54 - HCN
===

[00:00:00] [00:01:00] [00:02:00] [00:03:00] Dr. Ahmed, it is so good to have you on the show. I've been waiting, you know, to really I guess, tackle the question of children's health, pediatrics, what's happening with the state of, I think, so much of the impact of social media on kids.

Rick Gannotta: We've got a lot to talk about. Let's just jump into it because I think if there's any one question I wanna start with, given your perspective- Mm-hmm ... and obviously your unique position, from where you sit, again, from your perspective, if we look at America's children today, are they healthier than they were 15 years ago?

Dr. Amna Husain: I think yes. I absolutely think so. Um, you have to look at this from a bird's-eye perspective, and I will say that, um, as a pediatrician, we live in the field of primary [00:04:00] care. Preventative, being proactive, not retroactive. We have to think of how much we have learned. So we learned so much about screens, Internet.

Okay, pulling it back, giving it forward. Um, where can screens help? Where do they not help? In terms of just generalized safety, helmets, sunscreen seat belts, all of these things are things that we know so much more about, um, when it comes to children versus 15 years ago, 20 years ago. And we can always go back on that perspective of, "Oh, in my day, this was this way."

Of course it was that way because we didn't know any better. I think we know so much more now, and in some ways, and I do this as a parent too, there's a lot of information out there. You can't hit A+ on all the things, where you're never using screens or you're always doing organic or you're never doing dyes.

But we have a perspective of being able to, "I can control that this is important to me and my family or me and my [00:05:00] child, so I'm gonna add this in, not add this in." So we're healthier, but I think we're also having a more balanced perspective on things as well.

Rick Gannotta: So along those lines, if you, if you had to say...

And I'm, I'm, by the way, I'm really pleased with your answer too- Mm-hmm ... because I, I want things to, to be directionally positive, and that's- Yeah ... that's, that's fabulous. But what do you think s- what, what surprises you or concerns you the most, which you wish there was a, you know, a, a, a reset or we could do better on or we need to address?

Dr. Amna Husain: Generally, I think just fields related to children. If you don't realize unless you're in that field, but teachers, pediatricians, school counselors, social workers, um, daycare workers, all of these fields are focused on children. And you might see that just commercially, economically, it's not a very big representation.

It's very low pay. There's not as many, um, just generally advantages to working in that field. And so it takes a very dedicated, passionate person to go forward in [00:06:00] this field and say, "I really care about children's lives." But that field is quickly, quickly becoming overshadowed by just generally having to live in the society.

You need to pay your bills. Right. So we're finding more and more teachers- Leaving the classrooms and becoming tutors one on one. Because yes, of course, they love working with kids, but they also need to pay their bills, and as we're finding out that a lot of these fields with children, they're not funded enough, they're not paid enough, they're not appreciated enough, and people are noticing that.

Rick Gannotta: Yeah. I really appreciate that you're thinking even beyond, you know, the, the, the four walls of the healthcare- Yeah ... system writ large and thinking about, you know, the impact that, that teachers have and, and others in the profession, where they're, they're taking care of... They're... We entrust our kids to them.

And y- you know, it's, My wife's a teacher, w- worked for many, many years, and I know she had such a great affinity for the field and the people who worked in it, and it really is an extension of everything that you probably do clinically- Yes ... out into, into the real world. Let me pick up on that and, and [00:07:00] just ask you if you thought about...

Not that I wanna categorize it, 'cause we, we're clearly have a lot to, to cover here today, but do you think that the challenges you're seeing today, are they primarily what you might see in regular physiology? Are they more, oh, cuts, strains? Or are they emotional, emotional, or are they social issues? Or are they...

Has things kind of oscillated, or has any one area gotten more of an uptick than another? L- I guess another way to put it is basic primary care, one thing, you know, coughs, cold, chronic issues- Yep ... versus emotional or social issues.

Dr. Amna Husain: Yeah. I think the best way to address that is we're seeing all the things we saw 15, 20 years ago and more.

And I will say that in that, um, people bring different perspectives. So let's say it's the common cold, and you find a family that would like an antibiotic for a viral illness. Sure, we still have that situation arise. We still have those [00:08:00] discussions. And on the flip side, we have a bacterial illness, and we need to give antibiotics, and families do not want to do that.

So we have all of those same discussions that we used to have and other things, such as mental health is becoming much more prevalent. I can take you back to, you know, being a high schooler myself, right? So we're doing all these different math courses. People are doing extracurriculars. People are trying to, um, you know, prep and get their college resume all ready.

And now when I think of our babysitters who come through the door, this is a very anxiety-provoking situation for them. And I just... I mean, it was, of course, anxious to, to apply for colleges, to, to think of your next career step, but I, I'm seeing these kids, it's really fundamentally Affecting them on a physiologic level.

