"The Pediatrician and The Parent" with Dr. Jennie Berkovich

Julie Pernikoff: Hi everyone and welcome. I'm Julie Pernikoff, and this is Into Motherhood. And today we have Dr. Jenny Berkovich. thank you so much for joining us. ⁓ Dr. Jenny Berkovich is a board-certified pediatrician and director of education for the Jewish Orthodox Women's Medical Association, JOMA. ⁓ She is passionate about community health education, using movement as medicine empowering parents with tools and knowledge.

Jennie Berkovich: Yeah.

Julie Pernikoff: She lives in Chicago with her husband and four children and is the co-author of the recently published Jewish Woman's Health Handbook, available on Amazon or your local Jewish bookstore. Thank you, Jenny, for being here today. If you could just jump in and tell us a little bit about the book, I think that would be awesome.

Jennie Berkovich: Thanks for having me. Yeah. ⁓ so we're super excited. The book was definitely a labor of love and it was a joint effort by multiple Joma physicians who came together and really wanted to use it as an opportunity to share things that they felt or heard themselves saying on a regular basis to patients, things that they really wanted to like shout from the rooftops to people to either prevent them becoming a patient or things that they wanted to share from a preventative health perspective. So we have A chapter written by an oncologist, by an OBGYN, by pediatricians, of people who work in hospice and palliative care talking about end-of-life issues. And it's things that we sort of said, like if you could record yourself and share the recording of things that you were saying on repeat over and over and over to your patients, can we put that in a book? We found that there's so many ⁓ books on on healthcare, on healthcare various stages of life, but none necessarily from a Jewish perspective. And so that cultural nuance was also really important for us. There's so many unique things about our life and about our life as Jewish women that we felt really didn't exist in a book about healthcare and vice versa. There was really no healthcare books that that applied or ⁓ could be relevant or, you know, were were appropriate to read ⁓ into the types of homes that Jewish women would like to have. And so this was really a a labor in in order to provide that that kind of resource for people.

Julie Pernikoff: That's amazing. Thank you so much for sharing that. I can't wait to read it. I definitely got to peruse it a little bit and I was very impressed. So I'm I'm excited and thank you for doing that for the Jewish community. That's really important. For the Jewish women. talk to us a little bit about your work and how you got to this point, your your work as a pediatrician and now being part of Joma.

Jennie Berkovich: Thank you. Yeah, it kind of found me. So I'm I'm a practicing pediatrician. I always tell people that I if there was like a different way to become a pediatrician, if you didn't have to be a doctor, if this was just like a separate thing, I would have done that. Being a doctor was was a lot of work, but ⁓ it I knew from from the very beginning of my training that I was going to be a pediatrician. And then really during the pandemic, there were a lot of opportunities for community health education. There was a whole whole onslaught of like a tremendous amount of misinformation. And that's when I really started to get interested in what are different ways and pathways to use the work that I was already doing and use the knowledge that I already had in order to empower others and to combat the large amount of misinformation that was happening on the internet, on social media, in in all sorts of ways. And that's really when I got involved with JOMA. So I'm now the director of education. And what that means is I really oversee a lot of our community health content. We work with communities all over the United States, but primarily in the Northeast. And we do things like put out a book or do lectures or have webinars all about different topics in healthcare that may be interested both to healthcare providers and also just lay community members, really as a mechanism to combat the amount of misinformation that's out.

Julie Pernikoff: Wow. That's amaz first of all, that's very important. And we're definitely gonna address some of those things tonight. Some things that I might be misinformed about, I'm gonna ask you. ⁓ and but I'm I'm wondering though, like what your main job is with Joma, or are you also a practicing pediatrician elsewhere? How does that work?

Jennie Berkovich: Great question. So I'm a full-time pediatrician. I work for DOMA part-time. I actually got involved through DOMA as a volunteer. So if anybody's listening that is either ⁓ like in training to be a physician or already a physician, we're always looking for more members. DOMA has like two main pillars. So one pillar is mentorship. It's empowering women who are in the training process ⁓ to join this network of people that can speak to and ⁓ mentor and the unique experience of what it's like to be a Jewish observant woman going through training. And then the second pillar is like the part that I'm involved in, which is the community health and education piece.

Julie Pernikoff: Wow. Wow. And and then where the so that's your part time? So then where's your and where's your full time work?

Jennie Berkovich: ⁓ my I I live in Chicago. My full time work I I practice actually also in Chicago in person, part-time. I work at a local clinic. Shout out to Midwest Rafua where I see patients. And then I actually have a full time job. I work remotely for ⁓ a telehealth company where I I I do school based ⁓ telehealth.

Julie Pernikoff: Wow. Okay. So you have so many areas of expertise. I'm so excited. I'm I'm so thrilled and I'm so excited to learn more about you and to for to hear more about you. ⁓ and your thoughts on on matters that are so important to moms and women everywhere. ⁓ if you can talk to us a little bit about just personally, 'cause you said like, you know, if you could have done this even without being a doctor, what drives you? What led you to this from a personal perspective? And what continues to drive you?

Jennie Berkovich: So I was a mom before I was a doctor. I had my my first, who's now, you know, she's my oldest. I had her when I was still in medical school and I was fairly young. And I definitely appreciated ⁓ the overwhelm that came with being a new parent, with being a a young parent, but not even necessarily the age. It was just like being a new parent. If you've never done this before, it is so crazy and overwhelming. And the fact that they just like give you a baby to take home from the hospital with like nothing but a you know, thoughts and prayer and wait from the nurses, I think is insane. And it it was really hard. It was definitely a struggle. And I my pediatrician was a great source of hizo and a great source of support for me during that time. And I and I always remembered that and appreciated it tremendously. And so I strive to to be a little bit of that for for families.

