Cook Children’s Female Athlete program was designed with a comprehensive approach to keep female athletes healthy and at the top of their game. Located at the Cook Children’s Multi-Specialty Clinic in Hurst, it focuses on nutrition, mental health and injury prevention and treatment in preteen and teenage athletes.

Krystle Farmer, M.D., sports medicine physician, dreamed of this clinic which has now become a reality for female athletes.

“We see a lot of female athletes who have specific needs,” Dr. Farmer said.

Injury Prevention

The clinic, which opened this summer, sees many athletes who train intensely year-round, or those who participate in sports with a major focus on weight and caloric intake, such as dancers or female wrestlers.

“The red flags we look for are stress fractures, menstrual dysfunction, and recurrent overuse injuries, all of which can be a sign of energy deficiency in athletes,” Dr. Farmer said.

Referrals can be made to other members of the team including a gynecologist, orthopedic surgeon, endocrinologist, psychiatrist or physical therapist.

The clinical evaluation assesses any acute or chronic musculoskeletal concerns. If needed, a mechanical evaluation can be set up separately at the therapy center to assess throwing mechanics, squat form, muscle imbalance and/or pelvic alignment.

X-rays are available in the office when necessary and the clinic’s athletic trainer, Micaela Lozano, DAT, LAT, ATC, ROT, OPE-C, can provide home exercise teaching and personalized programs during the visit.

Nutrition

Frankie Kindy, Registered Dietitian with Cook Children’s Orthopedics and Sports Medicine, provides individualized nutrition counseling. Nutrition is essential for an athlete to be able to perform their best, but unfortunately under fueling is not uncommon in this population. 

Frankie uses information about the athlete’s sport of choice, current nutrition, level of activity, sleep, and more to give personalized recommendations for how each athlete can optimize their nutrition. Each patient receives a document after the visit with their personal goals and recommendations.

“Sometimes I see higher level athletes who have never had access to sports nutrition training,” Frankie said. “It is important for them to get this information, because athletes have very specific needs. I help these athletes tweak their diets to increase their energy, reduce risk of injury, promote recovery, and overall improve performance.”

A major focus of the program is prevention. Dr. Farmer orders bone density testing as well as labs (vitamin levels, inflammatory markers, and/or hormone levels) when indicated. The John and Tracy Sellers Sports Complex at Walsh Ranch is also developing preventative programs, including an ACL Prevention Rehabilitation Program.

“Our goal is to look at the whole athlete, including mind and body, so that we can get to the root cause of any problems and start preventive care so that our athletes perform at their peak levels,” Dr. Farmer said.

After all, this is a modern classic. So much so that October 3 has become #MeanGirlsDay.

From Heathers to Mean Girls, these ‘rites of passage’ movies have given us insight into the lives of teenage girls. While they may be full of snobs, cliques and at times, cruel behavior, they can’t fully prepare any girl for the reality of social bullying.

Parents, you may know social bullying all too well and not even realize it. This occurs when a group decides to leave someone out on purpose or tells other kids not be friends with a certain child or teen.

But unlike your favorite teen movie, there's not always a happy ending for the kids being bullied.

Social bullying, along with verbal bullying, is often referred to as “mean girl” behavior, said Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Cook Children’s Behavioral Health Clinic in Denton.

She says this form of bullying also includes name-calling, backstabbing, gossiping and spreading rumors.

“When ‘mean girls’ take this negative and aggressive behavior into the world of social media, it now includes cyberbullying, making it even more hurtful and instilling feelings of powerlessness,” Elliott said. “This can be quite painful and has the potential to be psychologically harmful.”

Girls may engage in this type of behavior for several reasons, including:

• Peer pressure.
• Trying to improve their status on the social ladder.
• Excluding those who may be perceived as a threat to their social status.

Regardless of the type of bullying, three elements are generally present:

1. An imbalance of power.
2. Aggressive behavior intended to hurt someone emotionally and/or physically.
3. Pleasure in observing the pain (or assuming there is pain) caused to the person being bullied.

Elliott says your daughter’s response to the mean girl is key.