If your sleep's impacted, your diet's impacted, if your ability to focus because let's say you're having anxiety about a certain situation or depression about a certain situation. I think mental health has taken on a much larger concept, [00:09:00] and that is also just going back to my prior answer where you feel the crunch.

Um, 20 years ago, you could do a pediatric appointment maybe in 20, 30 minutes, depending on the age group if it's a well check. But now parents are more educated, ask very good questions. Of course, with the onset of the internet and being able to look at, look up things, very good questions, and you want the time to address those questions.

You want the time to talk to your patients, and mental health concerns are not something you can wrap up in five minutes. So that's where you feel the crunch, I feel like as a healthcare entity, but then also just looking at your pediatric population.

Rick Gannotta: Wow. This, this is, um this is a loaded question, but I'm gonna- Yeah

I'm gonna ask it to you because I think it, it, it tells a lot. If, if kids, if children are the leading indicator of the nation's future health, what's the story that they're telling us? What are they telling you when you see them?

Dr. Amna Husain: I think we are potentially asking our kids, [00:10:00] I don't wanna say grow up too fast, but putting a lot of pressures on our kids very early.

And I say that from the onset of just careers and, and getting our kids to think about those next steps, and I say it in this way, um You know, the idea of doing a job over the summer to make a little extra cash, it's not just about that anymore. You're doing a job during the school year to look like- Mm

you are prepping your resume for being able to manage your time and different... These are big things that we're asking our kids to do. Take on additional college courses and credits, and it's not only just that we're asking them, but they are looking for it because their peers are doing it, and they don't wanna be left behind.

I think that that is asking a lot. What is the hurry? What is the rush to get all your college courses and credits done with? What's the rush to add another thing onto your resume, add another sport, another course, another job? It- [00:11:00] we're asking our kids to multitask very early.

Rick Gannotta: Mm.

Dr. Amna Husain: Checking your emails. I mean, I did not have an email address in high school.

Right. And I, I understand that technology's taking off, I do, but then, um, our kids are then being pulled in a different direction. Once they go home, they can't really unwind and unclick that off.

Rick Gannotta: Yeah, I've always thought you know, one of the worst things we could ever do to an individual is rob them of their childhood-

Dr. Amna Husain: Yeah

Rick Gannotta: or keep them from effectively maturing into an adulthood.

Dr. Amna Husain: Yeah.

Rick Gannotta: And I think what you're saying in some ways is, is really hijacking a lot of what we, or at least what I grew up ha- you know, being able to experience as a kid.

Dr. Amna Husain: Yeah. And I mean, I think that's not... I think I have to be very fair to parents here too, is that it's not something that we're doing in our households.

It's exposures we can't control. If my kiddo's on the bus and they talk to someone else who already has an iPad and is already buying different things, my kiddo doesn't have that option yet, does not have that responsibility, that privilege, and I choose not to. But they see other [00:12:00] kids do it. Um, I think that's one thing that I think our kids are potentially getting exposed to growing up, and also just generally being put in positions to make decisions and think ahead before they're quite ready to.

Rick Gannotta: Mm. Let me kind of expand the conversation here a little bit, and I'm gonna- I'm gonna use something we talk about probably way too much on this podcast, which is vaccines. Mm-hmm. But I'm gonna use that as a proxy for trust. Yeah. And really, what I would say is the, the relationship between families, in this case perhaps parents, and medicine, and you as a pediatrician.

And I don't want this to be a conversation, this part about it being about vaccines, but really more about trust. But let me ask you this. When it comes to that, and again, again, I think vaccine, the whole issue with vaccines is a great proxy for, for that trust issue. Mm. Has confidence changed when you see parents coming in?

And how do you manage the conversation? [00:13:00] How much of your office visit ends up being about education- Yeah ... versus persuasion?

Dr. Amna Husain: Yeah. I think this is gonna vary person to person. Um, you... One part of healthcare is burnout and moral injury and- We self-sacrifice quite a bit. In my field in particular, kids hold a very dear place in our heart.

Um, a vulnerable population, um, we are part of that medical home, we are part of that home that nurtures not only the child but also the parent.

Rick Gannotta: Mm-hmm.

Dr. Amna Husain: So you i- you look at it with that perspective, but also the perspective that there are all types of patie- patients and families that come through the door.

Some are Very confident in their decision, and there is nothing that you can do to change that, and you have to create a boundary for yourself then. That [00:14:00] boundary could be, "I will not see patients who do not vaccinate. I will potentially, um, see them on to the age of one year of age, or I will work with them and we will do a altered schedule, delayed schedule, and/or I will, um, see them, but every time they're sick, I have to send them out to this ER."

There's all types of different ways, and I think that's pediatrician-dependent, practice-dependent. If I own a business and I have a practice of five pediatricians and we all have different rules, that's kind of not sustainable. Um, so I think generally the confidence question as a whole, that's different. I just wanna talk about, like, how I would approach it and how I approach parents usually.

