Back in my days on the hospital wards, I was haunted by the patients I was taking care of who were suffering and dying from preventable diseases. I felt that we, as a culture, had let those people down. There were things they should have been taught—things about relaxation and eating and exercise, smoking and drinking and diet—along with reading and geography and math, starting back in the first grade. And not only had we let these people down, we were letting down all the children who are now studying reading and geography and math, and who could so easily be introduced to the skills of medical self-care. When I finished my clinical rotations, and had the opportunity to devote several months to an MD thesis project, I decided to set up a class in medical skills for first graders.

Getting the Project Started

The teachers I spoke to at the Foote School in New Haven were most enthusiastic about the idea. They all would have liked to make such information available to their children in their classes, but they’d had no training in such things, and they had few resources available to help them. Before long, three co-workers and I had arranged to take eight first and second grade children to an unused classroom two afternoons a week for eight weeks, to see what we could do in the way of teaching them medical stuff. We borrowed a videotape setup to record whatever happened.

From talking with the teachers,we felt it would be wisest to explore what the kids would like to learn about, rather than coming in with a prepackaged set of goals. We ended up defining the class to the kids like this: “This is a time for you to find out things you’d like to know about your bodies, about doctors and what they do, about what happens when you get sick, and about what you can do to keep yourself healthy. “Your job is to ask good questions and think of neat ways to learn about bodies. Our job is to answer some questions and to help you figure out how to find your own answers to others.” They ended up calling the sessions “Doctor Class,” and bragged about being included. The children who weren’t able to be in the group were pretty jealous.

Who, Me? Teach Medicine?

That’s what we wondered before starting the class. I’d had a little clinical experience, true, but none of us were experts. What if they asked something none of us knew? We finally came to understand these doubts as a reflection of our own conditioning about medical knowledge. There’s a very strong myth in this culture to the effect that medical information is so specialized and that a little knowledge is such a dangerous thing that it’s really best not to try to know anything about “doctor stuff,” but to leave that “to the experts.” One of the most important things we ended up learning for ourselves was that it’s all right for a group of people to get together and talk about illness and bodies—even though no one in the group knows all the answers. One of the most important medical self-care skills turns out to be asking good questions and then figuring out how to go about finding the answers. Being in the class got us involved in about questions we wanted to know the answers to, and what we’d have to do to find out. One of the questions I’ve thought a lot about since is, “Why do we have eyebrows, anyway?” Something I’d never learned in medical school. I’d still like a good answer to that one. We helped the kids use the library to find answers to some of their own questions, and to match other questions to resources we had available—”That’s a good question. Let’s write it down so we’ll be sure to remember to ask the vet when we go to the animal hospital.”

The Kids—What They Wanted To Know

They were fascinated by the doctor tools in my black bag. They also loved doing body exercises, relaxation exercises, yoga, and in learning parts of the physical examination. We found that an informal period right after a structured activity was a good time for questions. We’d all be, say, sitting around on the floor after learning to take our pulses, and somebody would ask about what a pulse was, anyway, before long we’d be off onto arteries and veins and red and white blood cells and the heart as a big, muscular pump. As often as not, the questions would lead off into areas of personal fears and concerns— “when my sister had appendicitis the doctor measured the white cells in her blood. What did he do that for?”—and we had to be sure to respond both to the technical question and to the feeling/concern behind it. (Could that happen to me?) But for all the interests the kids shared, there were many that followed the lines of their own, individual curiosity. It became clear that they each needed time to pursue their own interests. We ended up breaking our class period into three parts:

1. Organized group activity
2. Informal question period
3. Time for independent work on individual projects

Organized Group Activities (Examples)

