Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 137 | March 30, 2021
Motherhood And Milestones
Jennifer Ainsworth and Kristin Horwath
Specialists in Pediatric Physical, Occupational & Speech Language Therapy
Welcome to Difficult Conversations with Dr. Anthony Orsini. If you are a parent, first time mother, have a baby with special needs or perhaps have questions about how your baby’s developing, or about breastfeeding, wouldn’t it be great if you had someone to call who not only has the expertise to help but also knows what it’s like to be a mother? If this description fits you or someone you know, you really don’t want to miss this episode. Today, I have with me Kristin Horwath and Jennifer Ainsworth who are top notch pediatric and newborn Physical and Occupational therapists. They are Neonatal and Pediatric Therapists, and “mommas” themselves who are passionate to help mom’s and babies thrive. After working together at one of the top hospitals in the country, they teamed up with Adrienne Alexander and started Milestone Specialists of America, which is a baby resource/development coaching and therapeutic concierge service for mom’s and their babies. Most importantly, they bring with them the understanding that healthcare is about that human to human interaction we speak about on every episode of this podcast. As always, Dr. Orsini keeps his promise about two things, that you will feel inspired, and you will have learned valuable lessons to be a better and more compassionate communicator.
Jenn and Kristin tell us about their journey and what led them leave one of the best pediatric hospitals in the US and take the leap of faith to start Milestone Specialists of America. We find out who the typical client is that calls Milestone and the services they offer. We also learn how important it is for Moms and Dads to be involved in the treatment of their babies , and how Jenn and Kristin offer realistic and convenient ways to help parents along in the process. Kristin shares a story how she couldn’t breastfeed and how she worked through it. We find out how they’ve worked during COVID and the challenges they faced. We end with finding out the most difficult type of conversation that Jenn has, how she has navigated through the conversation, and she shares some advice on what to say and how she approaches that. Also, Dr. Orsini mentions the three goals of having difficult conversations, and Kristen shares how she approaches a conversation with parents who are in denial about their child and what she says to a parent who wants an immediate answer when there isn’t one. The lesson learned today and on every episode of this podcast is, it’s all about trust, building a relationship, and being a genuine person. If you enjoyed this podcast, please hit the subscribe button.
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Kristen Horwath and Jennifer Ainsworth (2s):
Typically, we get the mom that has been to four other places and they know something’s not right, but they don’t know what exactly that is. They will typically say I’m having issues with feeding. I’m having issues with weight gain. My doctor recommended us to do X, Y, and Z, but I need help. And so we will do a zoom call with that mom and get them on the phone with us. Talk to them, validate their concerns, listen to what is going on to them. And what’s their current situation and then we figure out what the needs are and how we can best serve that mom and baby.
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 35s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges of physicians, dentists, pharmacists, and nurses, struggling with substance abuse. Having worked with licensed medical professionals struggling with substance abuse since 1976, Veritus understands how extremely difficult it can be to ask for help because of how severe the stigma is in the medical community around mental health and how real the fear is of a potential repercussions from colleagues if found out.
Dr. Anthony Orsini (2m 18s):
Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate, Veritus brings world-class treatment to your home or office. To learn more about Veritus, you can visit www.veritussolutions.com. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. My name is Dr. Anthony Orsini and I will be your host again this week. Are you a parent, perhaps a first time mother or father? Maybe you have a baby with special needs, or just have questions about how your baby’s developing or maybe you need help breastfeeding or perhaps have a new baby and can’t find the owner’s manual.
Dr. Anthony Orsini (3m 4s):
Wouldn’t it be great if you had someone to call when not only has the expertise to help, but knows what it’s like to be a mother with all of the concerns and worries that come with having a baby. If that description fits you or someone that you know, trust me, you are not going to want to miss this episode. Today I have with me, Kristen Horwath and Jennifer Ainsworth, Kristen and Jennifer are amazingly talented, pediatric and newborn physical and occupational therapists with over 25 years of combined experience caring for newborns and infants. They are neonatal and pediatric therapists. And as they say, mama’s also who have a passion for wanting to help moms and babies thrive.