Julie Pernikoff: Yeah. That's so nice. I love my pediatrician also and I I'd love to hear that ⁓ that that's what inspired you because I think that's an that's an amazing thing. That's special. ⁓

Jennie Berkovich: It's really important. It's really important. I feel like we tend to like minimize the like overwhelm that comes with with new parenthood. and yeah, the the amount of misinformation that's out there I think also sort of like adds fuel to the fire and it can be very stressful and confusing.

Julie Pernikoff: Yeah, to say the least. Literally. So let's try our best to start right off the bat with combating some of that, ⁓ clearing things up for people. what can a mother expect right from the get-go with ⁓ taking her baby home? Even before that, actually, when she's pregnant, do you think that a woman should ⁓ Interview a pediatrician's office beforehand and then take us through that experience of starting off, you know, the baby on their first appointments. What is what does all this look like?

Jennie Berkovich: Yeah. So pre prenatal appointments, that's what they're called, are fairly common and one hundred percent normal. They're also not necessary. So if you're someone's living in a place where they they know who their pediatrician is going to be or either limited by their insurance and they're kind of like stuck and they know there's not gonna be an option, it's not mandatory for you to meet your pediatrician, but it's absolutely welcome and pediatricians are very used to having prenatal visits where it's sort of like an informal meet and greet with the family. And the actual doctor, and that may be something that a a a parent or an expectant parent may just feel really comfortable doing to give them peace of mind. So things that are important to ask for your pediatrician, you can ask them these types of questions. What can I expect on the first couple of visits? ⁓ how do you approach ⁓ advising breastfeeding versus formula? How do you hold regarding vaccine schedules? ⁓ do you have an easy way for me to contact you? How do you deal with questions, right? Can I use the patient portal for questions? Can I call you and and is it reasonable for me to expect a call back or is every question automatically going to require an appointment? The qu the answers to all these questions are going to be very different depending on your practice, the size of the practice, even the location. Some of this is mandated by state law and some of it isn't. And so it's really I just find it sometimes helpful and empowering for somebody to know the answer to these questions before the baby's born. Once

Julie Pernikoff: Absolutely. Yeah, sorry, go ahead.

Jennie Berkovich: The baby's born. So those are all like the pre-questions, right? Once the baby's born, hopefully, Mrs. Shem, everything's good. We go home from the hospital the same day ⁓ as mommy's going home. Sometimes that's not the case, and baby has to stay a little bit longer, whether it's the nursery or the NICU. Once the baby is home, we usually like for there to be a follow-up appointment with the pediatrician within 24 to 48 hours. Sometimes that makes people very, very stressed out. And I totally get it because I know what it's like to have a fresh newborn at home and your life is completely upheavaled. And now you have to like take this fresh little baby, you have to slap them, you have to like, depending on the season or where you're located, like put layers on, put them in the car seat for the first time. That exit can be very overwhelming. So sometimes people don't want to go to that first appointment. But I really want to emphasize the importance. One. We do expect for babies to lose weight within the first seven to ten days of birth. And it's important for us to trend that. We expect weight loss, but there's a certain amount that we're comfortable with and a certain amount that we're maybe gonna want to intervene on. And so even getting ⁓ a a length and a weight can can be very can be helpful for a pediatrician and for a family's care. But it's also the first time where you're seeing the pediatrician with the baby. So you they're gonna Good exam, and they're also hopefully going to be able to reassure you on some of the things that are maybe of of concern to you and answer some of your questions. Depending on how that first visit goes in terms of weight, you may not need to be back in that office for another two weeks. But sometimes, especially babies who are first babies, right? So first-time parents, you may end up going to the pediatrician a little bit more frequently within those first two weeks for recurrent or serial weights to make sure the baby's gaining weight again. ⁓ weight appropriately and it's it's likely that you'll have a lot more questions that come up at home. And so we really want to make sure there's adequate space and time to address those. Make sure feeding is established, where at this point you're deciding if you're going to be breastfeeding or doing any component of formula. All of those are very nuanced and you deserve families deserve appropriate time with their pediatrician to make sure all those questions are addressed.

Julie Pernikoff: So how do you guide mothers and and fathers, parents on that feeding experience? Because I think that I I feel like that is one of the very first big challenges because you're talking about weight and that has to do with feeding. And then that's gonna bring in the loaded topic of Fed is best, or you know, ⁓ whatever way that a mom wants go about that or can or is striving to like all of it. How how do you address that? How do you guide them?

