Joey Wahler (Host): It provides a wide range of care. So, we're discussing women's and pediatric health services at Beebe Healthcare. Our guests are Dr. Jenna Dafgek, a family medicine obstetrician; Dr. Kaitlyn Ruffing, a hospitalist and pediatrician; and also Dr. Harrison Eckert. He's a third-year family medicine resident. This is the Beebe Healthcare podcast. Thanks so much for joining us. I'm Joey Wahler. Doctors, hi there. Welcome.

Jenna R. Dafgek, MD: Hi. Thank you.

Harrison Eckert, DO: Hello.

Host: Yes, thank you. Great to have you all aboard. So first, Dr. Dafgek, what is a family medicine obstetrician for those unfamiliar with what you do?

Jenna R. Dafgek, MD: Yeah. So as a family medicine doctor, I see patients of all ages, from newborns to adults to geriatric patients. But I also did extra training in obstetrics. So, I do prenatal care for patients, both outpatient in the clinic as well as in the hospital, and I do deliver babies on the labor floor. The big difference is I do not do C-sections, so I only do vaginal delivery.

Host: Gotcha. And Dr. Ruffing, how does your role incorporate being both a hospitalist and a pediatrician?

Kaitlyn M. Ruffing, MD: Yeah. So, I'm double boarded in Internal Medicine and pediatrics. And one week per month, I am on the internal medicine academic service with the family medicine residents. And then, the other three weeks per month, I'm in the clinic precepting the resident doctors in the family medicine clinic. And like Dr. Dafgek says, we see all ages including pediatric patients all the way through geriatric patients.

Host: Okay. And Dr. Eckert, a third-year family medicine resident. So, how would you say your training with faculty so far has influenced you as a doctor? Obviously, it's a very impressionable time for someone at your stage in your career, right?

Harrison Eckert, DO: Yes, absolutely. I think the training I've received here at Bebee with the faculty here has been incredible. And I feel like I've learned the absolute most that I can in the entire realm of family medicine, which really encompasses all of medicine Dr. Dafgek touched on, and it's all ages and stages. And I'm really thankful I chose Beebe.

Host: How does the family medicine residency team and faculty collaborate to provide women's health and pediatric services at the Long Neck Health Center?

Harrison Eckert, DO: So, we collaborate pretty much throughout the entire day with many different individuals from the front desk staff to the patients, to the MAs, to everyone to really just ensure that everyone is getting the most comprehensive care possible. And, yes, we do focus on women's and pediatrics health. And we also focus on all of the other chronic comorbidities and conditions that can exist with that. It takes a village and it takes a team, and I think we do a great job at really getting everyone involved.

Host: Yeah. Well put at the end there, Doctor. Because while certain people by way of position, I suppose, may be more out front, so to speak, there are a lot of people behind the scenes that make this all work to treat people, aren't there?

Harrison Eckert, DO: Absolutely, yes. Like I said, there is a village to get just one patient in and out of the door. So, we appreciate everyone.

Host: Absolutely. Dr. Ruffing, what makes this collaborative model effective in delivering care like your annual screenings, prenatal and postpartum support, which is always so important for families? Contraceptive counseling is offered, pediatric visits. That's a lot of services under one roof. How do you make it all work?

Kaitlyn M. Ruffing, MD: It is. And I think the collaboration, especially between the resident doctors and the faculty members is terrific and a true advantage to the patients. They truly get like what we like to say two doctors for one. So, the resident doctor really takes on the role as the primary care doctor of the patient, and they're very committed to that long-term relationship with those patients. And the faculty member serves as, I think, a resource and as a support for that resident doctor, because they're board-certified and they're able to provide those extra pieces of help if needed. But the resident doctors are absolutely terrific and the collaboration that we have together really allows us to provide the best care in all aspects.

Host: All right. Dr. Dafgek, when it comes to women's health in particular, what symptoms, what changes perhaps might signal that it's time for an annual screening or followup? What are the things unto women specifically that they should be aware of?

Jenna R. Dafgek, MD: Yeah. So, I'll start by saying, ideally, I'd have all patients, even if they're not having symptoms, come in for preventive screening. Young women in their 20s, 30s, 40s typically are pretty healthy. But that doesn't mean there can't be things that we do to help ensure that they stay healthy later in life. So, things like Pap smears. Even if you're not symptomatic, it's important for us to screen for cervical cancer, STD testing, and the like.