Dr. Anthony Orsini (3m 47s):
So after working together at one of the top children’s hospitals in the country, they teamed up with Adrian Alexander, another amazing pediatric physical therapist, and started milestone specialists of America, which is a baby resource development coaching and therapeutic concierge service for moms and their babies. Before leaving to start milestone, I had the pleasure and honor to work with both Kristen and Jennifer, for more than six years. They are top notch, pediatric and newborn specialists. But more than that, they bring with them the understanding that healthcare is about that human to human interaction that I speak about every single week on this podcast.
Dr. Anthony Orsini (4m 30s):
In short, today we have with us the dream team of infant and pediatric physical and occupational therapy. Well welcome Jennifer and welcome Kristen. It is real honor to see you again, I’ve missed working with you, but I know that you’re doing such amazing and exciting things.
Kristen Horwath and Jennifer Ainsworth (4m 47s):
Thank you for having us.
Dr. Anthony Orsini (4m 47s):
So this is a first, I’m doing my first podcast with everybody in the same room. So we’ll see how that works out. It’s so much better because you know, I’m a big body language person, and this is really great to get the vibe and we’re all friends. So this should be a lot of fun. Thanks again. This is going to be awesome. Amy Alexander’s, couldn’t be here today she’s the other partner for milestone, but we’re going to have a really great time. When I do my workshops and I talk about the healthcare provider patient relationship or the business leader, employee relationship. The word that keeps coming up over and over again is relationship and trusting relationship. And the best way to form a trusting relationship is to find commonality and to be a genuine person.
Dr. Anthony Orsini (5m 31s):
I think that’s really important when we discuss how doctors can form relationships very quickly. And so I know you guys, I know how good you are. I know all about you, But before we start, I think maybe we’ll just take a few minutes for each of you to take some time. Tell us about your journey, how you got here, and then we’ll jump in and talk about milestone and all the awesome things that you do at milestone. So who wants to go first?
Kristen Horwath and Jennifer Ainsworth (5m 55s):
I’m Jen Ainsworth and I’m an occupational therapist and a feeding specialist. And one of the co-founders. How I got to occupational therapy. My bachelor’s is actually in elementary education. And I really loved children a lot and wanting to be a teacher forever and then graduated and was ready to get a job. And my dad said, you need to go to grad school. And I was trying to explain to him why that wasn’t possible. And he said, you need to go to grad school. So this was a long time ago because I didn’t need any hours or anything. So within two weeks I found myself sitting in my master of occupational therapy program because it was a place where kids who needed extra help at school could get some extra help.
Kristen Horwath and Jennifer Ainsworth (6m 42s):
And I’m forever grateful for that because I don’t think I would have loved teaching 20 years later. And I truly love being a therapist and working with little people and I just love it.
Dr. Anthony Orsini (6m 55s):
So usually there’s something in our past, you know, I always say we are where we came from and if you’ve read my books, you’ve start off with the story of me having epilepsy when I was a child. And I think that had a lot to do with me being exposed to medicine and what was right and what was wrong about medicine. So this might be a tough question. I’m putting you on the spot. So what do you think in your past that made you get drawn towards occupational therapy, but more pediatric and newborn?
Kristen Horwath and Jennifer Ainsworth (7m 23s):
Kristen might even, this will be news to her, but I actually had five, six maybe surgeries in middle school and high school. And I was in physical therapy frequently because a lot of them were orthopedic in nature and I thought physical therapy was so boring. So I didn’t want to go into that and went into occupational therapy. As I appreciated the sensory components as a sensory child, myself, I felt like I could relate to that a little bit more.
Dr. Anthony Orsini (7m 54s):
That makes sense. All right, Kristen, you’re up. So who is Kristin? How did she get here and why did you choose to go into physical therapy?
Kristen Horwath and Jennifer Ainsworth (8m 5s):
So I went into physical therapy because Jen, I had injuries growing up. I was a competitive cheerleader and through my injuries, I was introduced to the career of physical therapy and I was always athletic and wanting to be involved in sports. And I liked seeing change and helping people get back to what they love to do. And as a physical therapist, that’s what you do. You get people back to what they love doing. And so I went into my doctorate of physical therapy with the notion in mind that I would be an orthopedic sports medicine PT, and then I had my internships and I was in orthopedics.
Kristen Horwath and Jennifer Ainsworth (8m 53s):
And I just found that I ended up being drawn towards pediatrics. Because I felt peds and working with their families, you never knew what that baby or child would bring that day. So there was some sort of spontaneity and I had to be flexible and I liked the change and I could still make an impact on that baby’s life. And a lot of times it’s just bringing the knowledge and education to the families that I just found a passion for. And you set that baby and family up for change from the beginning and it can last through a lifetime.