I-- You get a gestalt on a patient, and you understand if this patient is willing to learn, be interested, you can provide resources, come to you with certain questions. [00:15:00] I think that's absolutely pro- something that I would be comfortable doing and talking to them. But if it's somebody who's not comfortable at all, does not wanna change their mind, I usually let them know that, you know, maybe we don't have the same values, um, maybe we don't have the same vision, and this is very important to me.

But that might not be the case for every doctor, every pediatrician, every primary care physician out there, and that's, that's fine. I have to accept that I'm not the doctor for everybody. Um, now, the confidence question. I think confidence in vaccines, I think if anything, it might be a little bit more...

Sure, it waxes and wanes. It goes up and down. I think especially post-COVID, we have developed a strong pro-vax population. Before, it used to be a everybody gets vaccinated, sure, and we have a loud anti-vax community. And now, [00:16:00] I think we have people who are pro-evidence-based also being able-- added to that party.

People who are really choosing to get out there and say, "No, you know, vaccinating is very important for my child who can't get vaccines-" Mm-hmm ... 'cause they are on chemotherapy. Please think of society as a whole. And I wanna be very careful that this is not shaming people for their beliefs. But just generally, I think you're have to understand that confidence is gonna come with all different vari- people who are very confident and people who are go-with-the-flow, maybe just be like, "Yeah, I mean, I'll, I'll get vaccinated.

I, I, I was vaccinated. I'll be fine with it," and then people who really don't feel comfortable I think, you know, on a perspective that things are positive, I do feel like pro-vaccination, pro-evidence-based medicine, it is in. Mm-hmm. It's popular, especially post-COVID. People want to know the facts, and they are choosing to follow public health officials, choosing to educate themselves on who exactly is the health [00:17:00] secretary and the surgeon general, and what are their credentials, and that kind of thing.

Rick Gannotta: What does vaccine hesitancy reveal about the relationship between patients and, you know, the providers, you as a pediatrician, but I'd extend it even beyond that for folks when they're looking for truth in this post-truth world.

Dr. Amna Husain: I love it, actually. Um, if you feel comfortable talking to your doctor, that's great.

We wanna feel approachable. Um, I talked about the time constraints, and that's not always, you know, dictated by the physician who's seeing you, unfortunately. Mm-hmm. Especially if you're working for a large healthcare system, those are things that are outside of our hands. But if you have that relationship with your doctor where you are able to bring up your hesitancies, your concerns, and your questions, that's what we want.

That's what we're here for.

Rick Gannotta: Mm-hmm. Do you in, in the folks that you see in your practice, but even beyond that- Mm-hmm ... I think that, that... And, and look, you have a big profile on social media, and, and you're a, a leading voice in the, in the field of, of [00:18:00] pediatrics. Do you think that institutional trust in medicine is eroding?

Where, where do you see it now? I mean, we talked a little bit earlier about there's now a pro-vax side that you're seeing. I think that's good. Yeah. But do you think overall institutional trust, and I'll just dial it up to even the CDC, FDA, what, what are your thoughts on that?

Dr. Amna Husain: I don't think institutional trust is eroding, but I do believe that we are in a society where Insta and tele is just so nice, right?

I don't have to get up from my couch when I feel bad. I'll just go, um, One Medical, Amazon One, um, order my va- You know, who are you seeing? Does this, is this person able to conduct a good exam for you? Um, these are the things that I think of as a physician, why I would be hesitant to fall for the easiest and quickest solution, because medicine is nuanced.

Um, I think there's a place for telehealth. I think that we as a society, [00:19:00] the instant fix is really nice, and, um, sometimes that's just not, not possible when it comes to medicine. I don't think trust is eroding. I think that medicine is not gonna be able to provide that instant fix that people are used to with where we are right now.

Rick Gannotta: And increasingly, I would say younger folks. Yes. Folks in your gen, they, they want it now. Yeah. I want the in- I want the answer now. I want that, that i, instant, answer, instant gratification- Mm-hmm ... and completion to whatever question I asked.

Dr. Amna Husain: Right. Right. And, um, it's nuanced. Mm-hmm. It's not always like that.

Um, you can, you know, put into ChatGPT your symptoms and something will arise, a differential, but- They could be completely off because they don't quite understand what your rash is, or they don't quite under- understand the constellation of your symptoms. Mm-hmm. And something that you might not consider a really big, important part of your history might actually mean a lot to us- Mm-hmm

when it comes to creating a differential. [00:20:00] I think that that's where, I wouldn't say that trust is eroding. I think that the goals and the vision of what general society is wanting is not gonna always be met by what medicine is- Mm-hmm ... and what it's meant to be.

Rick Gannotta: Yeah. And y- I wanna switch into the policy world because what, some of the areas that we're touching upon really easily fold over into that area.