For symptoms that should prompt you further, the things I always talk about are if you're having changes with your menstrual cycle, significant cramping, blood clots, those are reasons to reach out to a doctor. If you're sexually active in general, even if it's in a monogamous relationship, I think talking about safe sex is important, whether that's contraception, sexually transmitted disease testing and counseling. That's what we're here for. It can feel awkward to bring this up in general to bring it up to a doctor or a provider, but it's so important to make sure that you're healthy currently and that you stay healthy throughout your life.

Host: What a great point you make at the end there, which makes me wonder, from your experience, how important is building a relationship with a doctor so that you can have that trust and that relationship so that even if there is some awkwardness discussing certain personal things, at first, you're able to overcome that and now you know, down the road, you have a go-to person, right?

Jenna R. Dafgek, MD: It's so important. And that's one of my favorite things about primary care and family medicine in general is, when you meet someone the first time, you're just getting to know me as your provider, I'm just getting to know you, oftentimes people don't want to dive deep into those conversations, you know, whether that's they're having pain with sex, or they're worried about STDs, they're worried about being judged, or they want to talk about trying to get pregnant, which is an incredibly personal conversation. So, having those opportunities to really build a relationship so that patients can trust me as their provider, as a touchpoint, and to know that, really, I always say my role as a doctor is to equip my patients with information and knowledge so they can make the best decisions for themselves, their bodies, their families. And I'm not coming at it with any judgment. I really just want to be a support and an educator and help them navigate healthcare, which can be really confusing and overwhelming. And I hope that over those visits I can build that rapport so patients feel open discussing things with me that they might have felt uncomfortable before.

Host: And Dr. Dafgek, when you talk about patients being armed with information, I guess the good news is there's information everywhere nowadays. You can Google anything, you can AI anything. The answers are there, but the problem is they're not always the right answers, right?

Jenna R. Dafgek, MD: Yes. It is a blessing and a curse how much information is available. I always joke, my siblings are not in medicine. They reach out to me all the time that they read something, and they're like, "Is this true?" And sometimes it is. I think being an informed consumer, looking things up, knowing what your doctor or provider is talking about is important. But it's so hard to navigate what is accurate, what's reliable, and what truly applies to you. And I think that's where doctors come in handy and especially, you know, in a residency, physician residents have the benefit of extended visits, so they really have that time to dive in, sit down with patients and talk through concerns or things they've seen, things they've read, to kind of dissect it and understand it better.

Host: Yeah. Still no substitute for speaking to a living, breathing doctor, right?

Jenna R. Dafgek, MD: Yeah. Hopefully never, but we'll see.

Host: Yes, it remains to be seen indeed. But for today, we know that to be the case. Dr. Ruffing, for families, what signs in newborns, children that are slightly older, adolescents, any age group really for minors, what are the signs important not to overlook, and when should parents reach out for guidance, including when it comes to sick visits?

Kaitlyn M. Ruffing, MD: Yeah. So, you know, we're definitely in the middle of flu season and cold season now that it's the middle of winter and we're happy to address at our clinic, like you said, all ages of pediatric visits for sick visits. Things to not overlook—and I'll start with things that parents should really be thinking about going to the emergency department for would be if a child has increased rate of breathing, so they're breathing faster than normal, or you're starting to see them suck in above their clavicle here or below their ribs; if they're having less wet diapers or less pees than normal, about less than half what they would expect per day.

And then, the other thing I would say is if they're difficult to wake up. So if you're having difficulty waking your child from a nap or from when they were sleeping overnight.

Those three big things would be definitely things that they should be really going to the emergency room for. In our office, we certainly see, you know, all sorts of cough, colds, ear pain, vomiting, diarrhea, fevers, we see twisted ankles and things like that. So, we're happy to see pediatric visits all the way from newborns to adolescents and beyond for any of those sick concerns, especially during this time of year. And we're happy to provide guidance about things that can be done at home to help the child just feel better and get better sooner.