Jennie Berkovich: I really I first of all it's tough and I wanna like validate that it's super hard and super stressful. The first thing I like to do is like take the stress out of it. I for sure for sure hold that Fed is best, but I also really, really want to support a a mom's goals. And so if a mom comes, if a family comes and says, I really want to breastfeed at all costs, like I will support that. I'm not going to discourage and I'm not gonna say, Don't drive yourself crazy, just give formula. There is a certain place for that if I feel that the mom's mental health or even physical health now is going to suffer because she's so committed to to breastfeeding. But if someone's very committed and they're doing it in a balanced and safe way, my job is to support that. And so then we work together to say, okay, how can we optimize breastfeeding? What do we need to do at home? What support systems can we set up in order for you to be able to do that successfully? And then we bring the baby in to make sure that weight gain is happening appropriately. Breastfeeding has to be mutually beneficial. So that means the baby has to be benefiting, the mom also has to be benefiting. So if at any point we're at the point where that's not the case, and either mom is in danger, either because the mental load is too much or because physically it's it's unattainable, or the baby's in danger because now we've lost so much weight. I'm starting to worry about the baby, then we start talking about supplementation. And it doesn't have to be right, it's not a binary decision. It's not breastfeeding or formula. There's absolutely a place where those two can coexist very beautifully. And I would say actually the majority of my patients fall into

Julie Pernikoff: Wow. That's amazing. ⁓ my gosh. There's there's so much there. Like there's there's so much I think that a mom might end up struggling with in terms of the feeding piece. And I love that you said that you try to take the stress out of it. How how do you do that practically? Because there is so much emotional energy there.

Jennie Berkovich: For sure. I mean a lot of it is I just validate to say, like, I know this is hard. It's if it feels hard, it's because it is. It's not supposed to be like an easy, breezy experience. It's okay if this feels hard. So I think just hearing that sometimes can be really helpful. And then I also like having a concrete plan. So I'll never send someone home to be like, Keep trying, you're doing great. unless they're really doing great and I'll just say keep doing what you're doing. But if there's challenging challenges there, I like to have a concrete plan. I like to say, Okay, we're gonna have a lactation consultant come. And they're gonna talk to you and they're gonna see if there's a way for us to optimize the latch. And then I'm gonna bring you back in in a week. And if we're still not within this appropriate window of weight gain that I want, then the next plan will be this. And then I'm gonna have you pump. And then we're gonna see how much you're pumping, right? There's like sort of a stepwise approach to this. And I find that having a concrete plan for a mom to sort of like look at and say, okay, I know there's a plan if if this and that, if this then that. that sometimes can just take the stress out of it because a lot of the stress I think comes from uncertainty and being scared.

Julie Pernikoff: Definitely. Absolutely. Speaking of, I think, ⁓ uncertainty and some fear, ⁓ I I'm wondering how you might handle when moms themselves, aside from the feeding and aside from the ⁓ baby, even are are handling, you know, any post birth challenges emotionally or physically.

Jennie Berkovich: So it's really tough. And we do screen for that. So postpartum depression, postpartum anxiety, those are all things that pediatricians are asking about and screening for and looking for. And so ideally, a pediatrician's office has resources that we can refer mom to when we identify that those are the case. I would say from a practical perspective, we ask about support systems at home. We make sure that mom is able to physically care for herself in obviously very, very extreme situations if we feel like the mom or the baby or anyone else at home is in danger, then we have to have like, you know, more more of a social services involvement. Thankfully that is not as common. Certainly happens, but not as common. And so a lot of it is just making sure that mom mom is doing okay and having resources to offer her if that's not the case.

Julie Pernikoff: Yeah, yeah. What's one I guess one line of chizuk that you could give to moms, you know, in terms of that?

Jennie Berkovich: It gets better. It gets better. Like I always tell people that it if it sounds hard, it it is hard. It's okay. Like ⁓ just hearing that like it's not supposed to be super easy, I think sometimes can can help, especially when you're dealing with babies who cry a lot or colically. Remember, we're dealing with an extreme amount of sleep deprivation on top of taking care ⁓ and keeping alive like a brand new human being. And so this is like one of the most stressful experiences that anybody will have in their life. And so I think we

Julie Pernikoff: Yeah.

Jennie Berkovich: We probably like minimize that a lot as a society. And so I like to remind people like this is a very big deal.

Julie Pernikoff: Do you find that the stress for the mother and I mean obviously hopefully the father is, you know, dealing with the emotional burden too, but a a lot is gonna be on the mom. Do you find that it gets compounded by multiple children? Do do things change as they bring in more kids? Or is it like the first time is the biggest one?

Jennie Berkovich: Oui. I will I probably have to say that for the majority of parents, the first time is the hardest. There there's a different kind of hard that comes into play when you have to deal with sibling dynamics and taking care of another child in addition to the newborn. So it's not easy, it's a different kind of hard, but there's a very special kind of hard when you're doing it for the first time and you don't know what to expect. So remember we said fear and anxiety, all that comes from uncertainty. It's a little bit like the edges, a little bit taken off, I find with.

Julie Pernikoff: Mm-hmm.

Jennie Berkovich: like multiple kids. ⁓ so th the first one I think is really tough.

Julie Pernikoff: Okay. Okay. I think that's very validating for people. ⁓ so as as we move forward in the baby's life and in now in the mom's life and journey, we're eventually gonna hit vaccines. And I would love for you to just let us know how you feel about it. What are your thoughts? How what are some challenges that you've encountered with moms and and how can parents wade these waters, these confusing waters?

Jennie Berkovich: Yeah. Super tough. So first I just want to emphasize emphasize with how hard and confusing it is. And I definitely have seen a shift like post-pandemic of vaccine hesitancy, of families not being comfortable where they maybe were before. And I think it's completely valid given the tremendous amount of like confusion and misinformation everyone sort of had to experience during COVID. ⁓ I I will say that what what I share with my with my patients and how what I

Julie Pernikoff: Yeah.

