13. Visiting the Doctor: Tips from Dr. Kim Hoa Rogers

Hi, I'm Dave Whittingham.

And I'm Kate Morris.And on today's episode we're talking to Dr. Kim Hua Rogers, a medical practitioner, giving her some of our tricky questions about supporting the medical needs of neurodivergent children. We have a very special guest on our podcast today. We have Dr. Kimhwa Rogers joining us.Kimhwa is a medical family doctor and she also has lived experience with neurodivergence. She has neurodivergent family members and she cares for people who come into her practice who are neurodivergent.So I'm really looking forward to picking your brains today, Kim. Welcome.

Thank you very much for having me. I'm excited to chat.

Hi everyone, welcome along and welcome. Kim Hwa. Can you please tell us about your family?

Yeah. Hi Dave. So I have a husband called Lachlan and four children, Adelaide, George, Albert and Eleanor. And they range from 11 down to 5.And I have a very neurodivergent household as well. I am married to a neurodivergent individual and I have three out of the four who currently have a diagnosed condition.

Fantastic. So if we're going to, if we use the word neurodiverse, that would be your household. There's just a huge diversity in there, isn't there?

A hundred percent. And it's wonderful. Wonderfully chaotic, but wonderful.

Excellent, excellent.

That sums up a lot of homes.

And in that time you've somehow managed to become a doctor as well as being married and have four kids and you're in a practice now and seeing lots of different people, I assume. Are you enjoying that?

It has been a fabulous journey. I definitely am. Was I enjoying the whole process of getting through all of the medical training whilst having small children?I would say not completely, but now that I'm out and now that I've finished the exams, it's a wonderful blessing to be able to be a part of different families lives and hopefully, yeah, help make a difference to each person. I see. It's been a great blessing and I'm very grateful to God that he got me through it all.

Excellent.

We're grateful too Kim, because you just have a lovely way of working with families and your listening ear is just absolutely beautiful. And your understanding of neurodivergence is particularly helpful as well.And it's a really special thing when you come across a doctor who has that insight. Getting along to the doctors can be hard for some kids. I'm sure there are some out there who find it not a problem.

But do you have any tips for.

Parents who know that they really need to have their kids at the appointment. But it's a big thing on the mind for this kid and maybe a barrier for them to actually get out the door or to get along.

That's a really good question.And I've had my own fair share of times when my own children who we really have to be at the doctor even to just get that referral to see the next person that we need to see and they just don't even want to get out the door. So I think I can talk from my own experience only. I guess it depends on how anxious your child might be. Some kids prefer a lot of notice.They need days in order to process the fact that they will be going somewhere different to their normal every day. Other kids don't want as much notice because they will always overanalyze and become overanxious about what's to take place.I think social stories generally are especially helpful for some kids. It just kind of takes away that unknown of what is it like to go to the doctors, especially if you don't need to go that often.

So when you say social stories what do you mean there?

Yeah, so either a booklet which actually steps through a trip to the doctors. So there are actually some good ones. I've been trying to find some resources to actually maybe have you guys post a link or something underneath.The Royal Children's Hospital in Melbourne actually has RCH TV and they actually have some videos where there's different kind of procedures or kind of visits and you can actually click on them and watch a child go through that process.Perth Hospital also has some stories that you can print out and a child, you can read through them with your child about what it might look like, how it might feel, what the doctor might ask, what kind of things they might use as they're listening to a heart or checking an ear. So getting your child familiar with those kind of the kind of equipment that might be used can be helpful.A lot of kids or a lot of families seem to have medical kits floating around in their dress ups.Sometimes that can be helpful to kind of play out going to the doctors and kind of help your child to understand that they might need to listen to your heart and even that touch or that kind of someone else needing to do something on them with permission of course.Yeah is helpful so that when they're actually there at the doctor's they've they understand or at least they've experienced what that might be like beforehand.So yeah, think Also, Starlight foundation has some good resources, but I think as much as possible, you know your kid best, but trying to prepare them by either showing them a story of what's going to happen, showing them some of the equipment, if you've got some dress ups around, or telling them about the different sounds and things they might hear, and if hearing is overwhelming, reassuring them that they can wear headphones, they can bring something with them that is a comfort to them and thinking about that beforehand and having maybe a little pack together with some of their favorite things to just make that experience as smooth as possible.