“All bully behavior is intended to empower the bully, so your daughter’s response is critical – she must be able to acknowledge what the “mean girl(s)” are doing, but also communicate that they don’t have emotional power over her,” Elliott said.

She says if the victim communicates any type of negative emotion (verbally and/or nonverbally) – whether that be pain, hurt, rejection, fear, anger, frustration etc. then she has validated the bully. The bully will only be encouraged to continue the “mean girl” behavior, simply because it empowers them.

Instead, girls should try to respond to the bullies by using select words such as ‘so,’ ‘OK,’ ‘who cares,’ ‘whatever’ and ‘big deal.’

“These words communicate ‘I hear you, but you have no impact on me,’” Elliott said. “However, equally important is the tone in which these words are communicated. It is critical these words are conveyed with NO emotion! If ‘mean girls’ pick up on any emotional weakness, they will continue the negative behavior.”

Another strategy to apply is humor, where you laugh at yourself thus deflecting any hurtfulness.

“It’s important your daughter displays confidence and can defend herself in an assertive manner that is respectful, does not lower her to their level and does not encourage them,” Elliott said.

In addition to having a prepared response, Elliott encourages girls to stay strong, appear confident and smile, primarily because “mean girls” are quite adept at discerning which girls they can manipulate and control. The more confident your daughter portrays herself (not appearing dejected, insecure, hurt, nervous, left-out), the less likely the “mean girls” will repeat their aggressive behavior to her.

Equally important is being a positive bystander. If your daughter sees “mean girl” behavior happening to others, ask her not to stand by and watch. When “mean girls” do not have an audience, they lose power.

To foster your daughter’s self-confidence, help her find areas she can feel success in, such as school, sports, church, community service clubs, or talents like singing or playing an instrument.

You should also monitor her computer and cell phone, and encourage her to spend less time on social media. If bullying expands onto social media, then you need to talk to her teacher, coach or another school official.

While we’ve addressed “mean girls” in this article, no child is bully-proof.

Elliott points to the death of David Molak, a 16-year old San Antonio boy, as an example of the harm that comes from the constant harassment a child receives in the world of cyber bullying. She offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likeable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindness is the best way to break down their defense.

In the end, kids should know they may be the best resources to end bullying where they live.

Stories related to this topic:

• Bullying is a ‘serious public health problem’
• Are popular kids bullied?
• Is your teen's smart phone making them depressed?
• The warning signs of teen suicide
• Cutting: Why kids do it

Extremes in height- short stature or tall stature - further call attention to a person’s uniqueness and may represent challenges for some in everyday life. The judgment of what is normal height can be distorted in a variety of ways including media images, peer groups, and family/cultural backgrounds.

Being short seems to be negatively viewed in the range of height difference. Men and boys, in particular, seem more impacted by short stature with research reports from several decades ago reporting negative psychological and social effects in males with short stature. And while, more recent research calls into question whether or not there is a negative impact, it’s still difficult for many to forget old impressions and stereotypes.

Short stature referrals are one of the main types of referrals seen by most pediatric endocrinologists. While the medical evaluation of short stature is a fairly straightforward process (at least for a pediatric endocrinologist), navigating the family and emotional dynamics can sometimes be tricky. I think offering education to child and family about normal expectations is an essential part early in the first referral visit.

The first and perhaps most important part in short stature evaluation is understanding that a child’s growth and height are strongly connected to genetics of his or her family. In other words, short children typically have short parents.

It is also important before moving further for a reminder of average height for women and men in the U.S.

Average women’s height is 5’4”

Average man’s height is 5’10”

A handy formula used to help estimate a child’s genetic height target (the range of their adult height) is as follows:

Let’s look at two examples to illustrate,

Short Parent Family: Mom 5’0” Dad 5’7”

Height range for son: Middle of target: 5’6”Range: 5’2’ to 5’10”

Height range for daughter: Middle of target: 5’1”

Range: 4’9” to 5’5”

Tall Parent Family: Mom 5’6” Dad 6’1”

Height range for son: Middle of target: 6’0”Range: 5’8” to 6’4”

Height range for daughter: Middle of target: 5’7”

Range: 5’3” to 5’11”

The formula gives a target estimated height with a range of 4 inches above or below the target that will cover almost all children. Still, it’s a wide range when you consider the difference between being a 5’3” woman compared to a 5’11” woman.Knowing a child’s genetic height target range is important in determining the location on the growth chart like the one shown below where most of a child’s growth points should be located.