Jennie Berkovich: hold for my own family as well is that the recommended vaccine schedule, safe, effective, and has been proven over and over and over again to be the absolute best tool and resource that we have for preventing ⁓ infectious diseases, serious, serious infectious diseases in a very vulnerable population, babies. ⁓ and so I'm very grateful that we live in a time where we have these vaccines and we are unfortunately due to the vaccine hesitancy are now seeing a reemergence of diseases that we we had functionally eliminated. ⁓ and that's that's something that's very scary for me, both at an individual level, because I have a newborn who isn't old enough to have some of these vaccines and now she's unfortunately at risk for things like measles, but also from like a population health level and looking at society as a whole and really starting to think about what is what is pediatrics going to look like and even five, seven years when we're seeing a lot of the diseases that we really haven't heard of in a very long time. So I know it's I know it's scary. I know there's lot of misinformation, but I really, really encourage families who are confused or scared or have any doubts to have really open and honest conversations with their pediatricians. It's not annoying. This is what what we're here for. I'm very comfortable and happy when patients bring me or families bring me ⁓ questions or they bring up things that they've read on the internet. And say, hey, is this real? Is this true? Should I be worried about this? And we can talk about it. Nothing is risk-free. So I never tell everyone like a hundred percent this is the right answer. But I think it's really important to feel comfortable and empowered with the with the information that your physician gives you. And when you're seeing things in other places, the internet and social media, like by all means, write it down. If it's confusing, if it's scary, if it if it sounds terrifying and you think it might be true, please bring it to us. Our job is not to make you feel bad or to judge you or to minimize these concerns in any way. It's really to go go through what you're seeing and help you figure out like what's the MS, like what is real and what's a real concern and what's something that somebody just made up.

Julie Pernikoff: What is what's something that you've seen people bring in ⁓ as something that might be have been made up or just not true?

Jennie Berkovich: I think the biggest one I see that can be very confusing is that vaccines can trigger ⁓ like some some sort of massive reaction in your body. And it's going to make a child regress in development. Right. So the biggest ⁓ I think myth that everyone's unfortunately very familiar with is association with the MMR and autism that I think notoriously, famously has been mis misproven, not just that, the person that made that claim admitted to making up that claim, but that gained a tremendous amount of traction. And so now people like to link vaccines with like developmental regression. And so they think, ⁓ my gosh, like my child is perfect and developing on time and is beautiful and talking and smart. And then we're gonna give us a vaccine, I'm gonna lose it all and I'm going to like, God forbid, have a child who's developmentally ⁓ delayed or neurologically devastated. And that is a terrifying thought.

Julie Pernikoff: Mm-hmm.

Jennie Berkovich: And so I really spent a lot of time with families going through why that's not the case, why somebody may claim that's the case, why sometimes we see that happen because there was there was an underlying issue where anyway that child was going to del ⁓ have loss in development or have my loss in milestones for another reason. And because of the way that the vaccine schedule is, we sort of like have the two happen at the same time. So they're associated with each other from a timing standpoint. They're correlated, but they're right, it's not a causative relationship. ⁓ and so some that's that's why sometimes people claim that like the a healthy, you know, 12-month-old got an MMR and the next day they weren't talking. And obviously you're gonna link the two because my goodness, who wouldn't? But it's important to recognize that that child unfortunately that would have happened anyway. It is a unhappy coincidence that the timing fell out as after the MMR vaccine, but the one didn't cause the other. And so I think there's a lot of like things like that where you hear like something happened after the vaccine. And I would never invalidate someone's experience and say, no, it didn't. It didn't happen. Of course it happened. They saw it happen. But what I really want people to understand is that the vaccine didn't cause that thing to happen.

Julie Pernikoff: Mm-hmm. Mm-hmm. Wow. Wow. Definitely a scare. It's definitely scary. Like if, you know, if something happens the next day, like of course you're gonna be searching. What what was it? What what did it? ⁓ can you break it down for us for a second? Like at the risk of sounding silly, what exactly is going on with the vaccine? What is it? Like what's ha what's being what's in that needle? What's happening to the baby?

Jennie Berkovich: That's a great question. That's not a silly question at all. So there's basically two categories of vaccines in terms of the routine childhead vaccines that we administer. So the most common category are inactivated or dead vaccines, which is basically we took a form of the virus, we manipulated it so that it looks like the actual virus. So let's take polio. We took the polio virus, we changed it, we made it so that the body, when it sees that. Shape is going to say, ⁓ poliovirus, let me make antibodies, let me proliferate the immune system so that when I see this again, I will react to it and not allow this virus to infect the body. It's an inactivated form, right? So we be as a mechanism of the change that we made to the virus, it is not the poliovirus. This inactivated form cannot give someone polio. It is impossible. It is an inactivated vaccine. We took the part that makes someone sick and we threw it away. The body doesn't stop, the body doesn't know that. They see it sees the virus, it develops immunity to it. And if that person ever comes in contact with a real poliovirus, now we have antibodies in order to fight off that infection. So that's most of the vaccines. We have a couple that are not inactivated, they're alive vaccines, MMR being one of them.

Julie Pernikoff: Mm-hmm. Okay.