I think that's so helpful, Kim.And that preparation is so important for a lot of neurodivergent kids in We've talked before on the podcast about predictability and the importance of of predictability and how something that's unpredictable can actually give a reaction that causes fight, flight, freeze, react.

And so you can be making things.

So much less impactful by doing these things. But as you say, it depends on the child.

Yeah. Depends on the day, depends on how your morning's been with them.Yeah, you might, everything might be going really smoothly and then one small thing might set something off and you're, you were 15 minutes early and now you're running late. If that happens, I would say, and I would hope that most practices would be okay with you calling up and saying, look, we're running late.My child's just struggling a little bit. We're still coming. And see if they can actually move your appointment or at least just flag to the doctor that you're running late.Maybe the doctor can take in another patient. So you are still going to see them, but they can kind of work around their schedule to make sure that you can still fit in.Because that can be like if you've got them there, you don't want the doctor or the practice to then say, oh, sorry, you're too late, you can't.

Yes, that's right. After all that preparation.

Yeah. So as much as possible. Yeah. Maybe even calling up the practice and saying, I know how much of a struggle this is for my child.You might actually decide to book appointments at a certain time of day.So the waiting room is actually less overwhelming and less busy either first appointment of the day, so the doctor is generally hopefully running on time. Hopefully.Or the first appointment of the second session where maybe everyone's gone to lunch and things aren't as busy, that'll mean that there's less noise in the waiting room. And potentially if lights and things are an issue, wearing Sunnies or something else. If they're. If that's something that's okay on them.Can just help to kind of take away some of that sensory overload that can be present for kids. But that's getting a up to the doctors. Yeah, well, that's good. And then there's a whole other process.

Yes, that's right. And then when you're in the doctors, what sort of things can we be asking the doctor for in order to help them help our child?What sort of things might we communicate to the doctor in order to make it easier for everyone?

Sometimes you may want to start the conversation with, hey, we're a bit nervous about today. Just say we're a bit nervous. You don't have to say you are or the child is. We're a bit nervous.And that's an indication to the doctor to get to slow down and go, okay, you are a bit nervous. How can we make this easier? And then you might step in for your child and you might say something like, well, we don't really love sitting still.And the doctor might go, that's okay. You can run around. They might move things so that the child is able to move around and calm themselves down in the way that they like to.You might say they're really worried about this certain examination.Or you may actually just start with, well, we're here today because we are here for a checkup, or we're here because they've got a sore leg, a sore ear. And then normally what a doctor will do is just talk a bit. They're not going to do anything straight away.We're just going to have a chat about why you're there. And then we're going to decide if we need to do any kind of examination, what we need to do.And at that point you can say, can you just step us through how you're going to examine? And then that. Then the. It's giving the. It's opening up the opportunity.And I hope that as gps or as family medicine doctors, we would actually be explaining that anyway, because that's how we're taught. We're taught to explain what's happening, especially if someone hasn't had something done before.But if we forget, as sometimes we do, being that person as a parent or a caregiver who can step in and say, could you please just explain what's going to happen next, That's a reminder to us to go, oh, yeah, we should do this. Unfortunately, sometimes things need to happen that the child really may not want.There is A point where we will go, we can't do this examination because it's causing too much distress. And that's okay.We may not get the full examination that we want, but a lot of 80% of probably how we should be figuring out what needs to happen is actually just from talking.So if your child can't have the full examination because it's just too overwhelming, then we can make our best educated diagnosis or figure out what we think is the next best step.And we should always be putting in place some kind of safety netting or bringing you back or having a chat on the phone in a couple of days time to see everything's okay.So that's a few things I could keep going on because it's something I'm passionate about and I love to make it a safe place and a safe space because as kids get older they've got different needs and they get into being teenagers and they've got other things that they want to talk about.But yeah, generally speaking, advocating for your child and just asking what's going to happen next is a simple way of helping the doctor explain what's going to be the next step.

Do you have, have you found being a doctor for a little while now does, does relationship make much of a difference as you, as you go on? Because rather than the one off visit.

