Interview: Czech pediatrician on keeping kids healthier and happier in 2023 and beyond

Dr. Jitka Brázová has always loved children and from early in her career has been involved in their care. As a student at the 2nd Medical Faculty of Charles University in Prague, she worked part-time at the Institute for the Care of Mother and Child. As a Ph.D. student at University Hospital in Motol, Prague, she was involved in the care of and research into children with cystic fibrosis, a severe chronic inherited disease that can now be discovered via newborn screening. She continued her research at Royal Brompton Hospital in London.

After 15 years working in a Prague-based private clinic, she joined the team at Concierge Medicine Europe in 2021. A mother of two sons aged 14 and 11, Dr. Brázová recently spoke to us about how the concierge concept benefits children and their families and how preventive care is the way forward when it comes to children’s health.

Why is the doctor-child relationship so important in a child's life as they grow? 

It is very important for a child and his or her family to have a personal doctor that they can believe and trust. The relationship grows in time and is very critical especially during the teenage years, as well as during any times of stress in a child's life. Detecting any issues in the early stages of a patient’s life is important, so we can solve or treat them before progressing. That comes with continuity of care.

How have children's healthcare needs changed in your 20 years of practice? 

Life is much faster despite the Covid-19 pandemic. According to WHO, children's obesity is increasing, and we also see it a lot at Concierge. Teenage addiction to electronic devices and social media is another worrying issue. The pandemic increased and opened up psychological problems both in children and adults. 

On the positive side, parents seem to be more and more interested to be more involved in their children's health and are willing to participate more in decisions about their children's care. The internet and social media can help but also harm when it comes to educating yourself about children’s health – you can find a lot of relevant information but also lies and misinformation.

How was the Czech healthcare system stepped up to these challenges?

The Czech Republic is one of the leading countries in newborn screenings. We can now identify more children with severe inherited diseases like cystic fibrosis, severe combined immunodeficiency, and spinal muscular atrophy. I am very happy that Czech insurance companies are now covering for children more vaccinations against severe infections (Meningococcus, Human Papillomavirus, Pneumococcus) and it is then up to the parents' if they should vaccinate their child or not.

The Czech system has its own challenges, though, including a shortage of pediatricians.

Yes, pediatricians in the Czech Republic are getting older, and there are not enough new ones. One pediatrician can have up to 1,500 patients, which sometimes means a very rigid approach.

The lack of mental health professionals in the Czech Republic for children is also critically low. How does your practice respond to and treat mental health problems in kids? 

This is definitely one of our top priorities. Though prevention is always the best, the psychological problems and issues deepened during and after the pandemic. We, as pediatricians, act as sort of filters and pre-consultants of the psychological issues of our children.

We are working on building quality cooperation with a team of psychologists and psychiatrists, and we always try to do our best for our children and their families, because this is usually not just an individual problem, but a whole family issue.

How does pediatric care at Concierge Medicine compare to the Czech public healthcare system?

We have a maximum of 650 children per one personal pediatrician, as we try to have a good relationship with our children and also their families. We are a team of three pediatricians, which also allows us to have longer time for every visit of a child, to have enough time for the needs of every child and their families. 

Our patients don’t spend a long time waiting for care, especially if their child is not feeling well. Because we offer 24/7 care, it’s possible to discuss your concerns with us at any time. It is very important that there is always enough time for any question and that the personal pediatrician is able to see the child the same or the next day if needed.

In general, how does the overall approach at Concierge Medicine differ?

We focus much more on prevention of chronic diseases and evidence-based medicine. During developmental check-ups we discuss healthy lifestyle, focusing on nutrition, physical activity, sufficient sleep, stress management, good relationship, but also  prevention of certain addictive habits in teenagers.

Practicing lifestyle medicine principles such as participating in physical activity, eating mostly whole (non processed) food and minimizing stress can positively influence mental wellbeing, academic performance and even athletic performance in children. And the earlier we start, the longer and healthier we can live.

Would you describe your approach then as more proactive and patient-led? 

Our care and attitude are always very personalized and complex. Before labor, we already cooperate with our gynecologist team in educating mothers about healthy lifestyles, especially nutrition for them and their children.

Since birth, we take care of children and families regarding healthy lifestyles. Since we always have enough time for every patient's needs, during developmental check-ups, we focus on healthful eating, physical activity, quality sleep, developing strategies on how to manage stress, avoid risky substances, and form and maintain good relationships.

We plan individual goals with our children and their families, and we regularly check how they manage. We always try to work as a team and if there is a need for a specialist, they are added to the conversation, too.

Can you give examples of different issues that occur at different stages of a child's life and how preventative medicine responds differently than simply treating illnesses?

Prevention is always the key. Since their first visit, we educate parents and then also their children regarding prevention of chronic diseases. We focus a lot on healthy eating habits especially regarding age-related needs for macro and micronutrients. We educate families how to make their immunity stronger by having enough exercise, sleep, good nutrition based on a Mediterranean diet, rich in non-processed food, whole, plan-based food and full of vitamins.

When treating common illnesses, we are very careful with prescribing antibiotics. If needed at all, we try to use so-called ecologic ATB to prevent the increase of ATB resistance and protect our microbiome and environment. When in doubt, we wait with administration, check the child the next day, and possibly compare new onsite tests to help us with the decision. We always monitor usually via telephone calls with parents.

What are the benefits of concierge medicine for children? 

We want to make children as comfortable as possible. We always have great respect and understanding for children with special needs, and try to find a way to stress them the least, even if that means examining them in front of a TV with fairytales. If there is any difficult topic for the child or family, we offer consultation on our rooftop, where there are no walls that can have ears.

We also offer several developmental check-ups above the limit covered by Czech health insurance companies, we are open in details to discuss vaccination plans and any other stuff. We have a well working lab with the possibility to have blood test results in 2-3 hours if needed.

Our service includes after hours on call service with possibility to make a home visit or meet in the clinic if needed. Also home visits for newborns as an entry visit with us to make the mother's after-labor care as comfortable as possible.

What are the benefits of going to a pediatric concierge clinic for parents?

We all know that parents work as a model for their children. Therefore, a cooperative parent who understands and plans for their child's health care is the most important partner for us to keep our children happy and healthy. We are always a team – a child, parents (or at least one of them), sometimes also grandparents or siblings, and healthcare professionals.

It is very important not only to educate children and their families in healthy lifestyle principles but also to give them practical tools and skills needed to implement these principles. We offer a healthy living six-week program to educate parents on healthy lifestyle choices for the whole family.

Right now the cost of everything has increased. How can people make subscription-based care fit into their budget?

We feel that our health is an investment. In the long term, prevention is always cheaper than treatment of both acute and chronic diseases. Therefore, we offer a healthy lifestyle program for everyone who is interested in their health status and the prevention of chronic diseases.

As a new daily clinic in Prague (opened in May 2021) our patients who join us now still benefit from our early member offers and we are currently offering one of the most affordable membership-based care in Prague compared to other premium clinics while we offer the lowest doctor to patient ratio.

We have not increased our prices despite inflation and patients joining now will benefit from current prices for at least 12 months. We always try to find an individual way for any personal issues so everyone would feel happy.