Dr. Anthony Orsini (9m 33s):
I always tell my patients that the best thing you can do is stay in physical therapy. And so it’s interesting that you said you wanted to do orthopedics because when I entered medical school, that’s what I wanted to do too. I was all excited. I was an athlete in high school. I wanted to become an orthopedic surgeon and do ACL repairs and all that. And I signed up my third year clinical and I said, first thing I signed up for was orthopedic surgery elective. And I go into my first operating room and the orthopedic surgeon has a mallet and it shizzle and a drill. And I remember thinking to myself, if I want it to be a carpenter, I wouldn’t have gone to medical school and got $200,000 in debt, but no offense to the orthopedic surgeons out there, but I always felt more close to the babies.
Dr. Anthony Orsini (10m 19s):
And I really wanted that more human side of medicine and treat the person who’s awake. So it’s interesting that you said that, so let’s move on. So we worked together for probably six years. I think it was, I’ve been there about six years that you guys were really awesome. And one of my go-to people when I needed OT, PT for my little babies, I’ve personally learned a lot from you guys. So you’re working at one of the best pediatric hospitals in the country. And yet you decide to take this leap of faith to start milestone. So what made you say I want to go out and deal? Was it something that you wanted to do more of? What drew you to say? I got to do this and for milestone
Kristen Horwath and Jennifer Ainsworth (11m 2s):
Little side note, I have four little guys and I like to say my youngest is 19 months. So I technically made it through the, at least the infant years with all my four kids and have experienced a lot of different things as a mom, having four different children and my journey as a first time, second time, third and fourth time mom. So I feel like after my years in pediatrics, my years in neonatology, and then as a mom, Kristin and I were just always going back and forth, I would have friends ask me, can you look at my kid crawl? Can you look at my kids’ feet? And I would send a tourist and a picture and she’d respond or vice versa.
Kristen Horwath and Jennifer Ainsworth (11m 42s):
What about my kids feeding? What bottles do I buy? And we would always send each other text messages. Like we’re just throwing money away all the time. And then I had a friend of a friend at my house probably for three hours a Saturday and looked at her baby and FaceTime Kristin. And she did infant massage over video chat. And we were just like, there are moms out there that need a resource that is reliable and invested and truly cares. And we started doing some market reviews and just found that there weren’t that many out there for a baby that needs outpatient therapy. There is a plethora of resources, but not just the mom that needs a little extra, has some questions feels like something’s not right.
Kristen Horwath and Jennifer Ainsworth (12m 30s):
Or doesn’t know what to do next with the whatever her baby is doing.
Dr. Anthony Orsini (12m 34s):
Well, you said, I think it’s on your website or on your Facebook page. You say we’re not only therapists but we’re mamas. So how important is that? You think I’m sure it could be a good physical therapist. I guess there’s a certain familiarity with the mom who can’t get her baby to feed at 3:00 AM and is crying because she wants to go to sleep.
Kristen Horwath and Jennifer Ainsworth (12m 55s):
I think that motherhood changes you. There’s no doubt about that. We actually had a group of new moms last week and a few of them were nurses and the one says I never going to be the same nurse. And we laughed because we feel like that too. Of course, it just allows you to know, Kristen talked about this a lot. That every advertisement, every marketing, it’s always this mom that is just so peaceful and feeding her baby and her makeup’s done and her hair is done and, you know, breast or bottle feeding is going beautifully or they’re playing and everyone’s laughing on the clean play mat with no toys, anywhere else in the room. The whole house is clean and that’s just not it ever.
Kristen Horwath and Jennifer Ainsworth (13m 35s):
That’s never how it looks, ever.
Dr. Anthony Orsini (13m 37s):
Yeah. I know my wife was working when we had our first child. I was a neonatal fellow and I was able to do some research at home for a couple of months. We lost our daycare. And so I took care of my first born at home for a couple months. And she would come home at 3:30 from school teaching and the eggs were still on the table, dishes and the counters were still full and there’s crap everywhere. And she says, what has been going on in here? I’m trying, but, and then you don’t sleep. And so when they finally go to sleep, then you sleep. But it’s real important. I think that you can also relate. What’s the typical client that calls milestone that you have a Jen mentioned that sometimes it just moms are concerned, but I’m sure there are also, some moms will have some real legitimate concerns.
