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And Baby Makes ... Four

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Danielle Laraque
Mt. Sinai School of Medicine
1 Gustave Levy Place
212-824-7626

Practice: Birth through adolescence
HMOs: Most Hospital affiliation: Mt. Sinai
Partners: Fifteen at the hospital
House calls: No
Bribes: Stickers

When Danielle Laraque meets a new patient family, she shakes hands. When she knows them a little better, say by the second visit, it's hugs from then on (unless, of course, you're not the hugging sort). But Laraque's embrace goes beyond hugs. In treating 14-year-old Brandon Stevens for a sleep disorder, she sent the family for consultations at several hospitals, "wherever she thought we would get the best care," says Brandon's mother, Cynthia. "She talks to you and explains things. She'll draw a diagram if I don't understand. I can call her at her home at whatever time. When my son was in the hospital for surgery, Dr. Laraque's son was also in the hospital, and she still came to see Brandon. Unbelievable."

Laraque, 46, division chief of general pediatrics at the Mt. Sinai School of Medicine, probably would say there's nothing unbelievable about that at all. It's just part of the job she chose for herself at the age of 12. Her practice includes indigent families and impoverished patients who deal with a host of medical issues every day. "The first question I ask is, 'Do you have any questions for me today?' " says Laraque, sitting in her crammed office at Mt. Sinai. "I think it's really important to address families' concerns first, and let them set the agenda. People's lives are pretty complex. If we're going to address health in its broadest terms, we need to know what's important to children and families.

"I have a 2-month-old who comes in with his parents, and I know my role is to ask about the baby's nutrition," Laraque continues, "to make sure the home is safe, to immunize the baby, to do a good physical exam. I have to do that at every visit. But let's say there's a major crisis at home and I never gave the family a chance to discuss that. I don't think I'd be doing as good a job. I can't miss a case of pneumonia; that's part of good care. But it is my role to assist the family in any way they might find useful. When you think about it, that's what doctors did 50 years ago."

Practicing medicine is one thing; dispensing it quite another matter. "We overmedicate for many things," says Laraque. "If I don't think an antibiotic is necessary, I'll explain my reasons."

"Danielle is an enormously talented clinician," says Frederick J. Suchy, chairman of Mt. Sinai's Department of Pediatrics. "And she's enormously sensitive to the needs of kids and their families. She's a real advocate."

Frankly, Brandon Stevens would prefer that the word about Dr. Laraque not spread too far. When his cousins started going to see her, "Brandon was getting really jealous," says Cynthia. "He kept saying, 'Mom, why did you tell them about her? She's my doctor.' "

Max Kahn
390 West End Avenue
212-787-1444
495 Central Park Avenue,
Scarsdale
914-725-7555

Practice: Birth through college-age
HMOs: Cigna; PHS; Oxford (with approval)
Hospital affiliations: NYU, Lenox Hill Hospital, White Plains Hospital Center Partners: Drs. Michael Levi, Michael Traister, Herbert Lazarus, Jacqueline Cosme, Jane Guttenberg
House calls: Yes

Bribes: Stickers, tattoos, etc.

Max Kahn remembers with blinding clarity the exact moment he decided pediatrics was for him. There he was, doing an internal-medicine rotation in med school that involved giving an older woman a pelvic exam. "The lady said, 'I have to go to the bathroom.' And I said, 'I'm almost done,' and she said, 'No, doctor, I really have to go.' And so she did. I thought, If I have to get wet, I'd rather be gotten wet by children."

Judging by the parade of prams and strollers coming in and out of this busy Upper West Side practice, Kahn gets plenty of chances to be a target. There are lots of people in the waiting room of the old-fashioned, lived-in-looking office (there's a separate waiting room for sick kids). "Sometimes you can go and wait for a significant period of time," acknowledges David Frankel, the father of a 5-year-old and a 16-month-old. "But once you get in there, you get all the time you need and you never feel you're being rushed." To further ease things, the practice has an e-mail address where patients can schedule appointments and request prescription refills.

"We have a situation with our younger daughter where she hasn't started walking, and we're crazy West Side parents," Frankel continues. "Max told us for several months to calm down. And at one point he had us come when office hours were over and watched her play around the reception area. He never charged us for it; he just wanted to look at her. Eventually, he sent us to a neurologist, and the bottom line is, we think everything is going to be fine. And I haven't had to call him twenty times and say, 'Have you talked to this doctor or that doctor?' He does it, he interprets what the other doctors have been telling us, and he's called just to see how we reacted to the people he sent us to. All through it he's been both reassuring and factual."

One of the most difficult things Kahn, 53, has had to learn, he says, is "that you don't always answer the question that's asked, because often that isn't the real question. When a parent says, 'Gee, Doctor, what could this be?,' you could recite a list of horrible illnesses. Obviously you don't but, instead, say what you think is going on and when you'll know more." With his quick smile and soothing voice, he can instantly lower the anxiety level in the tensest of situations.

For Kahn, the great joy of the job is watching his patients grow up. And he recalls with pleasure certain points of the journey: allaying the anxiety of first-time parents so they can fully enjoy their newborn; forging a link with a slightly skittish 3-year-old. "I think I appeal to people who like to understand the reasoning behind things," he says. "What I do mostly is explain my thinking. But in pediatrics you can't do that without some hand-holding. If I find myself saying, 'Don't worry,' I know I'm wasting my breath. I'm a parent, too."


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