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And Baby Makes ... Four


Cynthia Pegler

992 Fifth Avenue, at 81st Street

Practice: Adolescents, predominantly girls, and young adults
HMOs: None
Hospital affiliations: New York-Presbyterian Hospital, Lenox Hill
Partners: None
House calls: Yes
Bribes: M&M's, Hershey's Kisses

Patients of Cynthia Pegler can spot each other immediately: They're the ones with the excruciatingly cool tattoo Band-Aids. The Curious George model is in high demand. For that matter, so is Pegler. "She's really easy to talk to," says Shira Gasarch, 16, whose sister is also a patient. "She makes you feel like your own person. She called me on my line to give me the results of a blood test. Obviously, I told my mom about it, but I like that Dr. Pegler called me directly."

When 18-year-old Courtney Singer went to Dr. Pegler for her first visit, what struck her, she remembers, was that "we just sat in her office for an hour talking. It was more than just a medical history. She wanted to make me more comfortable with her. It worked, because the next week I was calling her with questions. I speak to her once a week now. She definitely knew how to treat me medically, but she also knew how to treat me emotionally."

It probably helps that Pegler, 40, looks young enough to be her patients' contemporary. It also helps that she's perfectly comfortable exchanging tips about the care and handling of curly hair and is very admiring of current teen trends in eye shadow. More significantly, she makes it clear by her manner that she can be trusted, that she respects confidentiality.

At the beginning of medical school, Pegler thought she wanted to be a pediatrician; by the end she thought she wanted to be a child psychiatrist. In many ways her practice combines the two disciplines. "I like to see myself as an advocate," she says, "trying to help my patients make wise choices and allowing them to realize a doctor can be your ally."

Pegler often finds that a routine appointment can take an unexpected turn. "Someone will say, 'Oh, while I'm here, remember how you said I could get birth-control pills from you?'

"Some people will say to me, 'I have normal, healthy teenagers. They don't need to come to you.' They think my practice is just problem kids," says Pegler -- who does, in fact, deal with her share of eating disorders and wrought-up psyches. "They don't understand that I'm a transitional doctor -- the one between the pediatrician and the internist. And I'll say to these people, 'Well, most of my patients are normal, healthy teenagers.' "

Ralph I. Lopez

418 East 71st Street

Practice: Adolescents and young adults
HMOs: None
Hospital affiliations: New York-Presbyterian, Lenox Hill
Partners: None
House calls: No
Bribes: "We don't have lollipops, we don't have Kisses -- but we do have condoms."

"I have a simple policy," says Ralph Lopez, 59, who comes across as the really smart, really tough-minded teacher who taught you more -- and cared about you more -- than anybody else. "We start on time. I say, 'I respect your time and I expect you to respect mine.' " Other aspects of Lopez's simple policy: He won't ask embarrassing, confidential questions when the parental units are in the room. "That immediately establishes a boundary for them," he says. "I hand a prescription to the kids directly, and they usually hand it right over to Mom, and that's okay. The point is, I want them to understand that this is something going on between us. And I never leave without returning the kids' calls."

Lopez trained in pediatrics but, rooting about for a subspecialty during a fellowship, "I didn't find an organ that I liked better than any other organ. Literally, I couldn't come up with the notion that the heart was more fun than the liver or the kidney." Fortunately, there was a program in adolescent medicine, and suddenly Lopez had his life's work. In the intervening years, he has treated everything from strep throat to infected body piercings and has helped kids deal with homosexuality, pregnancy, drinking, eating disorders, and drug problems. "The art," he says, "is being able to listen in such a way that you come across as 'tellable.' Will a teenager tell you things? I found that I loved the age group. I loved the one-on-one -- and I didn't even mind the parents."

"I was very sick myself at one point, and we explained it all to the kids and thought they understood everything," says one parent, whose four children have all been Lopez's patients. "Well, it turned out they didn't know what we were talking about. My son, who was 12, called from school one day and said he couldn't concentrate because he was afraid of what might happen to me before he got home. So I took him to Dr. Lopez, who spent an hour going over what chemotherapy was and what cancer cells looked like. And my son was able to come out and feel like he had control over his feelings. So for that I will always be grateful."

"I think he's sensitive to an adolescent's needs," says Robin Meltzer, who switched her 14-year-old son, Martin, from another pediatrician to Dr. Lopez to help him start taking responsibility for handling his asthma. "I didn't want to be the one saying to him all the time, 'Take your puffs, take your puffs.' My son knows he can call Lopez any time, that he'll get a call back, and that he'll be respectful of confidentiality."

"I feel he's more realistic about everything than my pediatrician, who I felt just walked around sensitive topics," adds Martin. "Dr. Lopez talked to me about fitness. He talked to me about school and life and made me feel he was on my side. He made it seem like he understood how it felt to be 14 and the pressures I'm under."

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