Kristen Horwath and Jennifer Ainsworth (14m 26s):
Typically we get the mom that has been to four other places and they know something’s not right, but they don’t know what exactly that is. They will typically say I’m having issues with feeding. I’m having issues with weight gain. My doctor recommended us to do X, Y, and Z, but I need help. And so we will do a zoom call with that mom and get them on the phone with us. Talk to them, validate their concerns, listen to what is going on to them. And what’s their current situation. And then we figure out what the needs are and how we can best serve that mom and baby.
Dr. Anthony Orsini (15m 12s):
So they’re typically moms who babies have legitimate problems and they just can’t seem to get help. Or do you also get a mom that just is crying? I can’t get this baby to breastfeed. Yeah. Would you say it’s more babies with real serious problems?
Kristen Horwath and Jennifer Ainsworth (15m 25s):
I would say a mixture. There are those moms that have a baby that maybe doesn’t have a medical diagnosis yet, and we can help direct them and to whatever appointment they may need to get to see a specialist. We know who to call. We know the specialists in the area and working at the hospital so we know the direction to send them. So that way they can, regardless of the diagnosis, we’re going to treat the baby. Their symptoms, give that parent tools and education. But in order to get some services, there sometimes required diagnosis. So we will help in that regard, if there’s something definitely medically wrong, but we also get that call from the mom that is just struggling getting her newborn colicky, fussy, irritable, baby.
Kristen Horwath and Jennifer Ainsworth (16m 17s):
And isn’t sleeping. Isn’t eating great is not doing tummy time, not doing all the developmental play activities because that baby is just having a hard time adjusting. We call it the fourth trimester. So that first 12 weeks it’s mom is trying to adjust to being a new mom and getting to know her body and the hormonal changes. But also she’s getting to know the baby and the baby’s getting to know the world and adjusting to life outside the womb.
Dr. Anthony Orsini (16m 44s):
There’s probably a whole bunch of moms out there going that’s me right now. I need some help. So what are the exact services for people out there who are really interested right now? What are the exact services that milestone offers?
Kristen Horwath and Jennifer Ainsworth (16m 59s):
We have physical therapy, occupational therapy, speech therapy, and we have a postpartum doula who can help walk alongside the mom and the baby with lactation needs and just adjusting to life as a new mom, we have a lactation consultant and our OT is also a feeding specialist. So depending on the experience of the OT, we also have that. We have a neonatal pediatric registered dietician that also used to work in the NICU. And we have an allergy advocate mom, who has walked in the shoes with her own daughter, having severe allergies, seven out of the eight common allergies.
Dr. Anthony Orsini (17m 40s):
That covers just about everything. I think that’s just awesome. Did I get you to say some clients come from Europe and they even contact you from out of the country?
Kristen Horwath and Jennifer Ainsworth (17m 47s):
We have had a couple out of the country. One was in Guatemala. The other one was in Brazil. So we were able to help now with COVID times, we’ve been able to reach these moms and give them tools to make them confident in their decisions from afar and not being able to see them in person, but giving them the education and tools to do what they can do with their baby.
Dr. Anthony Orsini (18m 16s):
When I have these difficult conversations with parents in the NICU, perhaps we know that the baby is going to have developmental delays or just has some real challenges. One of the things that I like to say to the parents is that your baby’s fortunate because they have two loving parents who are going to do the exercises that the physical therapist and the occupational therapist has. And not all babies have that I think to me. And I’d like your opinion on this, the most important thing for a mother or a father. Cause we always forget about the fathers is that they want to do something right. Even in the worst set of circumstances. So how important is it that you can do a lot of education? I assume that they can do at home because you can’t see the baby every day.
Dr. Anthony Orsini (18m 57s):
So how important is, and you lay out instructions for them, how important are those home exercises.
Kristen Horwath and Jennifer Ainsworth (19m 3s):
For me, I always tell the moms and the dads like give them a role, something for them to do. And a lot of the dads, even in the NICU, they would love to do the exercises. And then, so that would give the dad purpose to do something with their baby while mom would do feeding. Yeah. I think the first thing though is even, I think we both, don’t all three of us with an array of situations, with all different complexities and a variety of developmental delays. And you always want to give mom and dad, no matter what is going on in the situation, something that they are doing right. And something they can do that will benefit their baby because any parent is of course going to want to help their baby.
