Making a difference beyond the hospital

I am a first-year pediatrics resident at OHSU Doernbecher Children’s Hospital. This means I have recently completed four years of training in medical school, received my medical degree and now am receiving further training in my specialty of choice: Pediatrics.

When I was in medical school and deciding on which field of medicine to pursue, one of the qualities that drew me to pediatrics was its diversity on all levels — the patients with whom we have the privilege to work, the settings in which we may practice, and the wide array of pathologies we see on a daily basis.

As I embark on my three (or possibly more) years of specialized pediatrics training, I am learning that there is one more important aspect of my chosen field that sets it apart from all other fields of medicine: that is, the unique role the pediatrician plays as community advocate.

As pediatricians, we are in the fortunate position of having a patient population that is largely free from medical problems. Often, our primary task with the children we see is not to treat their disease, but rather preserve and protect their health.

To achieve this, we visit with our patients and their families at regular intervals, monitor their growth, counsel caregivers about nutrition, vaccinate to prevent infection, screen for potential medical problems, and offer safety tips and anticipatory guidance.

While these measures are certainly very important, as I work with children from the newborn period to post-adolescence, I am beginning to appreciate that the well-being of the child extends far beyond the boundary of the clinic walls or hospital room.

The greatest threats to children’s health — such as domestic violence, obesity, lack of preventive health care, accidental injury and pollution — all have significant social and environmental factors that cannot be ignored.

It stands to reason, then, that in order to be effective in our goal as pediatricians to preserve our patients’ health, we must likewise step outside our clinical confines and into the community to help create systemic changes that improve the physical, emotional, and environmental condition of the child.

Recently, I had the opportunity to do just that. Earlier this month, Portland’s City Council voted in favor of fluoridation of its water supply, a controversial issue that has received a great deal of national attention.

Prior to the vote, two of my co-residents and I prepared and delivered testimony to Mayor Sam Adams and Portland City Council members in favor of this action.

Though relatively new to the world of pediatric medicine, we were nonetheless able to draw upon our personal experiences treating young children with behavioral, sleep and learning issues — as well as serious medical conditions requiring inpatient hospitalization — all arising from tooth decay. We also gave our perspectives on the financial and logistical barriers involved in the current practice of pediatric fluoride supplementation.

The process of researching the topic, preparing testimony, and making calls and emails to individuals involved in the legislation was not only gratifying, but also educational for me. Sitting in City Hall with my medical peers and supervisors, I heard more than six hours’ worth of testimony about the benefits and potential drawbacks of the plan for citywide water fluoridation.

I left that evening with a much greater understanding of the science of fluoridation, the public health implications of rampant tooth decay and the efficacy of large-scale preventive efforts.

More importantly, it was a valuable opportunity for me to not just advocate for what I believe to be in the best interest of the children in my community, but to understand any misgivings or complications attendant to the proposal. Indeed, the issues and questions brought to the table by opponents of the measure are the very same ones that are brought to my clinic by parents when I prescribe their children fluoride tablets.

Through this experience, I feel I have strengthened my ability to communicate my views on this topic — whether in the clinic, on the streets or in a government office. Further, through experiences such as these in my pediatric training, I am establishing an arsenal of tools that I may keep with me and use in future advocacy endeavors.

Children have little political voice of their own and must rely on others to speak out on their behalf. There will never be a shortage of ways in which I, as a pediatrician, may use my voice to help to better the lives of the children I treat.

Theresa Graif, M.D.
First-Year Pediatrics Resident
OHSU Doernbecher Children’s Hospital


4 responses to “Making a difference beyond the hospital

  1. This is great. I wish Eugene had flouride in the water. I am always feeling guilty for forgetting to give my 3 year old his flouride supplement. And then I put off taking him to the dentist because of the guilt! It’s a vicious cycle. I think it’s good public policy.

    I find it very confusing as to why there is such a backlash against good public health policy (like vaccines) in recent years.

    1. Hi, Rebekah. Thank you for the comment! I’m happy we can provide you with valuable content. Did you catch Dr. Nolt’s blog post on the importance of childhood vaccinations? Dr. Nolt tries to clear-up some of the confusion parents may have about the safety of vaccinations. We always strive to provide well researched and valuable information for parents and patients on the Healthy Families blog, so please continue to share your thoughts with us as we post new material! -Anne

  2. Dr. Grail should read the research on fluoridation published in the last 20 years.

    The best scientific information can be found in Dr. Paul Connett’s book, “The Case Against Fluoride,” published last year. It contains over 1200 peer reviewed studies (80 pages) and sound scientific reasoning showing the ineffectiveness and dangers to health from fluoride.

    You will see a petition at Dr. Paul
    connett’s site ( signed by 4200 professionals, including hundreds of dentists, hundreds of doctors, and other medical researchers calling on governments everywhere to stop fluoridation; also scientific evidence to show that it causes cancer, thyroid & pineal gland damage, broken hips from brittle bones, lowered IQ, kidney disease, and other serious health problems.

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