation honesty cultivating that, but you know, like you're just saying now at the end of the day you really have to individualize that. It's uh we often talk about the needs of the patient coming first and and that's one patient. We're talking about each and every time that we utter that phrase. And uh for me I know I'm taking away some things from our conversation today about thinking a little bit more longitudinal with my patient interactions. And I hope that a lot of our listeners, I hope that all of our listeners are taking away things that they can think about implementing in their practice as well. So, thanks for joining us today, jen thank you so much for having me and I just appreciate that you even do this because you all are wanting what's best for your patience. And so congratulations um for creating this program and thank you for allowing me to be a part of it. Oh thank you. We've been rounding with jen Rodemeyer about the importance of explaining the laboratory to patients. Thank you for being able to take the time to listen to this topic. Thanks for joining us today. We invite you to share your thoughts and suggestions via email. Please direct any suggestions to m C L. 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