Our Proust Questionnaire

Childhood Health AssociatesSalem, OR

Dr. Mark Helm shares why he chose pediatrics after 10 years working in the pharmaceutical industry.

  • Childhood Health Associates
  • Salem, Oregon

A Proust Questionnaire is a survey aimed at understanding one’s personality.

To help share your stories, The Independent Pediatrician created our own version of the Proust Questionnaire.  We hope you enjoy this small window into other pediatricians’ personal and professional challenges and aspirations.

Why did you become a pediatrician?

Atonement. Prior to going to medical school, I spent almost 10 years working in the pharmaceutical industry. I realized that I was going to spend the rest of my career learning about medicines and studying how physicians decide to treat specific diseases. I decided that I could continue to devote myself to helping huge, highly profitable multinational corporations become richer, or I could do something that might actually help real people. I guess I wasn’t a match for Pharma.

I say that I didn’t “pick” pediatrics, it picked me. In my third year clinicals, I insisted on doing pediatrics first, trying to avoid too many GI bugs and snotty noses… My first ward patient was a child abuse case involving a 3 month old. Needless to say, this was humbling.

My then fiancé (now my wife, Jade Helm; sommelier, writer and educator) knew I would do pediatrics before I did. She noticed that I always talked about the kids I had seen that day, even through Family Medicine, OB, and Surgery.

What do you like most about being an independent pediatric practice?

You have to be clever. I’ve always liked puzzles and problem solving. Since I was a teen, I’ve been interested in optimizing processes and systems. In private pediatric practice, there is always some issue that needs a solution. There is the opportunity to find problems and tweak systems to meet the unique needs and personality of a practice.

Your favorite qualities in a patient?

Being 5 years old.

What is your ideal state of mind?


Which living person do you most admire?

I think when asked this, most folks tend to think of people they don’t know. I’ve got lists of those. Sometimes people name their parents, if they are lucky (I am, and mine are great). But honestly, there are more than a few foster or adoptive parents I’ve known who aren’t rich or famous, but they devote themselves to the kids in their care in ways that I honestly do not think I could. I’m in awe of them, and if I weren’t a pediatrician, I would have no awareness of them.

What do you believe is the most important business aspect for an independent pediatric office?

Remaining profitable. That’s a focus on both generating revenue and managing overhead. I do not believe in being shy about charging for the services and expertise we offer. It is impossible to overestimate the value of a healthy child, or even the knowledge that a child is as healthy as they can be. “No margin, no mission,” is a good start, but that margin needs to be higher than the return we could get from another type of business activity.

Do you prefer to do sick visits or well visits?

Well visits are vastly preferred. It is so much more important to keep kids in the naturally good health that most are born with. So much of modern life is seemingly designed to sabotage reaching adulthood in good health, with good habits and an understanding of your self and your body.

How do you address urgent/after hours care?

Our group has a bunch of providers and offers great availability for our patients. Five days a week we are open from 8 AM to 8 PM, with regular Saturday morning hours, and availability for urgent needs Sunday mid-day. When we are not there, there is a nurse advice line for patients to call. At the moment, we are not feeling threatened by competition.

What’s your policy on vaccination?

I love them. I’m pro-vaccine and think that the human immune system is amazing. I’m also pro-vaccine in part because I’m anti-antibiotic. I think vaccines are at least 100,000 times safer than antibiotics. More than half the time an antibiotic is used it won’t do anything helpful for the patient, but there is a significant risk of side effects — even potentially fatal ones.

How do you manage the most challenging parents/families/caregivers?

I try to treat everyone, “challenging” or not, the same way. I am a bad judge of what goes on in interpersonal communications. It is a bit “Asperger-y,” but I really don’t pick up on non-verbal communication cues. I often tell people that I don’t have an ego, though I know that is not true — because my mother and my wife tell me so. I do try not to take anything personally.

I think it is important to communicate clearly what are the expectations in the doctor-patient family relationship. I let families know that I’m concerned about doing the right thing for their child. If there is a problem, I want to understand it and help — it just may be that I perceive a different problem than they perceive. My desire to help does not mean that I will prescribe treatments, order tests or make referrals just because they want that. Often it would be easier and faster to do that, but I wouldn’t feel that I had done the right thing.

The most frustrating families are the ones who schedule appointments and then don’t show up. I suppose I have a bit of a reputation for firing these families. If they don’t come, not only can I not help them, but they have prevented us from seeing someone else who wanted to come in. Invariably the “no-show” family will reschedule later, whether or not they show up then.

What is the biggest change in pediatrics you have seen in your career?

Because this is my second career, my scope is shorter than many. I trained after the current vaccines (excepting HPV) were in wide use. The shift I’ve most painfully perceived is the evolution of general pediatrics as a mental/behavioral health specialty. Our training programs are not geared toward the issues we face in the clinic.