Yeah.

Yeah. How does that help?

That's such a good question. That's why I'm in family medicine.Because that therapeutic relationship of getting to know particular kids and families really helps then build that comfortable, safe space when you come in to see the gp. But it also helps us to understand who you are as a whole person.And when we understand that there's certain things that you really like and other things that we know you find hard, we will try our best to make sure that every time you come in we can work with those things.And so it is important to try and find a family medicine doctor that is your regular doctor because that I think especially for families where there's neurodivergent individuals or as individuals who are neurodivergent, having someone who knows you and who knows how much explanation you might need for certain things and what you find tricky and what you really enjoy really makes a difference and, and also is helpful because you, I find that you can be better in getting information out because you're more comfortable.The child who comes in initially and is a bit unsure but feels overall like it was a positive experience, the next time they come back, they might say more and they might be able to give us a bit more information so we can ensure that we're getting. Giving you the best information for whatever needs to happen next.So, yeah, I think building a relationship, a good one with your family medicine doctor is really, really helpful.

We've found that that helps too, with. For one of mine, tablets are really complicated and our family doctor just knows that.And so it's like, well, you know, we won't go for the tablet option here. Here are some other options that we can try. And it's little things like that as well, isn't it? Is that it's easier for the child.It's also easy for the doctor to know what steps to try in doing things along the way. Kim, I know that one of your passions is exercise, helping people understand the importance of exercise.And I know that because you've sometimes helped me remember the importance of exercise in life. Can you help with kids just so often overwhelmed and exhausted during the week?How do we help build exercise into a schedule where we know exercise is helpful, but we're also trying to balance with rest and so on? What advice would you give to busy families?

Exercise is really important and to be honest, I love to talk about it, but putting it into practice is actually really tricky. But exercise is important for so many reasons. It's important for our mental health, it's important for our physical health for kids especially.The Department of Health actually has guidelines on. Well, in Australia, we have guidelines on kind of how much exercise would be nice to do, but they're guidelines. So, you know, we all try our best.But in terms of, I guess, thinking about how much movement, sometimes the word exercise itself is a little bit jarring. People go, exercise, but general movement and being outside in nature, sometimes just reframing that is helpful.You go, I can be outside, that's fine. I can move my body, that's cool. But call it exercise and there's this barrier.So maybe, just maybe just calling it movement in your family might work better in terms of why exercise is important. It helps with blood flow for kids. It also is helpful for their ability to their brains to work.Aerobic exercise, especially for neurodivergent children.For those with issues around dopamine, dopamine is lower, but in exercise it actually goes up and it actually can be very helpful for regulating some kids. And some kids just love to move.

That is what is dopamine and what is it? What does it do exactly?

Yeah. So dopamine is, let's call it hormone. It's like a signal in your brain and the more of it you have. It's called like the happy hormone.So the more of it you have, generally it makes you feel more relaxed and more happy and more calm. And we know that neurodivergent brains have lower levels of it. And so that actually is helpful when we are moving our body.The body actually helps create more of it. And so it can actually be a regulating thing for our body to increase its own levels of that happy hormone. I guess you could say.Yeah, but doing it is hard. So just remember that at school, your children will generally have done some kind of movement or will they will have at least been outside.So starting small is probably the goal. Like whether it's that you have afternoon tea outside and you kick a ball for five minutes or you.If you have a trampoline, everyone gets on the trampoline and jumps up and down for two minutes or something small, just achievable. And then often you'll find that once the kids are doing it, they'll probably do it for longer than that time.But if it's short to begin with, then at least everyone will go, well, there's a finish time. And then you won't feel so overwhelmed that it's gotta be. Cause the recommendation is three hours of being outside, moving your body for little kids.And then it's at least 60 minutes of moderate exercise as you get older. But that actually goes very quickly once you're enjoying the activity you're doing. So I guess that's the other key, finding something you enjoy.There's no point in getting the whole family to go on a 5k run when no one likes running.

That's right.

And building in.

These choices are so important. Are you going to be on your scooter or your bike? Are you going to walk, you know where. If we're going to a playground or something like that.Choosing how you're going to move.

Yep.

