Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How Sweet It Is


We have the responsibility to pay attention to the family members who accompany patients to their visits.

I’ve learned from my clinical mentors to be observant. In addition to being fully present with my patients, I try to pay attention to those who accompany them to their visits. Over the years, I am proud to say that I have made some astute diagnoses on the spouses and caregivers of some of my patients.


Last summer in a particularly hot spell in August, the mother of a newborn baby came to my office for her first postpartum check-up. The mother had the newborn, wearing only a diaper, nestled in one of those hands-free baby carriers strapped to her torso.


The grateful mom brought me a token of appreciation for having supported her with antepartum and now postpartum care, a small jar of some of Vermont’s finest maple syrup. It’s kind of a tradition around these parts for women to bring their doctor maple syrup after the birth of a baby.

 Maple Leaf

I’m not sure how it started, but I’m always happy to take it! I just love it on my pancakes in the morning! The jar was a little sticky, since my patient explained that it had leaked a little while she was checking in at the front desk.

Near the start of the visit as we were discussing her weight and her mood, the mom told me that her baby needed changing and asked if she

could use the examining table to change the baby’s diaper. Naturally, I let her.


I took advantage of the time to enter data into Epic, and as I got to the section on the initial postpartum visit form that asks about the sex of the baby, I realized I didn’t even know since I had been so focused on the mom. I walked over to the baby so that I could take a peek. I leaned in smiled, made “raspberries”, and cootchie-cooed the pudgy bundle…a beautiful baby girl.


Just then, I noticed some discoloration in one spot of the diaper. Upon taking a closer look at the Pampers, I noticed the sweet distinctive odor of maple syrup.

I refocused on my patient, the mom—completing the history, physical examination, and offering some counsel about her self-care.


Before ending the visit and arranging follow-up, I spoke to the mother about her baby. While the baby appeared to be doing well by all accounts, I told her that her diaper worried me—remembering learning about maple syrup urine disease in medical school. I suggested that she take her baby to the University of Vermont in Burlington to be seen by someone there just to be on the safe side. I know the pediatric geneticist there very well, since I’ve referred three other babies to her in the last few years under similar circumstances. Thankfully each of those little ones turned out to be completely healthy.



My clinical excellence pearl this month is to remind CLOSLER readers that while our patients’ family members may not be our patients, if we notice a possible medical problem, we have an obligation to point it out to the patient or family.

Red Barn