DISCUSSION

Dr. Kenneth Williams: I think the problem of staff avoidance which was alluded to is one of the major problems in our hospital. For example, on routine ward rounds, our leukemia patients are frequently bypassed with the attending physician saying, "Well, it's a hematology patient." Our children and our parents tell us this directly and indirectly in many ways. Dr. Bergman: I have just completed a rotation as ward attending physician and confess to doing just what you say. Obviously the parents and children are very aware of the regular ward routine and were conscious of being skipped. After becoming cognizant of this situation, I made special efforts to include all patients on rounds. Dr. Hartmann: There are some house staff whom we don't know how to approach. We're the plague; they won't even talk to us when they are assigned to a floor where there are a number of children with malignancies. We must learn some manner in which we can help them approach the dying child with an assured attitude. We ourselves certainly don't always have this. We feel guilty, we avoid the parents, we even tend to avoid the child terminally. There must be some way you can help us, perhaps by going back to the medical student or explaining to all of us who go into pediatrics that, even though we think we're going to cure everybody, we really don't. Dr. Rothenberg: I think part of the answer is when you mentioned medical students, because I certainly think this is where it should begin.