Interview With Dr. Neal Gittleman in Lakewood

When did you begin practicing in Lakewood?

I moved to Lakewood in July of ‘88, so it was more than 30 years ago. Originally, I joined another practice, but I opened my own practice in 1989.

What made you decide to go into medicine?

When I was in elementary school, I liked science and I liked helping people, so I guess that’s where it stemmed from. My parents are not proverbial pushy Jewish parents, but my father did encourage me to be a doctor after seeing my interests and strengths.

Why did you choose pediatrics?

I chose that field because it offered an opportunity to help people and I felt comfortable from a personality perspective with the role models I had in pediatrics. I was also most comfortable with whom I’d be dealing in pediatrics, both in terms of patients and colleagues.

What do you find unique to Lakewood medically?

I don’t know that I have a fair perspective because I came here straight from residency, but I do find that people are interested in top-quality healthcare from a hospital and specialist perspective but they need to travel much longer distances to get it compared to when I was in Brookline, Massachusetts, where I could walk to the world’s best hospitals.

Other unique factors are that here there are a lot of pressures to have children diagnosed and get them back to where they need to be because in many families, both parents are occupied outside the home.

Do Lakewood children get sick more frequently than others?

Again, I didn’t work in other communities, but we have a lot of “repeat performers,” so to speak, and it is known that children who attend daycare are going to have more infections.

It does seem like there’s a lot which can be attributed to the daycare situation and the pressures to get kids back on their feet, or their knees, in the case of toddlers. I think if the situation were a little different, some children who go to daycare when sick might stay at home and there would be fewer germs passed around.

What has been the feeling among patients recently with measles officially termed an “outbreak” in the community?

What we see is a lot of people calling about vaccines to get children updated, including a sizable number of people who might have been vaccine-hesitant previously.

There are also people who are more resistant who have come in at least for the MMR, in part, I think, because of changes in school policies that require it.

Additionally, we have people trying to get information about what to do if there are unvaccinated children in their playgroup or daycare or about family that they’re visiting if they’re going to communities like Monsey or New Square.

What kinds of recommendations do you make about being exposed to unvaccinated children?

I say that it’s something to be avoided when possible. In the statistical sense, it’s the unvaccinated who are most at risk, but you have here a loss of the “herd immunity” so that the small percentage of people whose vaccine didn’t take, who couldn’t be vaccinated because of illness or because they were expecting or who are too young to be vaccinated are exposed when they wouldn’t have been otherwise. It’s not just measles, unfortunately. It’s other diseases as well.

Do you think this is something that was bound to happen?

This is not the first measles outbreak. Boro Park, Williamsburg, and Crown Heights had an outbreak in the last 10 years which Lakewood avoided at the time. If the disease is introduced and people are not properly immunized, there remains that susceptibility and it’s bound to happen. There are those who attribute some of the recurrences to natural trends and fluctuations, but that has been debunked.

Why is the hesitation to vaccinate seemingly more prevalent in our communities?

It’s hard to say, but there are a few people who are very vocal about it. A large part of the public is not familiar with the reality of the diseases or the reality of the vaccines being much safer than the diseases.

Part of the ability to spread this misinformation is thankfully because the diseases are less prevalent. When people think the risk of contracting the disease is close to zero, if there’s even a small risk from the vaccine, people don’t see vaccination as worthwhile.

People have limited ability, time and access to really verify what’s going on and find out the truth about risks, so they are more susceptible to misinformation. This would be a classic study in motzi shem ra and lashon hara; people accept misinformation at face value and become frightened by it and can’t think rationally and make a well-thought-out decision.

I sometimes ask people if they heard about the baby who had a bris and then didn’t walk for a year. People hear this and give me a horrified look. Who knows what they’re thinking?

I made a perfectly true statement (How many babies walk before a year?) presented in a very negative way and people have trouble getting the story straight. Imagine when the situation is presented with lies and distortion, how much more difficult it becomes.

What do you do about reluctant vaccinators in your practice?

For better or for worse, the policy I’ve adopted is that I don’t discharge patients from my practice if they’re not vaccinated because I feel like they’re more likely to vaccinate if they stay.

However, there have a been a few families we have discharged from the practice because when they were faced with situations which presented actual risk, like significant breaks in the skin for which a tetanus shot was warranted, they were not willing to administer it.

Similarly, now, because we have a measles outbreak, we have required that people be vaccinated for it, and if they do not comply, they need to find another doctor.

Is there ever a valid reason not to vaccinate?

There are times not to, and these are delineated in places like The Red Book, which is put out by the American Academy of Pediatrics Committee on Infectious Diseases. But those circumstances are very limited.

In fact, New Jersey state law regarding medical exemptions clearly states that they should only be issued based upon valid medical reasons as enumerated by the Advisory Committee on Immunization Practices or the American Academy of Pediatrics guidelines.

People are getting notes from doctors claiming medical exemptions with reasons which very clearly don’t fit into these guidelines. It’s very disturbing and distressing that licensed practitioners are “going rogue,” as it were.

I have advised the schools that consulted with me not to allow those children to attend during our current outbreak.

What is the most challenging part of your job?

A long-term challenge is trying to educate people as to what circumstances warrant attention within seconds, hours, days, months and years. That’s something I seem to have failed miserably at, but the more that people understand that, the easier it is for us to prioritize.

There can be a time we get a phone call from someone who had labored breathing for three days and never called and we can have someone call several times because a message about a diaper rash didn’t receive a call-back within minutes.

Trying to keep these in perspective is rather challenging. We try to treat each patient as an individual and we understand that everyone’s child is their priority, but we are presented with a lot of children from a lot of different families, and we have to figure out what needs attention soonest.

If you could tell all parents one thing, what would it be?

We’re here to help you, but we need your educated help to help us. When people come in with issues I’m trying to listen to their concerns, but I’m also trying to categorize and prioritize my own concerns. The questions I ask will aim to cover both, especially if the two don’t overlap.

I have to listen to whatever parents have to say because the answers might reveal the real concern, but it’s also helpful for parents to answer my questions even if they don’t think they’re important. The information will help me determine what level of concern needs to be raised and how to proceed with an evaluation or other course of action to reconcile all concerns.

In general, listen to the questions asked when you come in for a sick visit and you’ll know what to look for. In almost every situation, it’s important for parents to know how the child is behaving, drinking, voiding, and breathing.

There’s a reason we’re asking; there’s usually some relevance to the situation.

What is your favorite part of being a pediatrician?

Seeing children growing, developing and thriving to the best of their ability.

Thank you, Dr. Gittleman!