Yeah. And I've thought for a long time that, that kids, children, and we know this in research and, and even beyond that, that they're probably the least represented constituency in in, in American healthcare, for sure, right? They don't vote. They don't lobby. They don't have a PAC. The, the voices that they have representing them, their parents, obviously have their own views, yet investing in kids is probably the, the best ROI, return, we can have for any healthcare investment out there.

All that said, I really wanted to get your views on, on what you're seeing and what you're thinking a- about in the [00:21:00] field in general, um, say Medicaid and CHIP. Yeah. I think the majority of kids right now in the, in the country are covered by Medicaid. And, I mean, it's a, this staggering number. The be- the behavioral a- health access question, we talked about that earlier.

Getting that covered alone is a big issue. D- let's just start with those two areas alone. Yeah.

Dr. Amna Husain: Okay. So this is a institutional problem. Yeah. This is a systemized problem because you think of who the patient is that is are needing Medicaid, needing CHIP. These people are absolutely depending on their insurance to, medical insurance to get their care taken care of.

Behavioral access. You find more times out of not that many psychiatrists and mental health providers are going out of network because the reimbursements are so low that to hang a shingle is, it's not possible really- Mm ... if you work within the confines of insurance reimbursements. [00:22:00] Now, they set a cash pay rate, and Medicaid is not able to pay that.

Rick Gannotta: Right.

Dr. Amna Husain: Or the patient who's on Medicaid, excuse me, is not able to pay that. On that note then, so what do they do? They have to go wait for someone who's in-network, and these wait times can be years long. Years. Years long.

Rick Gannotta: Years.

Dr. Amna Husain: I had my own kiddo once need to wait to see a developmental behavioral pediatrician.

The wait list was three years.

Rick Gannotta: Oh my gosh. That's in-

Dr. Amna Husain: Three years ...

Rick Gannotta: incredible.

Dr. Amna Husain: Um, so I paid out of pocket and saw somebody who was able to see her within the next month. But l- let's look at, for example, a developmental- Mm-hmm ... behavioral pediatrician- Yeah ... seeing a- You're developing

Rick Gannotta: over three years.

Dr. Amna Husain: I mean- Yeah, yeah

my two-year-old is- Yeah ... then gonna see this kid when she's five?

Rick Gannotta: Yeah.

Dr. Amna Husain: So, so let's say... And that's not because there is a, this doctor's, like, outrageous. No, it's because- There is just one doctor to see all these many patients. Mm-hmm. There has to, something has to make sense dollars and cents-wise for the physician [00:23:00] too.

Rick Gannotta: Right. Yeah. You know, I, and the number, by the way, just looking at the stats, I think 2023 it was peaked at, like, 43 million children insured through Medicaid. Mm-hmm. That represents, like, 58% of all insured US kids. And half of ki- US children rely on Medicaid or CHIP for their health coverage. So it is something that's baked into the system.

I talk about it a lot from a policy perspective, but what I'm hearing from you is the other side of it is, and I, I wanna be pragmatic, Yeah ... you know, from a, from a business perspective. If you're a pediatrician, if you're a, a pediatric psychiatrist or, or psychologist, and you're seeing folks, y- you're literally not getting the level of reimbursement you need to have a sustained practice- Right

if you're going to take 100% Medicaid. I

Dr. Amna Husain: mean, this is, this goes for pediatricians too. Mm-hmm. I will say s- a lot of, you know, sub-specialists, cardiologists you think make a lot more, endocrinologists make a lot more. That's in the adult world. [00:24:00] Mm-hmm. There are some pediatric sub-specialties that will actually make less than a general pediatrician.

So I'm gonna paint a picture. They literally did more training- Right ... and they are getting paid less. That is ridiculous. Yeah. And so I think it really comes down to the value of children. Yeah. It is a systemized problem. Mm-hmm. It is, it just, you know, if you want people to go into that field, you need to start respecting their work and their value and what they bring to the table.

Just like you said, investing in the future generation.

Rick Gannotta: Yeah, and, and I, I don't wanna, Too far, go too far afield here- Yeah ... but I think from a workforce perspective, we know that we've got a shortage of physicians coming out. Yeah. Certainly nurses, I think, three acts of, of where the doc situation. So a big crisis in both areas.

But have you thought about how that trickles over into pediatric care?

Dr. Amna Husain: Yeah.

Rick Gannotta: Again, pediatric nursing, some specialties- Yeah ... NICU, et cetera, on up to the physician side and specialties, I think we're seeing the same level of [00:25:00] shortage, maybe even worse for the- Oh, yes ... for the pediatric side.

Dr. Amna Husain: Oh, yes.

Um, every year it'll come out, you know, in terms of which physicians matched in which specialty. Um, I believe it was 2025, we had multiple spots for pediatrics go unfilled, and it's not because people don't care about kids. Trust me, they do. We are all still here. You'll find a handful of people who are still very passionate about it, but you have to see in this economy, too, it's, it, it has to make sense.

