June 2000 • Volume 6 • Number 6
Students get dose of health care, humor from family physician
It's not hard to understand why Jay Kravitz, M.D., M.P.H., likes to hang out in schools. Cracking jokes, making fun of himself, spouting wild exaggerations and bursting with energy, he almost seems like one of the kids. But the New York FP strolls the halls with a purpose: meeting the health needs of students and staff.
Kravitz checks eighth-grader Jamiel Pryor's weight and height during a recent visit to Hackett Middle School in Albany, N.Y.Kravitz, who maintains a private practice in Rotterdam, is employed as the school physician by two school districts. Mohonasen, a small middle-class community with just four schools, contrasts sharply with Albany, a large urban district with 34 buildings, including three high schools. With the aid of his physician assistant and school nurses, he spends about 200 hours a year addressing Mohonasen's health needs, while the Albany district consumes about 20 hours a week.
What's a typical day like? There's no such thing.
One day, he might perform health assessments for new students, meet with a committee to discuss special services needed by a child with a learning disability, serve as a liaison with the media on an E.coli breakout and report on a facility problem that poses a health threat. At the next visit, he might conduct bus driver physicals, meet with a superintendent to discuss a budgetary concern, touch base with the county health department regarding a measles epidemic and spend time in the classroom talking with students.
"Each day is different, and that's the beauty of it because there's so much going on and it's multi-faceted and ever entertaining," said Kravitz, who's been a school physician for about 18 years.
His mission is twofold: Keep everyone healthy, but also show students that health care doesn't have to be intimidating or scary.
Most of his hands-on work comes in the form of state-mandated health assessments at the schools for all new students entering the district. Students are encouraged to get thorough physicals from private physicians, but many never do. "All of the health assessments I do are because, for whatever reason -- finances, timing, the kid didn't take the note home -- the child has not been 'physicaled,'" Kravitz said, lamenting the limited time he can spend with each child and yearning for them to receive high-quality continuity of care. Yet he does frequently identify health problems, such as scoliosis, heart murmurs and skin ailments, and refers children to private physicians.
An enthusiastic class of third graders fires health questions at Kravitz during an "ask the doctor" session at Jefferson Elementary School in Rotterdam, N.Y.Although the health assessments afford the greatest opportunities to address health concerns head-on, Kravitz wonders whether his interpersonal activities don't have a greater impact. "One of my favorite jobs is to sit in a third-grade class on a chair, and the kids crowd all around and ask me anything," he said. "'Why did my grandpa die?' 'What makes up snot?' Why this, why that? You'd be surprised at the questions you get. I always try to interject a lesson during that conversation. While I'm entertaining them, amusing them, I'm also trying to instill 'wear your helmet, wear your seatbelt, say no to strangers, tobacco and drugs.'"
Kravitz hopes that children will feel more at ease with health care providers after their experiences with him.
"It's something I really enjoy," he said. "There's a certain warm fuzzy you get from it. Admittedly, when you're doing 500 physicals on a Saturday afternoon in the middle of August when everyone's hot and sweaty, it's not a great joy. The real pleasure is the recognition that the kids say 'there's the doctor' when you pass them in the halls, and being able to make a positive impact so they're not scared of their doctor. I wanted to be more than just a campus quack; I wanted to have a real impact."
His advice for other FPs interested in school health employment is: Do your research. Determine how much time you're willing to commit and how much money you need to offset your absence from the office. Kravitz said most community school districts need the equivalent of one morning every other week.
"Recognize that it is a time commitment, and you don't want it to sour because you bit off more than you can chew," he said. "It has to be a positive experience or it just loses all of the quality that makes it so joyous. It's very important to be real with the kids and let them know you're there not as a punishment, but as a resource."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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