Jennie Berkovich: Chicken pox, cervic salad being another one. And those still have a component of the virus in them. And so the mechanism is the same. The body recognizes that this is a virus. ⁓ this is what measles look like. I'm going to develop immunity to measles. So when I see measles again in real life, I will be able to fight off the infection. The difference is that live vaccines still have a very, very, very small chance of causing. Let's say a very minor reaction in the body that mimics the actual disease. And so at a very small percentage of people who get, for example, the MMR vaccine, some time later, some delayed amount of time later, sometimes they'll develop a rash that looks like measles. They don't have measles, they're not going to get sick from measles, but they have like an outbreak, let's say, of this type of rash that mimics measles. So that's the part that's important to understand. The critical piece though is the risk of that happening is much, much, much less than someone getting very sick from actual measles, which is why we still go go go forward with these types of vaccines. So that's like sort of the vaccine vaccinology 101 of how our immune system recognizes a vaccine, teaches the parts of our immune system to fight off the virus if it if it ever comes in contact with it out in the

Julie Pernikoff: Wow. I never heard the breakdown like that before. I I can't even believe it's the first time I'm hearing that. I mean, I don't know if that's because I just never really asked before, or I think I just assumed I knew and I didn't quite know it like that. That was amazing. Thank you. moving into the direction of kinda kind of jumping back when we were talking about ⁓ the Fed is best, the, you know, babies,

Jennie Berkovich: Great.

Julie Pernikoff: different ways of eating, if it's formula, if it's breast milk, ⁓ and then talking about lactation consultants. moving a as we move along, there's gonna be a lot of consultants that can come into a child's life ⁓ through the mother ⁓ or father that maybe they're speaking with and they they might end up ⁓ having slightly different ideas than what the pediatrician has. ⁓ and sometimes we might see this with, you know, I I d I just want to be careful in the wording because I don't want to put them at odds even in the sentence, but there's gonna be different theories sometimes f with let's say an occupational therapist or physical therapist about development ⁓ versus maybe the pediatrician. how do we and just a a practical example, let's say like the physical therapist might be a little more concerned about certain developmental trends, ⁓ to use that word ⁓ from before. And then the pediatrician might say wait and see, things like that. How do parents need to go about that? What's the best way to go about that? What what are your thoughts on the matter?

Jennie Berkovich: Yeah, it's super hard. I'll tell you, I don't think I fully appreciated like this tension and the challenge of navigating this tension until I was on the parent side and I had a child that I was worried about their development. My pediatrician was not so worried. ⁓ we got this child into physical therapy th physical therapy and the physical therapist was extremely worried and and was thinking, My goodness, like how did you even let this massive delay like you know, how how did you wait as long as you did? And so that's when I really started to recognize, like, wow, this is like diametrically opposed to even what I'm thinking, and certainly what my my pediatrician was like, it's fine, it's gonna be okay. So first, yes, it happens. I think the why is a little bit more complicated. ⁓ I think that when I I'm not a physical therapist or a therapist of any kind. So I can't speak to the training that they have or the literature that exists in their field, but I'm confident that it is high quality. ⁓ There's a reason that these fields exist and there's governing bodies and boards and all sorts of things. But I also want to recognize that it is different from the training that physicians receive and the literature that exists in our fields. And so it's okay that those don't 100% match up. I think the problems arise when therapists recommend therapy that isn't necessary and has a risk of being harmful. So what do I mean by that? How can physical therapy ever be harmful? So physical therapy requires resources. It requires time. Sometimes it requires money. And sometimes families don't have one of those two things or or don't have either of those things. And so I'm very careful when I'm seeing somebody who I'm not concerned about, but the family was either evaluated by a therapist at school or maybe a self-referral and therapy was recommended. I always tell the family, like, you have my blessing. Like, go, I I don't think it's harmful to get therapy, but This may not be like a great use of resources. And if those resources are limited for you, I'm okay with you holding off. And then I'll I'll support the family with whatever they want to do. If they're super worried, like I was super worried, then I'll say, Great, I'll support it, I'll sign off on it. We I'll follow up with the physical therapist. But just keep in mind if it ever gets too much from a medical standpoint, I'm okay with you guys not pursuing this. That's sort of how I navigate this. And I I would say,

Julie Pernikoff: Yeah. Thank you.

Jennie Berkovich: Most of the time, depending on where you live, if you have like state supported therapies, like early intervention, et cetera, then you know it's a family who just will have peace of mind if their child is enrolled enrolled in therapy and they have those services covered, great, amazing, live your life. But if if resources are tight and now we're going to be using limited resources for something that may not be necessary, that's when I sort of caution families to pursuing something that they may not.

Julie Pernikoff: Wow, I think that's a that's really interesting perspective. I actually I used to be a teacher. ⁓ I was an early childhood teacher, and we saw a lot of therapists come in and out of the room and we would talk to parents a lot about ⁓ therapy for children. And I think that being a parent now, I also my perspective also is a little different, ⁓ or just you know, nuanced. ⁓ and I think that your wording of, you know, limited resources that there's ⁓ A a market there for not from the therapy perspective, but just in general, that you know, parents are targeted for a lot of different things, even therapy aside for a second, because I I value therapy very much. ⁓ but there's also it also just comes down to like baby gear and you know, you need this, I don't know, this vitamin to give your baby this. So then all the more so all the more so with therapy, you're like, ⁓ my gosh, of course you want to do the right thing.

Jennie Berkovich: Yeah.

Julie Pernikoff: So I love that you're I I really appreciate that you're going about it with them. Like if you're able to, great. And if it's a challenge, let's go about it like this.

Jennie Berkovich: It it it can be very predatory. One thing that I don't love, which I'll say I don't love, is like the screening 'cause you mentioned you were a teacher. So what I've seen sometimes is like whole screenings that happen, like a a whole classroom or you'll get a letter or something from school or from a teacher to say, like, tomorrow we're having occupational therapists come and like screen all the kids. I I don't love that. I d I don't love that. And therapists will not agree with

Julie Pernikoff: I've never seen that before. I just wanna say I never saw that.