Kristen Horwath and Jennifer Ainsworth (19m 48s):
And I think that’s great. And people would often ask, how do you do what you do? I don’t have to break very much bad news. I can always give the moms this is what you are able to do. And to give the positive component of it, even in the worst of maybe a palliative situation, there’s always something positive and give them a memorable experience of ways they can interact with their child, because we all have an idea of how parenthood is going to go. You make a choice sometimes, so you get pregnant or not. And then you have an idea of how your experience through birth and into parenthood is going to go.
Kristen Horwath and Jennifer Ainsworth (20m 28s):
And sometimes your experiences don’t go as you thought they were going to go. And at the end of the day, parents just want to do something for their child.
Dr. Anthony Orsini (20m 36s):
And as you know, I’m a big person on body language and nonverbal language. And when I say that to a parent, this baby’s lucky because they have you. And that these are the exercises that the physical therapist, occupational therapists are going to give you. And I know that you’re going to do them because you’re a loving parent. If you know how to read a face, you could just see it. And you’re looking at me, nodding your head right now. They light up. They just, they want so much to do, even if they know the baby’s going to have big challenges, but the fact that they might be able to minimize that challenge just by a little bit, by doing the exercises. So I would imagine you guys write out a whole list of stuff for them to do and they can follow the plan.
Kristen Horwath and Jennifer Ainsworth (21m 16s):
Yes. And the other thing is we’re very big. So you asked earlier about being moms ourselves. My first little guy had mild torticollis, which required I was told to do these stretches four times a day. I had one child. It was very overwhelming and I didn’t get it done. And I remember thinking, wow, all these moms, all these years that I thought, why can’t they just do this with their babies? And here I was with good resources and a professional myself. This was my field and I still couldn’t get it done with one baby. And there are times that I just, I want to prioritize for the mom and we make an effort to do that.
Kristen Horwath and Jennifer Ainsworth (21m 56s):
We don’t want to give you a big list to do we want it to fit into your daily schedule. So whether we just say, after a diaper change interacts for two to three minutes, it needs to fit into your schedule in order for a parent, not to feel worse. And like you’re giving them a to-do list they can’t accomplish. And the other thing is we have the option to just be more available to the parent if they choose that. And when they get home later, Kristin, this is her line. You always forget what you wanted to ask on your way home. So just text us and we’ll walk you back through it or off, I do a lot of feeding. So I want to know how dinner went and make adjustments for tomorrow night’s meal. I don’t want to wait until next week’s appointment, but I want to know how the next bottle went.
Kristen Horwath and Jennifer Ainsworth (22m 41s):
There was a situation where a mom called us. We had met with her a few times and she called and said, I’m having trouble with this. The baby was sleeping. I said, feed him, made some recommendations, do this after now, call me when you’re done with that, she called me. I was like, let’s make these fewer more tweaks for bedtime. And she’d call me after bedtime. She called me. She was like, great, everything works. I’m going to try that for the next few days, if you have more problems call and it was like, parents are so busy, especially with newborns. They need things that are convenient and that are able to give them realistic ways that they can fix some of the moment-to-moment concerns that they’re having.
Dr. Anthony Orsini (23m 19s):
There’s a wonderful thing is it’s really concierge service. You guys are available 24 seven in my book, I talk about one of the principles of patient satisfaction is be the friend in the business. And that’s basically what you’re doing is you’re the friend of the business. The fact that they’re texting you after dinner, that’s just great. The other comment that you made that I think is really important is about the guilt of you were supposed to do it four times a day and he couldn’t do it four times a day. And I think that sometimes as medical professionals, we do forget that. And then the guilt follows a great example is breastfeeding, right? So you tell them mother that if she doesn’t breastfeed 24 seven, and if her baby ever touches a bottle or her baby takes one drop of formula, they’re not going to Harvard.
Dr. Anthony Orsini (24m 2s):
And so all of a sudden there are parents who can’t breastfeed. We’re a big breastfeeding advocates everywhere, all of us, but it’s a mother has to give a bottle of formula because she can’t seem to produce enough. We don’t realize. And there’s good data on that. There’s good data on baby friendly about the mothers who have shown depression because they can’t do that. So I think that’s really a good point.
