Growing up in Staunton, Va., the heart of the bucolic Shenandoah Valley, pediatrician Mark Langfitt always knew he was a country boy at heart. So it was no surprise when he applied for medical school at the University of Virginia, and then after graduating found himself at a community health service on the Eastern Shore of Virginia. Just north a bit, Maryland’s Eastern Shore town of Easton was a logical next step when he began searching for a place to practice.
“I like small areas, country and rural,” says Langfitt. “It has its challenges but it’s a good life.”
The good life includes a stable group of patients presenting an array of manageable general pediatric conditions. The challenges include providing primary care for children with chronic conditions like cystic fibrosis (CF), which is demanding enough in an urban environment as pediatricians must be ever watchful for subtle signs that may quickly turn into serious lung infections. When your practice is 100 miles or more from your patient’s CF center, the challenges of caring for the chronically ill patient become even more difficult.
“When your patient’s specialist is an hour and a half away you don’t say ‘Oh, you’ve got a cold so go to the CF center and get your lungs checked,’” says Langfitt. “Out here you’re more on the front lines of that care. You don’t want to get behind and have your kid’s lungs get much worse when you can coordinate and take care of him effectively.”
With a half-dozen CF patients, along with scores of patients with diabetes and liver disease, Langfitt and the two nurse practitioners in his medium-sized practice are well experienced in caring for children with chronic conditions. They know it’s not per-visit care but continuing care focusing on daily routines to prevent or reduce the risk of exacerbations. CF patients have to take their vitamins each day to grow, and they have to complete their therapies each day to keep their airways clear.
“Parents don’t want to cross that bridge to Baltimore every month for a cold,” Langfitt says. “You want to help them through the mild exacerbations before they become severe.”
How do you do that? Some of it’s “cheerleading,” says Langfitt, or acknowledging that the child is doing a great job with his vest therapies and inhalers. Patient education and shared care planning with parents is critical, he adds, citing his collaboration with Susan Leibman, mother of CF patient Atticus Leibman, who is also a patient at the Johns Hopkins Cystic Fibrosis Center.
“Because Atticus has a very motivated mom staying on top of his medicines and therapy regimens, he’s done very well,” Langfitt says. “I’d like to take credit but I can’t. I can give him an antibiotic when he needs it but what he needs is the day-to-day routine, and it’s the home and the family that keeps that happening.”
Like other kids, Langfitt notes, children with chronic conditions also need recreation and sports for both their sense of self and quality of life. So he strongly encourages patients like Atticus to be as active as possible.
“Find ways for them to feel like a normal kid without feeling limited, so who they are is not completely wrapped up by their CF,” Langfitt says. “We work hard to help them find their identity outside their disease.”
For the most effective care, Langfitt concludes, the lines of communication between the specialty clinic and the pediatrician must always be open. For patients like Atticus, he adds, that hasn’t always been the case – but times have changed.
“We get a response back from the attending much faster than we used to, which is great,” says Langfitt. “That’s the key, especially for a patient like Atticus.”
For more information, call 410-822-8550.
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