Jennie Berkovich: I I don't love it. I don't think there's a place for general screening. I think if we're screening, we should be looking for something. And if we're screening, we should have a a concern and then screen and not screen and then identify that concern. I I do find that a little bit predatory. And so that's the one thing I I caution against that I'm I'm not a fan.

Julie Pernikoff: And then a concern. Yeah. Right. Absolutely. I had never heard of that. That's very interesting.

Jennie Berkovich: Yeah. Maybe it's just a Chicago thing. I don't know. We have it here.

Julie Pernikoff: I don't know. It's yeah, listen, we learned everything, you know. it it so interestingly enough, the the my next question is about advocacy for parents. It sounds like you're a strong parent advocate in general. How do you empower parents to be their own advocates? ⁓ in a in a in a in a confusing time. They they they need your help, but they also need to utilize their own ⁓ abilities. How how can they do that?

Jennie Berkovich: Yeah. So for sure, ask questions. I think that's the number one way to empower yourself is ask questions and make sure you understand not just the what, but the why. If you don't understand why you're getting a treatment, why you're we why we're getting a workup, why we're not getting a workup, it's it's okay to ask. And if you are getting pushback from your doctor or they're not answering your questions to the ⁓ amount that you need to your satisfaction, I would say that's probably not like a good relationship. I would support like seeking

Julie Pernikoff: Mm-hmm.

Jennie Berkovich: Seeking a different practice that will be able to answer all your questions. At the same time, our time, unfortunately, appointments are limited. Depending on the practice, you could have each as little as five minutes per visit. And sometimes it's not realistic for us to answer all of a family's questions. And so I think again, depending on your practice, we have a patient portal that sometimes you can send questions into. And then there's like a triage system where you have a nurse or a medical assistant or someone else.

Julie Pernikoff: Yeah.

Jennie Berkovich: kind of help help the doctor answer the questions and refer some of the more complex questions to the doctor. ⁓ places to do research, I think that's where it gets really, really tricky because now there's like a million places to look and how do you know you're getting the the right thing? So I think using ⁓ tools like AI, like Chat GPT and things like that, I love asterisk. Use them, I think, to like help you get your thoughts together, clarify like your

Julie Pernikoff: Yeah.

Jennie Berkovich: your your concerns and so you can be organized and not be scrambling and frantic in the office when you're asking questions. I worry about using those tools to like get information from because there's there's there's a lot of fakeness out there. Chat GPT famously makes stuff up. ⁓ I have experienced this myself. So that's not that's not something I I the example I always give is

Julie Pernikoff: Right now. Really?

Jennie Berkovich: I once had to, I was doing like I think a podcast like this or I needed I needed my bio for something and I couldn't find like my standard bio and I was too lazy to write one. So I I put into Chat GPT and there's like a lot of information about me online. Like my my bio is very public and so I thought like, okay, this will be fast. And it totally made it up. It made up where I went to medical school. It made up, ⁓ I think it what Joma stood for, it made up. It it made up some other thing. And that's when I was like, gosh, I can't can't trust this because it didn't even like get my own my own stuff. It's so scary. So that's why I don't love it for like asking questions, but it's definitely, I think, can be like a good thought partner to if you're feeling, you know, stressed or overwhelmed or your child is having a work up or something and you're like, What are we doing? What is this blood test for? Like ask chat to organize your thoughts. So the next time you talk to your doctor, ⁓ you you sort of have have it a little bit together and

Julie Pernikoff: So scary.

Jennie Berkovich: write stuff down during the appointment. That's the other thing I would say is that I know we talk a lot. We tend to talk really fast because we have limited time and ⁓ sometimes that can be really overwhelming. So write stuff down or ask for a copy of the visit summary afterwards. Make sure that you if there's a patient portal, you'll be able to see a copy of all this later in the patient portal. Like I I think leveraging all those tools can be really beneficial.

Julie Pernikoff: Absolutely. I th and I think also what you mentioned that some there's pe there's somebody fielding the questions a lot of times. Like once they are in touch, I think that's also really important that they know that there's like recourse, like there's someone they could bounce back to if they forgot something, maybe they could re-ask.

Jennie Berkovich: Yeah. It depends on the practice. So I if someone's listening to be like my doctors don't do that. ⁓ for sure. Not every doctor does it. And that's why if you need a place like that, if you have, let's say, a medically complex child or you know you just you just have a lot of questions and and that's okay, you also want to make sure you're gonna be in a place that can support

Julie Pernikoff: Yeah. Yeah. That's definitely something I think that's a like a widespread phenomenon at this point that the pediatrician is for the child but also for the parents ⁓ in many ways. So you want them to be a fit. ⁓ you you touched on this, but I want to just ⁓ go into this a teensy bit more about getting a second opinion. How how practically how can they know even not even just like based on their comfort level, but maybe like for a medical issue? How do they know if they need to go see another doctor and maybe speak to someone else?

Jennie Berkovich: Yeah, I would say if you are thinking about it, if you have doubts, if you aren't convinced, it is never ever wrong to want a second opinion. Ever. And it's always okay to ask for one. I have had families tell me if I'm let's say managing their anxiety or depress child anxiety or depression. And as far as I'm concerned, things are going great. And the family would be like, C can you send us to a psychiatrist? And I'm like, sure, no problem. But can I ask why? We just want a second opinion. I said, ⁓ I thought everything's going great. Why do you want to see someone else? We just want to make sure we're on the right track. Great. Totally valid. I see no problem with anybody ever getting a second opinion. I don't take it personally. I don't think it's offensive. It's part of, I think, parents advocating for themselves and for their kids. And so I think if if you have it in the back of your mind, like, I don't know, I'm not so sure. Maybe I just want to hear from someone else. And that's never ever wrong.