And building it into the schedules. I like what you said there, that you can do it at particular times of the day. I think that's really important.And it's regulating and so it will help people actually wind down. We walk in our home, we do something with your body and something cold. Because for my kids, cold is regulating.And so sometimes they're able to combine the two.

You can have a drink of cold.

Water while being on a balance board.

Or something like that.

And that's when. Yeah, that's when they feel like they're really maximizing their time.

Yes. And any kid, I mean, this is.We're probably speaking to school age kids at the moment, but kids coming home from school, most of them don't want to talk about their day.They just want something to eat and they want to do something that's going to calm their nervous system from for some of them having had to highly mask or kind of just fitting to the rules of the school day and the school routine because they know that that's what needs to but they've spent all of that energy by the school's finish time and so they actually just need to do something that they want to do that they're in control of that can kind of take away that overwhelm that for some kids is probably there. Even if they're doing really well at school, that doesn't matter.They've probably actually spent a lot of energy just even trying to sit and listen to what's going on or trying to not be overwhelmed by the noise and everyone else talking in the classroom and the transitions that have to happen or the fact that this was meant to happen today and instead something else happened. That's a lot. So yeah, we don't want to probably be asked about what happens in our day straight away either.So yeah, just some kind of outside time with a chill, with an ice block or cold or if someone needs to be wrapped in lots of fluffy blankets and just kind of let be read a book, whatever that is, do that first. So don't try and put exercise at very at the end of like the school day, maybe wait a bit, let them re regulate.But for those kids who just need to regulate and move to regulate their body, let them go.

Yeah, that's right. Kids all have such different needs and as we've said, they change over time.They can change day to day having this communication open with them and working out how to collaborate, work out what they need, help them to make good decisions. It's a lot when kids are unique, kids are changing, parents are unique. Can you have four kids in your family, two adults?So there are a lot of different needs going on. Just outside of being a medical doctor, how do you kind of keep afloat with all of these different pulls on you and on your time?

That's a tricky but helpful question. I guess I don't do it all. I don't think anyone can.And the social media picture perfect lifestyle of I'm doing all these things with my kids all the time is probably not very helpful for me personally. I know that there's only a certain number of hours in the day and there are going to be priorities for each of my kids and my husband and myself.And we just can't say yes to everything. We need to have time where we are actually just chilling as a family. Some of my kids need extra time to do that.So there might just be times when you've got a lot of events that you could go to and you need to learn to say no or not this time. And that can be hard if you've got people who are extroverts and love to be out and about.But you need to value the downtime that your family needs to regulate because a regulated individual is just going to deal with life better. So for me, I definitely try and prioritise what we're going to go to and what we're going to say. Not this time.For the kids in general, we actually choose not to do a lot of things at certain times of year.So they may have played sports at one time of the year for a time, and then they may actually just have more downtime in what is our summer to just be and to choose to do things that they're interested in rather than us getting out the door and going to a certain thing all the time sharing responsibilities. I am very blessed in that I have a husband who most of the time enjoys cooking, so he will do a lot of the actual cooking of dinner.We actually share most of the jobs in the house and we kind of pick up where the other one might be feeling a bit overwhelmed. So having a good support network to be able to go. I'm not feeling it today. No one's ever feeling a hundred percent all the time.You might only have 25% left or even less. You might have 5% after the day you've had. And that's all you've got to get you through the rest of the day.Just acknowledging you won't be able to get it all done and knowing that that's okay. It doesn't make you less. God still loves you and you're still his child. You don't have to do a hundred percent of the stuff all the time.That's very vague and.

Yeah, but no, that's really helpful. But I guess it leads into my next question of how does. How does being Christian affect so on. On your.On your average day as you talk with your children, as you help your children, as you lead your children. How. How is. If we had a camera shining into your home, how.

Which would be good on some days and not on others?

Yeah, yeah, yeah.If we were totally creepy how would we see, I guess, the gospel affecting and changing the way your family operates and the way that you're parenting?