A child growing below their expected height range needs a closer check. A child progressively falling lower on the growth chart likely needs an in-depth investigation to determine if a problem exists.

Causes of short stature in children are numerous, ranging from normal variations in growth to serious underlying health problems. My first priority when a child is referred to me is to further investigate short stature is answering the following question:

Is the child's short stature OK or not OK?

What I mean by OK is that there is no apparent underlying negative reason for a child’s short stature. There are really only two reasons that fall in the OK category.

• Familial (genetic) short stature
• Constitutional delay of growth

Children with constitutional delay of growth will start off slower in growth compared to other children. They will fall to the lower part of the growth chart in early life which can concern parents and pediatricians. A child with constitutional delay grows at a slower, but normal pace during childhood and early adolescent years and gets the growth spurt of puberty later than average. These “late-blooming children with constitutional delay will eventually reach a height within their family height range.

Answering that initial question of OK or NOT OK can sometimes be difficult. Return visits to monitor growth are almost always a necessity to reassure that “growth and health are OK.”

Key steps in the process of monitoring a child’s growth include a medical history and an examination. The first two steps help me and other pediatric endocrinologists decide both if further special testing is necessary and what kinds of special tests may be needed. Different kinds of special testing include

• Bloodwork
• Radiology tests such as a bone age X-ray or MRI scan of the brain
• Growth hormone stimulation testing

The bone age X-ray is an important tool used by me in the early stage of short stature evaluation. The test looks at the appearance of growth plates in the hand. The growth plates start out in early life with lots of room to grow. The size of growth plates becomes progressively smaller as a child ages. By the time an average child reaches the end of puberty…...

• Girl around age 14 years
• Boy around age 16 years

…….the growth plates are nearly closed, and there will be very little increase in height.

A bone age is a very useful tool in helping me figure out quickly my level of concern and the types of testing which might be done in a child’s investigation.

For instance, look at the two bone age images of a boy’s hand below. The white arrow shows a growth plate located on tip of the finger. A 10-year old boy's hand is on the left and a 15-year-old boy's hand is on the right:

10-year-old boy's hand:  15-year-old boy's hand:

Get to know Joel Steelman, M.D.

Dr. Steelman is an endocrinologist at Cook Children's. He trained in endocrinology at the University of Colorado Children’s Hospital in Denver, where the magnificent setting turned Dr. Steelman into a lifelong outdoor sport enthusiast, with a strong desire to lead a healthy life. On his rare days off, he could be found skiing, mountain biking and trail running. He loves to go back to the Rockies as often as possible, and just a few years ago, he ran the Pike’s Peak ascent half marathon. He continues to run for exercise regularly. 

During his tenure in Colorado, where he met his future wife, Dr. Steelman trained at the internationally renowned Barbara Davis Diabetes Center, one of the world’s largest and most esteemed diabetes medical facilities for adults and children, specializing in type 1 diabetes research. Along the way, he discovered another strong research interest in the area of bone disorders, and Dr. Steelman began to treat children with osteogenesis imperfecta, or brittle bone disease-- a rare, crippling malady. After completing his training, Dr. Steelman left the West to enter academic medicine at Vanderbilt Children’s hospital in Nashville, Tennessee. Over the next seven years he focused on research projects and medical education.

As a self-described ‘techie,’ Dr. Steelman has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to Checkup Newsroom.

According to data released Thursday, suicide rates doubled among girls and increased more than 30 percent among teen boys between 2007 and 2015.

At Cook Children’s, this news comes as no surprise to the behavioral health care workers who see the young adults struggling with depression and other mental health challenges each day.