Learning to take your pulse. Demonstration of radial pulse (in the wrist) and carotid pulse (under the angle of the jaw). The neck pulse was easier for most of the children to find. We had them count their pulses for fifteen seconds. (We’d call ”Start,” and “Stop.”) We wrote the totals on the blackboard. Next, we asked everyone to walk outside and run as fast as they could—once around the school. Then we had them count their pulses for another fifteen seconds. Again we recorded the results. We asked what things besides exercise makes your pulse increase. (Fear, excitement, fever). We talked about the effect of prolonged exercise training on pulse rate.”(People in better physical condition have stronger hearts, and slower pulses.) We talked about how the pulse can be used as a guide to exercise training. (Maintaining a pulse of 34 per 15 seconds for a prolonged period – 20 minutes to an hour—maximizes training effect while minimizing stress in such activities as jogging).
Using the Stethoscope. One stethoscope and eight kids equaled chaos. We ended up getting an inexpensive stethoscope for each of them. ($2-$5 from your local medical or hospital supply house.) We found it best to hand over the stethoscopes and ask them to find as many things as they could in (1) the room (2) their bodies that they could hear with it. They found things we’d never have though of. (My toes wiggling inside my shoes.” “The radiator making hot water.” “My hair.”) Afterward we’d go through the body together listening, in turn, to the vocal chords while talking, the heart, the stomach and intestines (especially just after a meal), and the lungs while taking a deep breath. The kids discovered that your heart sounds a lot different (not only faster) after you’ve been outside running around.
Doing Yoga. There were several questions about this and we had a friend who taught yoga, so we had him come in for a session. The kids loved it. He wisely emphasized the animal poses—the cobra, the elephant, the lion. There’s also an excellent book available, Yoga for Children by Eve Diskin, $4.22 post- paid from Independent News Co., 75 Rockefeller Plaza, New York, N.Y. 10019. (We reviewed it last issue.)
Throat Examination. Our kids were fascinated by tonsils, though they didn’t quite know what they were. We had the kids pair up, equipped each pair with a regular flashlight, and had them look in each other’s throats. Children’s tonsils are usually easy to see. They look like this:
We asked the kid being examined to “pant like a dog . ”This almost always made using a tongue blade unnecessary. (If one was necessary, we had the person being examined hold it.) The examiner first locates the uvula, a small midline flap of skin hanging down above the back of the tongue. Then, on either side of it, the tonsils. Children who have had many sore throats will have larger tonsils. Those who have had tonsilectomies won’t have any.

Informal Question Period

We started the class with very skill-oriented goals. Would the kids be able to use a stethoscope? A blood pressure cuff? Would they be at all interested in nutrition? The most striking effect of the class was reported by the mother of one of the girls a few weeks after the class had finished. We didn’t formally evaluate our sessions with parent questionnaires, or before-and-after tests. (We probably should have.) So this sole report may have been exceptional. Anyway, Mrs. P. Curled up on her own initiative to let us know that C. (her daughter), had always had a terrible time with doctor’s visits—staying awake the night before, crying, etc. But this time—her first doctor’s visit since the beginning of the class—she had seemingly had none of her previous fears. The doctor came in with his stethoscope and C. said, “Oh, I have one of those too!” And they went on to talk about their respective stethoscopes. During the question-and-answer sessions, the kids exhibited a good deal of anxiety about doctor’s visits—particularly about shots and other painful procedures. Our children—and most of the rest of us as well—usually only saw the doctor when we were sick. If we only see the doctor when we’re ill—or when we need shots—we’ll leam to associate the doctor’s office or clinic with being frightened or in pain. The questions they asked reflected their concerns—and their sense of helplessness— about what happened when they visited the doctor’s office or were in the hospital—”What happens when they give you gas in an operation?” “What happens if you have cancer?” “What happens when an animal dies?” (We found that in talking about sex and death they preferred to talk about such things happening to animals.) In responding to these questions, we found that our most important job was to help the child asking the question to fully explore the feelings that his or her questions expressed. The hardest thing for us was to keep from giving a superficially-correct answer at the expense of letting the child share a deeply felt concern.

Field Trips

I wish we could have taken more field trips. My first choices would have been the children’s ward and newborn nursery of a local hospital, and a pediatrician’s office. Because of scheduling and supervisory problems, we were limited to one field trip. The kids choose to go to an animal hospital. It turned out to be a fine choice. The veterinarian showed us all the cats, dogs, and other animal patients, and explained why each one was there. We got a tour of the operating rooms, and a description of the most common surgical procedures he did. Perhaps the most fascinating part for the kids was the demonstration of dog and cat x-rays. We had to drag them away.

Independent Projects

In most cases this involved working with library materials—and with us individually— in putting together “books”—hand drawn and lettered—on their chosen topics. One boy chose to learn to use the microscope. Another boy brought in his collection of bones he had found in the woods, and compared them to some human bones we were able to borrow from the anatomy department of my medical school. Some were able to concentrate on their chosen topic with only occasional questions. Others needed nearly-continuous adult support.

Afterthoughts—What We Should Have Done

After the class was over, of course, we thought of all kinds of wonderful ideas. Like a game called “Make Yourself Sick,” in which each child would think of as many ways of making your health worse as he or she could. We should have included some way to evaluate the effects of the class. Maybe a “draw-the-inside-of-your-body” test and a “feelings-about-doctors” questionnaire. According to the kids’ regular teachers, most of them continued their projects begun in our group after the official class was over. It would have been helpful to work out some kind of continuing health focus in their regular class. All-in-all, it seems as though we raised more questions than we answered. The videotape we made is available for rental ($35) or purchase ($75). It turned out pretty well. People who’ve seen it say it’s been helpful. We are now working on a resource guide for parents and teachers interested in teaching health/medicine to their kids. The guide would include a lengthy annotated bibliography—books for kids of all ages and adults as well—and a number of articles by teachers, parents, and others. We’d welcome your suggestions and contributions—letters, accounts of your own experiences, suggestions of books/resources to mention, other possible contributors.