Host: Absolutely. Dr. Eckert, we're talking so much here about providing such a wide range of services. So when you're diagnosing and treating common needs ranging from prenatal care to postpartum wellness, contraceptive planning that was mentioned earlier, everyday pediatric concerns, what's the overall approach to getting a diagnosis and figuring out what direction to go in with care?

Harrison Eckert, DO: That's a great question. I think the most important thing is kind of how we've been alluding to, is just making sure you're building that relationship built on trust and really just establishing a comprehensive intake that the patients are willing to kind of open up and tell everything that's been going on about their symptoms that they've been having. It's not always the most crucial to get a definitive diagnosis at the exact moment. It's just kind of important to make sure we're getting an entire picture together so then we can order the appropriate tests, order the appropriate workup, to then really navigate and figure out what's going on down the road.

Host: Dr. Dafgek, preventative care, fortunately, is something we're hearing more about than ever these days, regular screenings, annual checkups, kind of heading things off before they become a negative issue if possible. So, how do you help families stay on track with things like immunizations, healthy habits in general, ongoing wellness for both women and children? What's your best overall advice when it comes to making sure that all of that is kept on schedule?

Jenna R. Dafgek, MD: Yeah. So, I think, on the patient side, asking, making sure that you're bringing it up. Oftentimes with preventive care, with adults, we think of cancer screenings; with kids, we think of immunizations, vaccines. But those can apply to everyone as well as certain labs we should be screening for in patients.

One thing I am very passionate about is adjusting screenings for patients who are pregnant and had complications. A lot of pregnant patients don't know if you had gestational diabetes, you should be screened more frequently for diabetes than a patient who didn't. We also, in our EMR, which is our electronic medical record, Epic, have a sidebar that has all of our care gaps, we call them. And it's reminders to us as providers that, "Oh, it looks like this patient is overdue for a Pap smear," or "They're due for their Tdap vaccine," and it flags for us to tell them. So, that's a system on our end. And for patients, again, I think just having that conversation. At any point, you can come in for a twisted ankle and get a vaccine that day or schedule a Pap smear if you ask.

Host: Yeah. Often you can kill two birds with one stone, right?

Jenna R. Dafgek, MD: Exactly. Save yourself a visit, and we'll get as much done as we can in one.

Host: Yeah. I was recently at the doctor myself, I can't remember for what, and he said, "Want a flu shot while you're here?" I said, "Why not? Let's do it," right?

Jenna R. Dafgek, MD: Exactly.

Host: A couple of other things. Dr. Ruffing, picking up on that, for those joining us that may be hesitant about preventative care, unfortunately, there are still those, especially maybe some older folks who subscribe to the theory, "I'll go to the doctor when I need it. Until then, I'm not," or "I'm reluctant to." What practical advice or encouragement can you offer them to change their ways and do it before it needs to be done?

Kaitlyn M. Ruffing, MD: I would just say that, number one, we're all here to help and we're here for you. Nothing is a hundred percent set in stone and needs to happen tomorrow. So, I think the biggest first step is just picking up the phone or picking up your smartphone and downloading the app to make an appointment, because we're really happy to talk to somebody about where they are and where they want to be with their health, and that includes pediatrics as well. We don't have to do anything that first visit besides just introducing ourselves, understanding where you come from, from your health experience and where you want to go next. And we really want to support patients in their decision-making and giving, like Dr. Dafgek said. The information that they need so that they can make the best decision for themselves for their health. So, I really just want to say, you know, we're all here for the patients and we want to help them on their health journey.

Host: And in summary here, speaking of appointments, there is availability for new patients right now. So, Dr. Eckert, how can our audience go ahead and make that appointment?

Harrison Eckert, DO: Absolutely. We are definitely accepting patients all ages and stages. Our phone number is (302) 645-3150. Give us a call. We'll get you in with one of our residents, and we're happy to see you.

Host: Well, folks, we trust you're now more familiar with women's and pediatric health services at Beebe Healthcare. Doctors, keep up all your great work and thanks so much again.

Jenna R. Dafgek, MD: Thank you.

Harrison Eckert, DO: Thank you so much.

Kaitlyn M. Ruffing, MD: Thank you.

Host: Absolutely. And for more information, please visit beebehealthcare.org. Again, a reminder, for appointments, you can call 302-645-3150. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of the Beebe Healthcare Podcast.