“It’s not surprising. It’s absolutely heartbreaking, but not surprising,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of Cook Children’s Behavioral Health in Denton.

Since 2015, the number of children and teens admitted to Cook Children’s Medical Center after trying to kill themselves has increased significantly. There’s no data available yet to say for certain how many more of these cases there have been, but it’s safe to say the percentage is in the double digits.

“We see the increase in the numbers of calls we receive from parents looking for help whether it’s for therapy or hospitalization,” said Elliott. “Not only is this a real problem across the country, but it’s affecting families right here in North Texas.”

Elliott says one big mistake parents make is believing that stories like this don’t apply to their children. She says when suicide is in the news, parents should use those stories as an opportunity to talk to their kids and teens.

“Ask them why they think this is happening and if they find themselves wishing they weren’t here,” said Elliott. “You can find out a lot about how they are feeling, and how their friends are feeling.”

Also know that kids may not tell you the truth, even if you ask.

“I think it’s important for parents to be mindful and recognize warning signs of suicide, even if their child denies having suicidal thoughts,” Elliott said.

Warning signs of teen suicide include:

1. Increased use of alcohol/drugs
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved ones goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

Bottom line, Elliott says kids need to understand that problems are temporary, but suicide is permanent.

If you feel your child needs help, please click here to find a Cook Children's Behavioral Health location near you. You can also address your concerns with your child’s pediatrician, psychologist or therapist.

Cook Children's Behavioral Health Center

Growing up in today's world is hard and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. As a parent or a caregiver, it can be hard to know when to ask for help. The Behavioral Health Center brings all services together in an expanded space that will provide a talented, dedicated team of caregivers, physicians and professionals with the facilities, resources, tools and programs they need to ensure that these most vulnerable children receive the high quality treatment they need and deserve. Click here to learn more about an appointment or referral.

Unfortunately, stories of mothers harming their children have become far too prevalent in recent years. But there are often times hints a mom may abuse her child.

Joy Crabtree, Psy.D, a licensed psychologist for the Urgent Care and Pediatric Specialties Clinic in Southlake, said there are sometimes warning signs that a mom’s mental health is unstable or depression may be a concern including increased irritability, loss of patience, quick mood changes, excessive energy or extreme fatigue, and a sense of feeling hopeless or overwhelmed.

More serious warning signs, possibly of psychosis, include trouble distinguishing what is and isn’t real, a sense of extreme suspicion or paranoia, and even hearing voices or seeing things other people don’t see.

At times when psychosis or even an extreme depression is present, a woman can have irrational ideas about her baby — such as that the baby is possessed or that she has to hurt herself or her child. This condition can be extremely serious and disabling, and new mothers who are experiencing these symptoms need medical attention right away.

Women who have other psychiatric illnesses, such as bipolar disorder, major depression or schizoaffective disorder, may be at greater risk of developing postpartum mood symptoms. Any significant changes in behavior or bizarre beliefs require immediate medical attention and, often, a brief hospitalization. If you or someone you know is experiencing symptoms, don’t delay getting medical attention.

“The person who is in the midst of some type of mental health issue likely doesn’t know what is or isn’t reasonable,” Crabtree said. “Family members, friends, teachers, or other professionals in contact with parents need to step in if they feel a person needs help. A child should not be left alone with a parent in crisis. The care of the child then depends on other adults.”

Richard Roberts, M.D., a neurosurgeon at Cook Children’s, wonders what it’s worth for your child to play sports with a reputation for head trauma.

“I think the fact that when the NFL players sued the league initially and won, the judge said the settlement (more than $700 million) wasn’t big enough,” Dr. Roberts said. “That says a lot about this growing issue more so than anything else.”

The issue discussed in the NFL cases has been CTE (chronic traumatic encephalopathy), a progressive, degenerative brain disease that has been found in some athletes with repetitive brain trauma.

Research is currently being done to study just how playing contact sports such as football mainly, but also soccer, can cause damage to an athlete’s head. But is it worth it for parents to wait for the results of this work.