Kristen Horwath and Jennifer Ainsworth (24m 26s):
Yeah. I was that mom that couldn’t exclusively breastfeed. So I relate to those moms that are struggling. And with all three of mine, I just had that expectation that it was okay. And I gave myself that, that, okay, you’re going to be fine. The baby’s going to be fine. And I make the comparison all the time with Jen and I she’s on one end, she’s the exclusive breastfeeders and I was the supplement or formula moms. So we offer that support to moms, both ends of the spectrum and how it can all work out in the end. And I have three girls and all my three girls are functioning just fine.
Dr. Anthony Orsini (25m 9s):
Well, and they all love you. They hate you.
Kristen Horwath and Jennifer Ainsworth (25m 12s):
Nobody knew who, if, when they’re all together playing, nobody knows who was breastfed or who was bottle fed. Nobody knows
Dr. Anthony Orsini (25m 19s):
You walk this fine line in medicine about 25% of you out there are not even in medicine, but just so you know, we walked this fine line in pediatrics of really wanting to encourage breastfeeding, but you can cross that line and make that mother who can’t breastfeed feel like a really total failure. And so it is a tough line to encourage, but I find it sometimes hard to find that line. Like, I really think it’d be great for your baby, but it’s you don’t want to it’s. Okay. So it’s tough. And I love what Jen said is generally do what you can do. I think that’s really great. And to have you guys there, when that mother is feeling guilty or is having struggling is really important. Let’s move on to Covid cause you mentioned it.
Dr. Anthony Orsini (26m 1s):
I think Kristen did anyway, I’ve had to really pivot during COVID because most of the teaching that I do is workshop related. I love to stand in front of a crowd and I like to see the faces and we do some interaction that became really impossible during COVID. And so it’s actually worked out for us because it’s forced me to start doing some learning modules. I do a lot more teaching remotely. You went full-time in the middle of Covid. Some people just wouldn’t say that’s crazy, but how has that worked out? Are you able to navigate through it?
Kristen Horwath and Jennifer Ainsworth (26m 32s):
We’re always up for a challenge. I always joke that I learned things the hard way, but honestly, during this time we’ve found that there are so many more moms that are struggling more right now because they can’t find the resources or they can’t make that easy doctor’s appointment that they used to before. And now that offices are opening up more and there’s a longer waiting time and we can get on the phone or get to that mom sooner. We can see or talk to her that day sometimes and see the baby the next day.
Kristen Horwath and Jennifer Ainsworth (27m 14s):
So that’s our biggest goal is to help that mom as soon as possible,
Dr. Anthony Orsini (27m 19s):
But you do infant massage and you teach it, but you also would like to do it. Are you still going to house with masks or are you waiting till I COVID is over, they’re coming to you. How does that work?
Kristen Horwath and Jennifer Ainsworth (27m 30s):
We primarily see the babies and the moms in the clinic with mask and all the precautions. However, there are certain instances where we will go to the home, especially if it’s a mom that doesn’t feel comfortable bringing their newborn out, but our clinic is accommodated to have one family in the office at a time. So it’s more isolated and we can work with that mom just with our team.
Dr. Anthony Orsini (27m 59s):
And I know it’s safe, then you clean it and everybody wears masks. I know there’s still this COVID hysteria out there. Hopefully the vaccinations will come in and we can get back to normal here. So yeah, I think COVID has forced us to be more creative, but in some ways it’s good and I’ve done some pieces on telehealth medicine, which is not going away. Everybody loves telehealth medicine. Now it is really hard to form a relationship over zoom, but it can be done if you use the right techniques. So the title of this podcast is difficult conversations and I make a promise to my audience to inspire and to learn some communication techniques. And so I usually talk about at the end of each podcast, the most difficult type of conversation that you have had, it could be your private, it could be a personal, it could be a specific conversation that you remember that was very difficult or just the type of conversation.
Dr. Anthony Orsini (28m 54s):
So I’ll take one at a time. Tell me about the most typical type of conversation that you have and how you navigate through that conversation and give us some advice on what to say and how you approach that
Kristen Horwath and Jennifer Ainsworth (29m 7s):
In the hospital. I mean, I think the most difficult is of palliative situation is just the most difficult. And I think that everybody constantly thinks they need to say something when it’s the opposite. You actually need to be quiet and just listen. So you don’t have to be equipped. Dr. Orsini clearly offers some excellent communication tips. Then you should listen to them all, but you don’t need to have a script. You really just need to listen and allow someone to speak. They want to feel in the situation. And I even think not a palliative situation, a significant developmental delay, or is my child ever going to walk?