Rick Gannotta: Right.

Dr. Amna Husain: And I don't, I don't blame them. Yeah. I don't blame them. I get it.

Rick Gannotta: Let me talk about some of... We, we, we mentioned earlier some of the investment side of things. If you thought about preventative investment- Mm-hmm ... in a perfect world where, let's just say you could get the reimbursement you need- Yeah

or you could get the kind of funding required for a platform that's very different, what would early childhood investments look like to you if you said, "This is what we should focus on so that these [00:26:00] kids can actually become happy, healthy adults, high income w- owners- Yeah ... workers, et cetera"?

Dr. Amna Husain: Yeah. Okay.

So I think we break it down by age group. In that zero to three age group, that is a very important time when you're looking at developmental milestones, right? Um, and how fast the brain is developing. That is the time that we make, and, and thankfully many states do this, but we make healthcare accessible in the way that they are able to easily get to their appointment.

Um, that's not... I used to work in DC, that was one very hard thing. Get to your appointment, but then on that note, if something is, comes up, your, your child doesn't meet all their gross motor milestones, able to get physical therapy very quickly, able to... These are all things that are in- set into place by the state, but for some patients, all those barriers along the way are very difficult.

Mm. So for example, being able to get your qualify- go to your doctor, get qualified for physical therapy, all of those [00:27:00] things. So you are able to, zero to three, qualifying for your therapies if you are delayed. When you're looking at three to five, three to six, that starting preschool age group, that's talking about your, um, readiness for school.

I think a lot of families don't know some of the skill sets that, that are very important at that time, and that's because you might find that we-- that's that in-between age group where they might not be ready to start school yet- Mm-hmm ... especially the three, four, five. Parents are at home perhaps. It might be a s- you know, a single family household, and they are not aware of all the school readiness skills that are out there I think that's the other part too in that age group of five, six under, is, um, childcare.

Childcare is one big problem. So if you could do one thing that I think that would also support is childcare. You have parents who are burnt out. You have, like we mentioned, daycare providers that are burnt out, but also, like, daycare, childcare is an [00:28:00] expensive- Mm-hmm ... is a very expensive field.

Rick Gannotta: Is if, you know, if you looked at new models of care- Mm-hmm

if I could characterize it that way, is there an an opportunity with school-based health centers playing a bigger role if you thought about primary care, the, the behavioral health side, um, some of what we are, are trying to do. And you mentioned it, the access piece-

Joe Woolworth: Yeah ...

Rick Gannotta: to kinda break down any kind of barriers for transportation, the missed opportunities for parents if they have a competing job issue versus taking their kid- Yeah

to a doc, that kind

Dr. Amna Husain: of thing. And, and, and they used to do more of that, you know, school vision screenings- Mm-hmm ... hearing screens-

Rick Gannotta: Yeah. I

Dr. Amna Husain: remember- ... dental. Yeah ...

Rick Gannotta: I actually remember them. That's-

Dr. Amna Husain: Yeah, dental, dental access. Um, gosh, there used to be so much built into the school system, and, you know, I'm, I'm not an expert on the school system, so I can't say why that policy was taken away or some of them aren't as embedded in.

But I will say that that then depends on, I'm gonna bring an ugly side to this, is just school support. Mm-hmm. My own daughter's [00:29:00] school, she has asthma, there's not always a nurse on hand- Mm-hmm ... to give her the asthma medication she needs because that nurse is now supporting a couple of other schools.

Multiple

Joe Woolworth: schools,

Dr. Amna Husain: yeah. So if this is gonna be a more school-based health center, then we have to turn around and start investing in the school system. Yeah. It's, it all builds on top of each other, and unfortunately, once you uncover one, you know, one corner of the rug, you'll see all the dust bunnies underneath it.

There's a lot of things that we put Band-Aids on, but if we're gonna ask the school system to do this, which I think is a wonderful idea, the school system does so many great things in terms of providing meals for children who need them, providing that resource, counselors. Like, I'm the medical home.

They're a completely different kind of educational home for the child. Then we need to provide them with those resources.

Rick Gannotta: Yeah, but it, it gets back to what you were saying earlier- Yeah ... in terms of the, the the funding piece- Yeah ... that or the lack thereof- Yeah ... even on the educational side. Yeah. And if we don't have enough money for teachers, then where does the school nurse come in in the [00:30:00] hierarchy of, of that calculus and equation?

Right. So, I mean, really tough questions, certainly policy questions- Yeah ... for the state. I wanna get to what I think might be, um, certainly for me or m- probably many of our, our listeners- Yeah ... and folks who follow the pod, question that they have when it comes to kids, and that is social media- Hmm

technology on the developing brain. I'm saying the developing brain because, yeah, obviously children, but I don't think it ends there when we think about perhaps even up to the third decade of life- Yeah. Yeah ... and how the back of the head comes together with respect to neural pathways, and I'm not an expert in that.