Yeah. So I guess as we believe in who God is and what he did in sending Jesus to die on the cross, we know that we're forgiven. We. That we make mistakes.We know that as parents, we don't always get it right.And I think that as a parent, knowing that I am a forgiven sinner, it's much more easy for me to say I'm sorry to my children when I don't get it right.It might be hard and maybe that doesn't gel with other people, but I feel like it's important when everyone's feeling overwhelmed and dysregulated and things aren't going according to plan and we're not doing our regulating activities as we should. I find then at the times where we're probably at our worst reminding each other of the fact that Jesus has died on the cross. I'm a forgiven sinner.I still make mistakes. But it's important that I say sorry to my kids is probably one way that you'll see that come out in other ways.It might be that when the kids are struggling or overwhelmed with something, we will try and sit down and pray with them about whatever is going on, acknowledging that we might not have all the answers, we might not exactly know what's next, but we know that we can bring everything to God in prayer. And he is a God that loves us and listens to us, and he has our best interests at heart, even if we can't quite grasp what that is in the moment.You'll also see it as we sit down around the dinner table and talk about our day. We try and do a something that made you happy, something that made you sad.So we talk about the hard stuff and something you did to help someone in that day. And then we try and pray and give thanks to God for those things that went well and ask God to help us with the things that didn't go so well.And yeah, reading the Bible as a family, I definitely can't say we do that every night because sometimes we have a really dysregulated evening and things don't go according to plan.But we do try and talk to them about why we do the things we do, what's behind, you know, the choices that we make, why we don't go to something necessarily on a Sunday when it clashes with church, why we bother getting out the door to go to church each week, which actually, for some Sometimes, especially recently, has been a bit difficult because church in itself is an overwhelming, overstimulating experience.Sometimes we've had to sit in the car with our children who just can't get into church, but we still find it helpful and encouraging to be at least in the church grounds, maybe having a conversation with someone afterwards or being at church because we know it's encouraging if we're there, even if it's been a struggle for us to get there. So, yeah, we make that a priority, even though it would be far easier to just sometimes not.We know the importance of meeting together as Christians and being encouraged by each other. So that's another thing. You'll see.You will see the dysregulation about an hour and a half before church starts as we try and, you know, reregulate everyone enough that they can get into the car to then get out of the car to walk into church. And if you haven't experienced that need to transition and how difficult transitions for some people can be, some people just don't get it.But, yeah, knowing that the purpose of why we do these things is because we want our kids to grow up knowing and loving Jesus, even if it's hard, it's worth, worth the effort in the long run because we believe the Bible to be true.

So helpful.It sounds like you set the agenda, you set the priorities and you work towards them, but also with the grace to say, you know what, today it's just not working, or this evening, you know, we're just not getting to those things. But there's still the goals that we're aiming for, which is so different to just saying, this is so hard, we're just not gonna do it.Yeah, keeping the main thing, the main thing, but always with that level of grace. And I love. Sorry, I'm just, I'm loving everything you said.But I particularly liked at the beginning as well, you talked about being willing to ask for forgiveness from your children. I think there'd be so many people out there who would say, I've never heard my mum or my dad say sorry or ask for forgiveness.And you can, you can tell your children that they should be asking for, for. And, you know, we have to teach that.But the model of you doing it and acknowledging your own sin and saying, yeah, look, I've messed up is so powerful and particularly within the messiness of life. I mean, our kids are going to see it all the time, aren't they?Both when we sin, but also things that aren't necessarily sinful, but are just struggles. Life is hard.

Right.

And so being able to acknowledge that with our kids and still model to them how we do the important things and how we make sure that the priorities are the priorities.

Well, Kim, I feel like you have shared so much with us today from the perspective of being a family medical doctor, but also just as being a mum, a Christian woman. This has been really helpful and thank you so much for the encouragement and just I think the boost to kind of we're in this together.Sometimes it can feel like we're. We're so different to other families around us.It's just lovely, isn't it, to just get together and have a conversation and recognize that families might operate slightly differently. But, you know, we've got the same God and the same kind of goals across families that. That can look quite different.So thank you so much for joining us today.

Thank you so much, Kim Hwa.

It's my pleasure. It's been fabulous. And thanks for having me on to have a lovely chat. Awesome.

Absolutely. And we will put those links that you give us down in the show notes so people can check out those resources. But for now, we'll say goodbye.Bye, everyone.