Kristen Horwath and Jennifer Ainsworth (29m 52s):
Are they ever going to talk? And in reality, we don’t have direct answers to that. However, nobody does even a physician. We can suggest things through scans, but we don’t really know the extent and communication for example has an array. It’s not just verbal. It’s actually a lot of it’s non-verbal. So I think always sitting down and getting on eye level with the mom and allowing her to speak and present her concerns and where her baby’s at. So the most difficult is in a palliative situation stating I don’t understand because I haven’t walked in your shoes because that is another thing I know where you’re coming from.
Kristen Horwath and Jennifer Ainsworth (30m 33s):
I haven’t personally lost a child. I don’t know where you’re coming from and validating, I cannot imagine how hard this is and then giving her adequate time or dad to speak and then just providing support. So I always, as a therapist, I’m able to give how they can touch their baby and hold their baby. You can always at any level saying and read to a child and hold at all, I think stages. And so there is always something that can be offered. And I really think that that’s honestly the extent of the conversation, give them a few things to do so they feel useful in this situation.
Dr. Anthony Orsini (31m 19s):
And I talk about the three goals of having difficult conversations. One is that you come off as being compassionate, that they really feel that compassion from you. And it’s great. We use sitting there silently is sometimes the most important way to show that too is to be the expert in the room and to let them know that you’re going to give them some advice on how to get through this. Even though, as you said, you can’t relate to it. You don’t really understand, but you’re the expert in the room and three that you’re not going to leave. That those are the three things. Kristen so I would think, and I know this personally is that we have babies in the NICU. We have babies have gone home that had no, maybe get perfectly normally at birth.
Dr. Anthony Orsini (32m 1s):
The mom calls you. I’m worried. My child’s not rolling over my child’s not sitting up. The pediatrician wants me to go to the neurologist. But as we see, there’s a lot of denial. I don’t think there’s anything wrong with my baby. So I want you to come and evaluate and do you find this baby who’s buried, delayed, maybe hypertonic or whatever. And I always say, when you break bad news, the patient’s job is to prove you wrong. And my advice to doctors out there is provide the evidence first of your bad news and then give the bad news. And so you’re put in a situation, I’m sure where the mom and dad and tell me if I’m wrong or saying, my doctor thinks there’s something wrong.
Dr. Anthony Orsini (32m 44s):
So please tell me there’s not. But then you say you find there is. So how do you approach that conversation? That’s got to be really hard.
Kristen Horwath and Jennifer Ainsworth (32m 55s):
Yes. So we have those situations where Jen and I will be like, something’s not right. And the mom, like you said, is either in denial or hasn’t been told exactly what’s going on. So in that situation, we always make sure that we let them know that we’re on their side to support them, not to. I mean, any mom isn’t going to, or any parent isn’t going to want to be told that something’s wrong with their child. So dealing with that fragile situation, just going in, making sure that they know that you’re on their side and supporting them, regardless of what’s going on and telling them we’re here to help hold your hand along the way.
Kristen Horwath and Jennifer Ainsworth (33m 40s):
Whatever’s going on we’re going to do whatever we can to facilitate typical development in your baby. This is what your baby is doing rather than focusing on what the baby’s not doing. And we always tell the parents that development is it’s a forward progression. So that’s what we want to see going in the right direction. So it doesn’t matter necessarily when they’re going to do it. We just want them to get there and we’re going to help get them there. Whether it takes us two months, three months,
Dr. Anthony Orsini (34m 14s):
Put you on the spot though. Right? Cause they say, tell me the doctor’s wrong. And then what do you say when they say that? It’s like, well, I have concerns. How do you have that? I mean, there’s someone out there that says, I need to know what to say to that question.
Kristen Horwath and Jennifer Ainsworth (34m 28s):
We don’t have the glass ball to say when or what this is going to look like in a year, but we treat what we see and we’re gonna do what we can now. And if something is wrong, it doesn’t mean that something’s going to necessarily get worse all the time. But we had a mom in the NICU that had a kiddo that had, there just wasn’t something right. And we didn’t know the diagnosis at the time, but we made sure that that mom could, we were working with the baby, but could also confide in us and help work through what she was going through, dealing with the situation of accepting what’s going on with the baby, knowing something’s not right.