Julie Pernikoff: Yeah. Okay. Wow. It's it sounds like it sounds like also you ha like you have that experience even as a parent. Like you're you're it's it just sounds like from what you're saying that it's you you know the experience of both sides.

Jennie Berkovich: Yeah. I think ⁓ you know, I always say, I don't think you have to be a parent to be a good pediatrician. In fact, I know two like fantastic pediatricians just off the top of my head that are not parents and I would trust my my kids with them. But I think ha being a parent gives you an additional, I think, perspective where and sometimes like my my patients will hear me say this. If they ask me a question, I sometimes I'll say, Okay, I'm gonna give you my doctor answer and then I'm gonna give you like my my mommy answer. And sometimes they're not the same. ⁓ and so I I think, yeah, understanding that there's a lot of anxiety and fear and uncertainty and all of that that goes into being a parent, I I fully support anybody who who wants to hear, even if it's the same thing that I'm gonna tell them, ⁓ from somebody else. I think that's never

Julie Pernikoff: So to touch a little bit more on, you know, hearing from somebody else, ⁓ the ChatGPT issue is is alive and well. How how do you, you know, how do you think parents should go about that? It's the middle of the night. They see something on their baby, they don't want to be that annoying parent to maybe call the hotline and wake up the doctor. can they take a picture and show chat GPT? Should they not? Like, what are they supposed to do?

Jennie Berkovich: Yeah, that's a good question. I think if it's in the middle of the night and you are thinking you might need to go to the emergency room or you're so nervous that of what's happening that you're thinking, I I I better start getting the car seat. I think you ⁓ absolutely that is what the hotline is for. That is for what what your on-call doctor is for. I am never ever upset at being waking up in the middle of the night when someone's like, baby has a fever, breathing really hard, isn't drinking, or none of those things are Whatever, baby has a rash, but I'm really scared. Should I go to the ER? If that's your question, that's what the hotline is for. If you wake up in the middle of the night and you're changing a diaper and you see a rash and you're like, ⁓ I don't know, baby is fine, but I don't know what this rash is. Sure, take a picture, show chat GPT. I don't mind. But keep in mind what I said in the beginning is that it's not the best place to like ask information, re receive information. It's a good thought partner for like organizing your thoughts. ⁓

Julie Pernikoff: Mm-hmm. Mm-hmm.

Jennie Berkovich: It's not a good diagnostician with that kind of stuff. I think it will be and I think it's getting better, but I don't know that I would trust it for like a slam dunk. This is what it is, this is what you should do just yet. ⁓ and so I think you can use it to reassure yourself in the middle of the night. But if it's daytime hours and you're still worried, you pick up the phone and you make it.

Julie Pernikoff: Yeah, okay. Absolutely. I think all of that I love that you keep saying thought partner. I think that's great. Chatchy BC could be a nice thought partner.

Jennie Berkovich: Nobody, I have it open throughout the day and I ask it questions and you know, I I I bounce ideas off of it, but I've learned not to trust it to to give me advice.

Julie Pernikoff: Yeah, I mean the bio story is like that's enough to that's scary. That's crazy. ⁓ if you don't mind, if we could talk to you now as a mommy a little bit. We would love to just hear your thoughts. You know, as a mother that is also a doctor, what is that experience like for you and what's that like for your family?

Jennie Berkovich: Yeah. I mean I think for me.

Julie Pernikoff: How are they doing during this interview? Is everybody okay upstairs?

Jennie Berkovich: I think they're okay. I don't hear it. Sometimes the silence is even scarier. But ⁓ it's a blessing and a curse like everything else, right? So the the blessing is that we thankfully, thank God, thank God are healthy and don't go to the doctor unless it's our checkup. So I am not my kid's pediatrician. I think that's important. I take them to a pediatrician. I take them for checkups because I think checkups are very important. And when I go there, I turn off my doctor brain. ask my pediatrician to talk to me as a mommy.

Julie Pernikoff: Mm-hmm.

Jennie Berkovich: ⁓ and and I really think it's important for us to be treated like that. ⁓ the not so good part is that my brain sometimes goes to like very dark places very quickly when something is wrong. And so instead like if someone has a tummy ache, I know that the most common cause of a tummy ache is everything is fine. But instead of everything is fine, my brain very quickly goes to like the you know, tenth most likely thing that it is, which is like a very bad thing. And it cycles through that like very quickly and I have to turn off my mommy brain, turn on my doctor brain sometimes and say, okay, like objectively if this was happening to somebody else, what would you say? And then that's sort of the only way sometimes that I can get through like minor illnesses and, you know, tummy aches and and things like that.

Julie Pernikoff: Yeah, wow. Thank you for shedding light on that. That's that's so human of you. Absolutely.