But we've never allowed a billion-dollar engagement-funded algorithm interact more with developing brains at any time before in our history. It's probably the biggest social experiment ever. I hate to characterize it- Yeah ... that way. What are you seeing? What is this attention economy doing to these kids?

You mentioned the anxiety side, but are you ... [00:31:00] And, and I think even sleep, but how about loneliness, depression? Is is that coming through as well? Yes. And I hate to say it, what are parents doing? Are they enablers, or are they ... Y- I mean, I ... And I'm just gonna put that out there, too.

Dr. Amna Husain: Yeah. Um, good question.

Loaded question. Good question, and I think that you said it. We know that this is a ugly part of, of the internet. Social media can bring really great things, but then it also brings with it, just like you said, the attention deficit. Um, you know, we're used to Insta. Scroll, new thing. Scroll, new thing. Read a little bit, move on, next thing, um, swipe, and life's not like that.

Mm. Sometimes you can even look at the cartoons. Things are ... The way colors are changing, screen captures are changing. The attention piece is, is a tough one. It also doesn't help that many of our work-based homework, school-based activities are [00:32:00] also sometimes now moving to screens. I think it's certainly across- You

Rick Gannotta: mean literally the school-based activities?

Yeah. So yeah.

Dr. Amna Husain: Yeah. I mean, I mean, kids are going home with Chromebooks, right? Right. Checking their email, doing their homework, submitting it on Canvas. Not the way that we used to do it. Right. And I think, um, that's just the new reality. Um, so that you can say social media is one part of it, but also just being in front of technology is another part of it, right?

Where it's a completely different way than pencil, paper, which data has shown us actually helps more with rote memory. Mm-hmm. So, um, I think you're right. It's a social experiment that we are now seeing the effects play out in real time.

Rick Gannotta: Mm.

Dr. Amna Husain: And it's not an easy answer because- Every school, every, every school is different, but also parents have different perspectives.

So I'll tell you alone for just Wake County, there has been a big push by [00:33:00] parents to limit how much technology is used, and that would not have even been there five- Mm-hmm ... eight years ago. So parents are pushing more and recognizing more about these potentially detrimental effects that it's having. We don't even have to say it's anxiety or depression or attention deficit.

It's just that I don't really want my kid being on this to get their, their assignments. I'd like them to submit them in a different way, and parents are pushing for that.

Rick Gannotta: Mm-hmm.

Dr. Amna Husain: And I think that There is a good side to that, but then also a bad side. These technology being able to send home a Chromebook is to help prevent that digital divide that we see.

Right.

Rick Gannotta: I was gonna say, if I mean, the other side of it is if we do not give young people, starting with kids, the requisite skill set needed- Yeah ... to be able to navigate a world that is going to increasingly... It's already there- Yeah ... from a technological standpoint and, and I think in five years it's [00:34:00] gonna be vastly different than it is today.

Dr. Amna Husain: Yeah.

Rick Gannotta: Then I think it, it, you know, you gotta balance that out with any kind of harm that's being done. Yeah.

Dr. Amna Husain: I think, yes, and you know what? The other aspect is y- you'll see it, parents arguing that this gives your kid an advantage because this technology's here to stay, but then the other aspect is they'll learn typing.

Yeah. They will. They'll learn. They'll learn how to click, but does it need to be introduced this early?

Joe Woolworth: Yeah.

Dr. Amna Husain: And I think that is the nuanced question that now we are facing. Things went... COVID very rapidly put education on a digital platform.

Rick Gannotta: Mm-hmm.

Dr. Amna Husain: And then it became a almost ease of distribution, and now I think we're coming backward and trying to reel it back in.

Um, I can only speak for Wake County, but this is state dependent, this is county dependent, this all depends on each school system, all of those things. Yeah.

Rick Gannotta: Differences between boys and girls, male and female?

Dr. Amna Husain: [00:35:00] I think that in terms of, I th- I've, for sure girls there's a big stigma that's always out there in terms of the comparison game.

I think absolutely. Um-

Rick Gannotta: And we're talking about kids here too, right?

Dr. Amna Husain: I mean- Yes, we are. We are, and so that's why there's certain rules that you should absolutely not have your kid having a phone before the age of 13. You should not have them having social media apps before the age of 13. So these are all things that have been thrown out as different rules in hou- households.

Um, but enforcing it is all dependent on the, the caregiver in the home, and that is tough. You're right. Um, so it could be the comparison game for young girls, but also for y- young boys it could be the fact that they don't have a phone and you're sitting there with your group of four or five friends, and they all have phones.

Rick Gannotta: Mm-hmm.

Dr. Amna Husain: So not only are you then com- you're comparing yourself to all your peers in the room.

