Dr. Lazarus

George Lazarus, M.D.

How did you first become interested in pediatrics?

I realized that I wanted to be a pediatrician as a second-year medical student. If I had thought about it, I could have made the decision even earlier, because I had always enjoyed working with children. In college I had been a camp counselor and also had worked with underprivileged children growing up in poverty in New Haven. I arranged some exposure to pediatrics in my second year by working in the pediatric emergency room. When I got to my pediatric rotation third year, I knew that I had made the right decision. The medicine was challenging and interesting, and I liked the pediatricians and working with kids again.

As a pediatrician, you see gender differences at the earliest stages. What are some common gender differences as children develop, both physically and emotionally?

Boys and girls are different from the very beginning. Boys are bigger at birth, by about 200 grams. We have different growth charts for boys and girls from birth to 18 years of age. Some diseases are seen only in one sex or the other. For example, Turner’s Syndrome affects only girls, and hemophilia (and all other X-linked recessive diseases) is seen almost exclusively in boys. Other diseases occur in both sexes, but present differently in boys and girls, and the different presentations can be important clinically. For example, consider virilizing adrenal hyperplasia. The disease results from an enzyme deficiency, which affects production of the adrenal hormones. An affected female fetus is virilized, with enlargement of the clitoris and fusion of the labia, which may make the baby look male. An affected male fetus will look normal. The effect on the female genitalia is likely to lead to early detection in the newborn nursery, which can be life saving. Undetected and untreated, the condition can lead to salt wasting, shock, and death in the first weeks of life. The affected male is likely to be detected only when he goes into shock at home, or he may just die and be considered a "crib death."

Puberty occurs earlier in girls, and growth patterns during puberty are completely different between the sexes.

The emotional development of boys and girls is fascinating to watch. As just one example of how they differ, consider the junior high school age boys and girls. If sixth or seventh grade boys fight, they do just that. They punch each other, scream, and move on pretty quickly. Girls talk on the phone and torture each other verbally. The girl-to-girl abuse is almost never physical, but it can be severe, as any parent of a young teenage girl can tell you.

These are just a few random examples of the many differences between boys and girls, both physical and emotional.

At what point do you think we begin to treat, in a medical sense, the two genders alike?

We should never be oblivious to the differences between the sexes. The treatment for pneumonia or pharyngitis may be the same whether the patient is male or female, but ideally we are treating the patient and not just the disease. It is always relevant to know who the patient is, and what else is going on in his or her life. In a busy office or clinic, this may be temporarily forgotten due to the pressures of daily practice, but awareness of the total patient is always the ideal, and then gender automatically enters into the equation.

You teach pediatrics at Columbia. Are gender differences a major issue in your classes?

When I am teaching on the pediatric service at Columbia, we are discussing specific patients. Gender is always a part of our discussion. We don’t follow a formula that includes consideration of gender differences. It just comes up in the course of evaluating patients.

You have been a practicing pediatrician for more than 20 years, and your patients range in age from newborn to their early 30’s. What advice would/do you give your patients when they leave your office for a general practitioner?

When my patients leave to see an internist, I hope that they will find someone they feel comfortable with and who will get to know them. When I’ve taken care of young people from early childhood through young adulthood, I get to know who they are. I’ve had the advantage of watching them grow up. The internists who inherit my patients have a bit of catching up to do, and it takes some time to get to know people. The best doctors do get to know their patients. Some of us are experts in specific diseases but not sensitive to people. I hope that my patients will find internists who are both sharp medically and interested in them as people.

What advice would you give general practitioners about gender differences?

The better we get to know and understand our patients, the more effective we are as doctors. There is so much that is relevant — where does someone live, whom does she live with, where does he work? When we consider so many aspects of a person’s life, is it possible to ignore something so basic as whether the patient is a man or a woman? We should educate ourselves about the medical consequences of being male or female, because that will make us better doctors. And that is where the Partnership can help doctors.

The Partnership’s goal is to spearhead research on gender-specific medicine and to develop comprehensive and unique educational programs that communicate the new knowledge to healthcare professionals and the public. What advice would you give the Partnership for achieving its goal?

The Partnership can help doctors become more knowledgeable about the medical implications of being male or female. Personally, I think the name of the Partnership is not ideal. I would prefer the Partnership for Gender Sensitive Medicine, but I understand that there are practical reasons for the name being what it is. The Partnership should be involved in research and education in all our clinical departments. Grand Rounds presentations would reach medical students, residents, and attending physicians in each department. First and second year medical students getting introductory lectures in clinical medicine should also be exposed to the Partnership’s message. Guest lectureships relative to gender sensitive medicine should be sponsored and publicized. The Partnership has had a wonderful beginning, but I think more needs to be done to make the Medical Center community aware of the Partnership’s goals.

You are a featured speaker at the Partnership’s Annual Update Conference in October. Would you give us some thoughts on what issues you’ll be addressing?

I was very flattered by the invitation to speak at the Partnership’s conference in October. I plan to let people in on a secret that all pediatricians (and a growing number of internists) know — namely, that boys and girls are different! I hope to give a number of examples of how boys and girls differ in ways that are especially pertinent to medical care. The central issue is patient-specific medicine. The better we understand our patients and their health, the better able we are to take care of them. If we ignore the differences between males and females we are failing to take advantage of clinical knowledge that is available to us. Thanks to the Partnership, that knowledge base is growing.

About George Lazarus, M.D.

Dr. George Lazarus received his B.A. summa cum laude from Yale College in 1967 and his medical degree from Columbia University College of Physicians & Surgeons in 1971. He did his internship, residency, and chief residency in pediatrics at Babies Hospital, Columbia Presbyterian Medical Center.

Dr. Lazarus began his private practice of pediatrics in 1976 and today his patients range in age from newborn to their early 30’s. Dr. Lazarus is a medical staff member of the NewYork Presbyterian Hospital and Lenox Hill Hospital and teaches pediatrics at Columbia. Dr. Lazarus serves as school physician for the Allen-Stevenson School and for Park Avenue Methodist Day School. He is an honorary police surgeon for the New York City Police Department.

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