Kristen Horwath and Jennifer Ainsworth (35m 15s):
Even though we don’t know exactly the diagnosis or the prognosis, she knew that when we were there, we were doing everything we could for that baby and doing what the baby could do and capitalizing on that and giving mom some things that she could do to help her baby, even though things were not right. I think the word hope comes to mind because we want to state what they’re doing and then give the next developmental thing that we would work towards. And it just gives not false hope, realistic hope, and here’s how we’re going to get there.
Kristen Horwath and Jennifer Ainsworth (35m 54s):
Yeah. And even our kiddo that we had was making very slow progress. And so sometimes it could seem like to other people, we weren’t doing much. We were helping maintain that baby’s status and preventing that baby from regressing. So at that point it becomes, we have to maintain where that baby’s at rather than just having the baby get worse.
Dr. Anthony Orsini (36m 21s):
And this podcast episode has come full circle back to what we had spoken about originally that this is about trust and relationship building and being a genuine person. We’ve been doing this podcast every week now for probably about seven or eight months. And I think almost every week, those three words keep coming back, trust relationships, being commonality genuine. And at that particular moment, when you’re discussing this with the mother and having this very difficult conversation, if she doesn’t find any commonality with you, she hasn’t formed a relationship with you. And I always say, you can form a relationship in 56 seconds. This has been studied and she doesn’t feel that you’re the expert in the room and that you’re compassionate.
Dr. Anthony Orsini (37m 3s):
You’re dead in the water. So she’s just going to say, Jen you’re a hundred percent wrong. You have no idea what you’re talking about. I’m going to go find somebody else, or she’s going to listen to you, scale your compassion and say, okay, I trust you and let’s move on and how we can help our baby. And I think this concierge style style that if you don’t mind me using that word or this relationship, this style really forms and helps those relationships with these parents. And you’re offering a service to people that I think from again, from someone who just doesn’t know how to be a mother, I mean, these babies don’t come with owner’s manuals. And sometimes we have moms, grandmas, and granddads that could help us.
Dr. Anthony Orsini (37m 45s):
And some people don’t have that. And then sometimes grandmoms gives us really bad advice, put your baby on their stomach when they’re sleeping. Don’t do that. So what you’re offering I think is great. I think it’s something that’s building and you’re already showing some great success. It’s really great. Everybody out there. What is the best way for them to get in touch with you? I know you have a great Facebook page. So tell us about that. Your social media is awesome, but I’ll put this in the notes, so you don’t have to write it down, but what’s the best way for them to get in touch with you guys. And again, you can be in Europe and this podcast, actually, I have no idea why this podcast is number seven in Spain and health. It’s in English, but in Spain, but we were in top 100 in the United States for a little while.
Dr. Anthony Orsini (38m 29s):
So if you’re out there in Europe listening, how can they get in touch with you or anywhere?
Kristen Horwath and Jennifer Ainsworth (38m 40s):
So our website is www.milestonespecialists.com. And on there, we have a contact page and you can fill in the information and it will send us a message with your contact info. Also, we are on Instagram milestone specialist and Facebook as well. And you can search us as milestone specialists of America. We just want to allow moms to know that they’re doing the best for their baby help you understand the why. So you can enjoy the moments because they pass so quickly.
Dr. Anthony Orsini (39m 15s):
You’re right. I just came on one of those Facebook things, you know, 10 years ago, 11 years ago, my son was playing football. One of my favorite sayings as the days go very slowly, but the years fly by. So enjoy your babies. And these ladies here are here to help you. If you liked this podcast, please go ahead and hit subscribe and go download all the previous podcasts. If you need to get in touch with me, or you can do that through theorsiniway.com, I’ll put all of the milestones specialist contact information on our show notes. And thank you again. And please spread the word and contact me or milestone people at any time. So thank you everybody. And we’ll talk again next week.
Dr. Anthony Orsini (39m 56s):
This episode was brought to you by Veritus. Veritus offers virtual alcohol drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet unique needs and challenges of physicians that this pharmacists and nurses struggling with substance abuse. The virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work confidential, convenient and compassionate Veritus brings world-class treatment to your home or office contact Veritus for email@example.com.
Dr. Anthony Orsini (40m 37s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast. Visit firstname.lastname@example.org.
Dr. Anthony Orsini
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It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini
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