“Amateur sports are different than professional sports because no one is feeding their family with the activity that they are doing,” Dr. Roberts said. We need to look beyond the short term and really understand what could happen in the long term. That potential for long term problems should be the primary thought, not the secondary thought.

“What is the actual incidence? We don’t know. But if it was your kid, how much would you be willing to risk? Even if it was 1 in 10, would you roll the dice on your own kid?”

Dr. Roberts has previously worked at Children’s Hospital in Philadelphia and Charity Hospital in New Orleans. While he saw concussions at the other hospitals, he’s never seen parents argue with him about concussions as he has seen at Cook Children’s.

“Part of what I’ve seen which is different here than other places is that I do get push back from parents who I think underestimate the severity of some of these injuries,” Dr. Roberts said. “Some of it is that they want their kids to play and I think some of it is the short term nature of some concussions.”

Children get concussions and they do well relatively quick, so opposed to having a broken arm which is in a cast or needing surgery and having stitches for three weeks, kids hurt their heads, they are knocked unconscious for five minutes, but then feel essentially better soon after. This apparent sign of improvement makes it difficult for some parents to grasp that their child may have a fairly significant brain injury.

“The more we understand concussions and the more we see people who have hurt their heads for various reasons, soldiers, professional athletes, anyone who has suffered a head injury, I think that we are seeing that in adulthood they are starting to have more cognitive issues,” Dr. Roberts said. “Now the science is not perfect yet. We can’t say to a football player you had three concussions and that’s why you have dementia. We can’t say to the soldier you were exposed to be a bomb blast and that’s why you have dementia because it could be multifactorial. It could be that you have the right genes to make you this way later on. But the percentage seems higher in people who have had traumatic brain injuries.”

Dr. Roberts says parents should be concerned after head injury one. He knows you have to let kids live their lives and be kids, but the brain wasn’t made to get beat up like happens sometimes in sports.

It’s not known for sure that after one concussion, people are more likely to get more, but Dr. Roberts’ suspicion is that it is likely the case.

And when does he have a serious heart-to-heart with the parents and the athlete?

“After two. We discuss no longer participating in the activities which could cause further injury because the likelihood of you having a head injury in your lifetime is still pretty high,” Dr. Robert said. “You are going to hit your head on a tree branch or you are going to fall off your bicycle or someone is going to run into you. You are going to be stepping out of the car and slip or walking across ice and fall down. My opinion after behavior has shown us that you are going to get injuries in a particular sport, you should probably not be playing in that sport because you are not able to protect your head.”

Dr. Roberts has seen strong reactions from both the parents and the kids after being told he or she should quit playing their respective sport. And it’s not just football as most people expect. It’s with the gymnast who has fallen off the bars and knocked herself out or the soccer player who has headed the ball and gotten knocked unconscious.

But football still remains king in Texas – in popularity and in concussions.

So what can be done about it?

Dr. Roberts is not sure there’s a good answer to that question. Building better equipment helps, but then armoring players probably makes them feel invincible and they hit harder. If you take away the facemasks or hard shell football helmets, he expects you will return to the old days – less concussions, but more skull fractures and in the process, immediate deaths on the playing field.

For now, Dr. Roberts wants parents to monitor their kids closely and to take the recommendations from their doctor closely. If they say it’s time to stop – stop!

“All the steps that sports are taking to make it safer are positive,” he said. “I think that everybody involved has to think less about return to play and more about long term health.”

About the source

Richard Roberts, M.D., is a neurosurgeon at Cook Children's. When a child with a neurological disorder requires surgery, the experts at Cook Children's Medical Center offer comprehensive care and state-of-the-art technology. With the help of such state-of-the-art equipment as the revolutionary intraoperative MRI (iMRI), our neurosurgeons are able to determine effectiveness of surgical procedures for cranial and spinal nerve disorders and tailor the treatment to each child's unique needs.

A disturbing trend on social media, the #kyliejennerchallenge, has left some teenagers in pain and not the look they were hoping for … to say the least.

So what is the challenge?”