Rick Gannotta: And they're isolated- Yeah ... and separated- Yeah ... and not one of, one of the group. Yeah. And I think the other pieces of it w- [00:36:00] certainly I think on the, on the young kids, the boys, perhaps gaming could, could take them down in, into another world that leads to that isolation, and also a lack of a reality-based learning, I mean, for, for lack of a better way to put it.

Y- you know, that's something that, that I've thought about for a while because when you s- the representation of a, of th- a virtual world is so far afield from what they're gonna actually experience.

Dr. Amna Husain: Right, and I, I mean, I'll, I'll take it a step further is, like, you know, vlogging. Mm-hmm. Vlogging is, not only is it easy, it's everywhere, so then you're actually sharing parts of your day so frequently with- With a digital community that it didn't used to be a part of our life and our lifestyle before.

And now, as a pediatrician, as a parent, you're thinking of the safety aspect- Mm-hmm ... but you're also thinking of the social aspect. Yeah. Here I am sharing [00:37:00] all these important events with who? Digital, my digital followers. Yeah. My screen, my-

Rick Gannotta: Everything that was backstage is now onstage.

Dr. Amna Husain: Yeah. Um, and it's just normalized.

Mm-hmm. Vlogging is so normalized. Get ready with me while I do my homework. Get ready with me while I do th- You know, it's just, I think, and this is a big part of a sort of my, um, MO as a pediatrician, is just protection of- Mm ... that age group. That age group, sometimes it's hard to wrap your head around just how much safety and information you're putting out there, how much of your privacy invasion, and I think that's the tough aspect of it.

Rick Gannotta: Yeah. Um- And I y- when you hear these stories of bullying and- Mm-hmm ... and, and, you know, and tragedies that have occurred- Oh, yeah ... because of that, it, it is a lot of what I think you're saying, that, that exposure of parts of your life that should have remained private.

Dr. Amna Husain: Right.

Rick Gannotta: Yeah.

Dr. Amna Husain: Um, you know, influencer is a job now.

Mm-hmm. That's what people want to do. They wanna strive for it. And with [00:38:00] that power comes great responsibility. And, um, and some children are not ready, some teens are not ready to take that on. And I think that my job as a pediatrician is, um, you know, working with that coun- I work with the Council of Communications and Media for the AAP, is recognizing the safety aspect for children.

Mm-hmm. And you know, nobody may have asked, you know, John and Kate Plus Eight, "Did you," you know- Mm-hmm ... about the privacy of their kids. But that is becoming a very real thing now for our TikTok influencers and our families, is, like, getting consent from these kids because you are really publicizing their lives before they're ready to do so.

Rick Gannotta: Right. Yeah. I mean, that's, We, we, we've seen a, a little snapshot of that with childhood actors, I think- Yes, yes ... in, in some of the, the, the really you know, m- m- many times tragic, other times not, but how that exposure of their life has clearly created issues, you know? Yeah,

Joe Woolworth: yeah.

Rick Gannotta: And I think that n- not enough [00:39:00] folks probably are aware of the, of, of the scale to which some of these social sites go.

Dr. Amna Husain: It's, it's a deep, dark, ugly world. Mm-hmm. I'll put it that way. I mean, you have, There's children on YouTube who are making millions. Yeah. And and, you know, power to them if that's what they choose to do with their family's blessing, and their parents guiding them, and all of that, looking after their safety.

But I know that as a parent, there are certain lines that I choose not to cross yet, and I think that that's our important thing is raising awareness of these are all aspects and things that are controllable as of this time that we can help guide our children in.

Rick Gannotta: Let me bring us home with something that obviously is related to what we were just talking about, but really goes back to some of the notions we said earlier.

If, if today's kids, today's children, are gonna become tomorrow's patients tomorrow's workforce, tomorrow's leaders, right? The, the folks who our healthcare [00:40:00] system is going to be paying attention to because whatever they grow into and the problems they have, that will be some of the issues we'll be dealing with with that large population.

Mm. What trends are, are you seeing that, that concern you and that we should be aware of that are going to unfold over the next decade?

Dr. Amna Husain: I think just, like, kinda some of the things in terms of technology that I mentioned would be, like, I think we don't realize how much vlogging kind of romanticizes the everyday life- Mm-hmm

that we may not actually our everyday child may not see or have, and that makes them feel like they are missing out. Mm-hmm. Um, you know, not only just FOMO, but also just being like feeling like I don't have enough. It's the scarcity kind of- Right ... illusion. I think that's one trend that we're finding.

Um, gosh, I see it all the time in my own house. No, you don't need another squishy. No, you do not- Mm-hmm ... need another squishy. [00:41:00] Um, but I think on another more positive note, one trend that we are raising more awareness of is generally just where screens can fit in- Mm-hmm ... and how they have a benefit. Um, you know, certainly digitalizing your family calendar, that can be very helpful.

Chore charts, photos, that sort... FaceTime, all of these are really positive things. Social media can be positive- Mm-hmm ... can be negative. And I think that's where I see our trending Sort of, um, vision is that people are realizing that there's... N- it's not all good.

Rick Gannotta: Mm-hmm.

Dr. Amna Husain: It's not all good. So, you know, you can still have technology, but you can balance it.

Rick Gannotta: Right. I think if you have grandparents who are in another state, and you say-

Dr. Amna Husain: Yeah ... "

Rick Gannotta: Hey, let's get on FaceTime," that is obviously a positive.

Dr. Amna Husain: Yeah.

Rick Gannotta: But, you know, the same could be said for, wow, I'm looking at, you know, my the classmates, and they have X and I don't, or they live, m- you know, in this area, and I don't, and [00:42:00] that creates that, that anxiety, divide- Yeah

and more of that isolation. It's kind of that both sides of the, of the issue that you're con- that you're speaking to.

Dr. Amna Husain: And, and, you know, just to put something else on parents, then you start having to think of, well, I wanna find friends who are like-minded. Mm-hmm. So my kids, you know, we, w- In the COVID days, we used to call it, like, a school pod or something, right?

So we'd all get together, and we'd do school at home rather than being digital. So now we're thinking of trying to find friends who are phone-free until 13 so that my kids don't feel like they're the only ones.

Rick Gannotta: Mm-hmm. Mm-hmm.

Dr. Amna Husain: And I think that's how parents are thinking now.

Rick Gannotta: On the investment side, if the US healthcare really came to the conclusion that children were our greatest healthcare investment, w- what would they be investing in?

Dr. Amna Husain: Oh, universal parental leave, I think. Oh, that would be... You know, we are so behind on the ballgame when it comes to, like, l- look at Europe, look at all these nations where they're able to provide support to, [00:43:00] after a baby, that for the mom to be able to get extended benefits, the father to be able to get ex- a family unit to be able to really take that time and heal emotionally, mentally.

Um, and that is something that this country and the US, we do not, we, we do not focus enough on that. And I'm not just saying this as a pediatrician and/or as a parent, but that is something that it you know, going back to your mental health discussion, like, this is a very trying time for so many families, and this is a benefit that should not be, you know, just taken for g- like a privilege.

Mm-hmm. It's, it's something that should actually exist. It's a, um... So I think universal parental leave is incredibly important.

Rick Gannotta: Hmm, and that's a straight up policy issue. That really is.

Dr. Amna Husain: That is straight up policy. Yeah. Mm-hmm. I mean, these are, these are parents who you know, "I, I lose my job if I don't come back in six weeks."

Mm-hmm. Um, whether... And, and then you're [00:44:00] forcing yourself to find daycare. Mm-hmm. It's a domino effect. Yeah. It is a, then, "How am I gonna pay for my daycare bills? I have to work more. I see my child less," which means that then it, screens come in. Like, this is all a domino- Yeah ... effect. Um, and the stress, how it trickles into parenting, and then it trickles into your behaviors with your children.

Rick Gannotta: Mm-hmm.

Dr. Amna Husain: Oh, yeah.

Rick Gannotta: Let's bring it home. My final question for you. What is the one message that you wanna leave healthcare leaders, the folks in the sector, the policy ma- policymakers that are out there, the hospital executives, the payers that are out there- Yeah ... and, and the other physicians? What do you want to tell them about America's children?

Dr. Amna Husain: So you probably heard this before, but children are not small adults. They have their own medicine. They have their own physiology. They have their own unique set of problems, and that comes with a lot of responsibility, a lot of training, [00:45:00] and a lot of love and dedication that go in there, and I think that that couldn't be overstated enough.

I th- To bring importance to that, that children are the next generation. We are investing in those same problems that you are, we are working our butts off to fix. Mm-hmm. Obesity in America, diabetes in America, chronic health diseases, autoimmune diseases. This is a chance to invest in that generation very early.

Um, the digital divide, all of these things that we've just briefly hit on, but that are deep, deep-rooted, systematic issues, we are having a chance to invest in that very, very early and have that play into effect very early on to create a trickle-down effect.

Rick Gannotta: Fantastic answer, and I, and I really hope that it's something that I, I know our, our listeners are gonna take to heart.

Yeah. And those who can should get out there and do what they can, because as you said, they're not just little adults. These are folks [00:46:00] who are special in so many different ways. We don't wanna rob them of their childhood, but also wanna make sure that they're able to be productive adults who have a world- Yeah

that is healthier than the ones that we're experiencing as adults.

Dr. Amna Husain: Right.

Rick Gannotta: So with that, Dr. Hussein, thank you so much. This has been a great conversation, a delight to have you on, and we look forward to having you back.

Dr. Amna Husain: Thank you. Thank you. Appreciate that.

Rick Gannotta: And thanks for everyone for listening to the Healthcare Nation podcast.