Jennie Berkovich: Yeah. And then I think for them, I don't know. They don't I don't think they know any other existence because I had my oldest when I was in medical school. So I think by the time like they were aware, ⁓ most of them, I was already doctor. So it's the only life they know. I think they know it's a little bit unusual that we don't go to the doctor when for like minor illnesses. ⁓ but even today my four year old was asking, like, can't you like why do we have to go to Dr. Elwell? Shout out to Dr. Elwell, our pediatrician, like, why do we have to go to her? For my checkup, aren't aren't you a doctor? And so I have to like explain to him, like, I am, but I'm not your doctor. Dr. Elwell has the vaccines and she's gonna weigh you. And like I really, really want them to like have a good relationship with their pediatrician because there may come a ti may come a time where they have a concern about themselves or their health or their body that maybe they're not comfortable sharing with me. And I actually think that pediatrician relationship is sacred. ⁓ and so I really empower them to even at a very young age to like advocate for themselves, answer questions themselves, ask questions themselves. If they need to step out of the room and ask questions, ⁓ I I make space for that. ⁓ so I that's that's I think the other like unique thing is that I don't know that people like really care or want that for their kids, but to me it's really important that my kids have a good relationship with their pediatrician.

Julie Pernikoff: Yeah, it definitely. I think that's really interesting. I it's it sounds like you're very much a thinking person and and feeling for sure you're very ⁓ empathetic with moms and with parents and how how do you feel like you've grown from having both roles as a person?

Jennie Berkovich: That's a good question. ⁓ I think that as I've gotten to experience my kids like in different stages. So like my oldest was fourteen and I also have a baby and I have kids of ages in between. It makes me appreciate the unique challenges that come from each age. And it helps me understand my patients at that age a little better. So I'm just now like having a teenager and learning what it's like to have a teenager. and it really makes me value the relationships that I have with my teenage patients because I see like it it's a struggle. Like it's hard to be fourteen. And so I it g gives me, I think, maybe an added layer of compassion, but also helps me understand the families when they're navigating like different stages and ages. And, you know, in our circles, sometimes you're doing all that at the same time. It's not uncommon to have like adult kids but still have babies in the home. And I think it's also like very interesting and unique. ⁓ and I think having part of that experience adds hopefully a a layer of depth and and compassion to to the care that I give to my families.

Julie Pernikoff: Absolutely. Wow. Is is there anything you'd want to share with moms in all stages, you know, handling all the different types of patients as their children?

Jennie Berkovich: Probably probably I don't know how you do it. I don't know how you do it is probably what I would wanna share because ⁓ I have families in my practice. I I take care of w where I work in Chicago, most of my ⁓ the families I take care of are are observant. So it's not uncommon to have people who like already have grandkids, but they're still like having babies. And I'm just like in awe of of people who do that. I think it's amazing. ⁓ and people who have like large families. I I think that's the other thing I want to say, like, I don't know how you do it. I think it's amazing. People who have like many children, ⁓ who have large families, it is, I think, incredible that they have the coach and they've been given this like amazing skill and tools that ⁓ I think not not everybody merits. And so it's fascinating for me to learn from them. And also I think that's what I would want to share. Like, wow, just wow.

Julie Pernikoff: ⁓ that's so nice. That's really special. ⁓ if you don't mind, I'm I'm also just curious, honestly. I'm gonna throw this one in here. ⁓ you know, I remember being in school and ⁓ you know, at first I was a teacher for for the last many years, and then I became a social worker now. And these are jobs that like, you know, one might think this is, you know, ⁓ an accommodating job for a Jewish from woman ⁓ in our community. What what what words of wisdom can you give over to a young woman who might want to pursue being a doctor but is scared that it's not gonna work with being a mom?

Jennie Berkovich: I will say that it does work. And I will also say that people told me the same thing. It's like a very common, I think, thing. And I what I have learned is that you can make anything work. Anything. There's somebody in Joma ⁓ who is a trauma surgeon. She's super cool. She's amazing. She has, thank God, a large family, and she's a trauma surgeon. And she always says like her lifestyle is perfect for motherhood because she does shift work. So when she's on, she's in the hospital for Know 24 hours, she does a call, then she comes home and she's home for like three days and she's with her family and she travels and she goes to her kids' school performances. But you would never think like a trauma surgeon would be like family friendly. So I think you can make anything work. And by the way, the opposite is true. There are pediatricians who work crazy hours, who never see their families, who maybe have to travel for work. So I I I think what whatever you want the job to be, you can make it be. And I think Ever anything can be compatible in in a way that still allows you to preserve your values. You just have to put your values first. So there are people who have to make choices of maybe the kind of job that they're willing to take, depending on what that job requires. You can be a pediatrician and work on Chavez. I'm a pediatrician who doesn't work on Chavez. That's a value. And so I know that I will never sign a contract for a job that has me working on Shabbos. And so I think as long as you're able to prioritize your values, you can make anything work.

Julie Pernikoff: Wow. I think it's a great lesson for life in general. Thank you. That's beautiful. If moms or parents, ⁓ women want to reach out to you, ⁓ how can they find you? And how can they see your work?

Jennie Berkovich: Yeah. Yeah, so Joma.org, I would say go on the website. You can see some of our community health work, some of our webinars are posted on there. You can also check out the Joma book. I would say most of like the last several years of my work at Joma in terms of community health and the lectures that we've put out and the handouts and the pamphlets and all of that collateral, most of that has been compiled in the book. So I would say that's that's always a good place to start. And then if you have questions or have a suggestion for a topic that you think we need to be ⁓ more ⁓ public about or you would like to join our listserv where we do a community health newsletter ⁓ monthly, you can email us at infojoma.org.

Julie Pernikoff: Amazing. Joma's J O W ⁓ A.org for those listening. And then I'll add it into the show notes also. Wow. Jenny, Dr. Jenny Bergovich, thank you so much for joining us. This was fantastic. I'm so glad I got to speak with you. I feel very fortunate to have been able to. So thank you.

Jennie Berkovich: Thank you, Julie. It was a pleasure.