“Kids suck into a container, often a shot glass, to increase blood flow to the lips, giving them a temporarily fuller, more pouty look,” said Justin Smith, M.D., a pediatrician and medical advisor for digital health at Cook Children’s.

Why should you tell your teenager not to do it? Dr. Smith has a few reasons:

• Pain
• Bruising
• Chapping/cracking – any cracking can lead to infection
• Cuts (some severe) from shattered glass

About the source

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Dr. Greenspan, a pediatric endocrinologist, offers insight on medical reasons for earlier puberty in girls. The co-author, Dr. Deardorff, a psychologist, offers insight into the behaviors and emotions in early puberty.

The book draws on the experiences of  two ongoing research studies and has almost a decade worth of scientific observation with some startling statistics and impacts.

By age 7, breast development was seen in:

• 25 percent of African-American girls
• 15 percent of Hispanic girls
• 10 percent of Caucasian girls

Some of the worrisome impacts of early puberty on girls highlighted by the book included:

• Higher risk for depression or anxiety
• Higher eating disorder risk
• Higher breast cancer risk

Puberty is a normal process in life that eventually happens in the life of every child. It can be an uncomfortable challenge though for a girl who experiences puberty much earlier or much later than her friends. Earlier puberty is a challenge perhaps more for girls because of more visible changes. Emotional changes that accompany puberty occurring early may also be distressing to many girls and their families.

Some key medical challenges in investigating puberty from a medical standpoint include determining the difference between normal early puberty versus abnormal precocious puberty. The authors give parents some guidelines to help guide them on when to see their pediatrician for a check-up.

Clear reasons to schedule an appointment include:

1. Breast development at 7 years old or younger

2 .Pubic hair development at 6 ½ years old or younger

3. Bad acne, moodiness and having an abnormal growth spurt

4. Menstrual periods starting before age 10

Perhaps one of the greatest challenges for me and other pediatric endocrinologists is figuring out the cause of early puberty. There are definitely situations where there is a clear reason for early puberty, but these situations are often rare, leaving the task of finding an answer a difficult one. The book authors tackle the tough question of what causes early puberty. They offer three theories.

1. Obesity effect

2. Endocrine disrupting chemicals

3. Social and/or psychological stresses

Obesity has the longest history as a known association with early puberty. Higher body fat may change the hormone balance in a girl’s body causing the adrenal gland to activate early and produce hormones which cause body odor and pubic hair growth. A portion of estrogen is made by fat in the body; therefore, a higher amount of body fat may lead to higher estrogen levels and drive earlier breast development.

Exposure to estrogen or estrogen-like chemicals has effects on puberty. There is now a lengthy research on natural estrogens, called phytoestrogen. Tea tree oil and lavender oil both have estrogen-like effects and have been linked to breast development in some children. More concerning though than phytoestrogen exposure is the possible effect of endocrine disrupting chemicals (EDCs) on puberty. EDCs are chemicals that have hormone-like effects in the body, including estrogen-like effects.

The authors discuss the unknowns of EDC impact on developing girls, at what dosages, and during which time points might effects be seen? Recent research examining various chemicals in personal care products also adds concern about possible effects on puberty of these exposures.

It is already a sad reality that some children grow up in chaotic homes, and many are exposed to the early images of violence whether in real life or in media. The information offered by the authors on the effects of stress on brain chemistry leading to early puberty was perhaps the most shocking to me.

The book not only explores the why of early puberty, but also gives tips on what parents can do. A whole section is devoted to strategies to avoid or minimize EDC exposures. Practical tips include developing emotional closeness early to aid in talking about puberty and dealing with the rapidly changing moods of puberty.

Early puberty presents challenges both on the part of parents and physicians. Especially with early puberty, the dividing line between normal and abnormal is blurred making choices of investigation and management harder to make. I just purchased the book and am looking forward to the new insights, which will help me better care for the physical and emotional health of girls dealing with early or precocious puberty.

To learn more about precocious puberty, please read  my three-part  series I wrote in 2011:

• Part 1
• Part 2
• Part 3

About the author

 As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices.