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Thursday, February 2, 2012

15 Years of Change in Pediatrics

By Roy Benaroch, MD

Baby and Doctor

I’m not what I think of as an “old doctor”—but I’m fast approaching 15 years in practice. Even in that relatively short time, I’ve seen big changes in the way pediatrics is practiced, the kinds of problems we see, and the way children are being raised. I’ve come up with my own “15 changes in 15 years” list. Feel free to add your own in the comments!

  1. More people are involved in medical decisions. It’s not just the doctor and the patient—now insurance companies, pharmacy benefit managers, and more government reviewers are involved than ever before.
  2. MRSA has become a common germ. Hardly a week goes by when we’re not seeing MRSA impetigo, boils, or other infections by this resistant staph.
  3. We’re being stingier with antibiotics. One example: not all ear infections need a prescription.
  4. Vaccines against the two common causes of blood poisoning and meningitis have made these diseases very rare and have changed our approach to fever in young children. Vaccines have also made chicken pox and severe rotavirus disease virtually disappear during my career.
  5. More in-office testing is available for quick answers: strep, mono, RSV, flu, and other infections can be more reliably diagnosed, quickly.
  6. Some diseases we thought were defeated have snuck back, especially pertussis and measles. We had them beaten, and anti-vaccine misinformation has led to their return.
  7. The internet provides some great information and some complete falsehoods. Sometimes it’s hard to tell which is which.
  8. Higher copays and deductibles mean fewer office visits, or office visits that wait until kids are sicker and diagnosis and treatment is more complex.
  9. There’s more paperwork than ever.
  10. More complex insurance schemes and regulations and laws make it nearly impossible for normal people to know what’s covered.
  11. Drug unavailability has become commonplace—either because the medicine isn’t on the shelf or because insurance coverage is so poor and the price so high that no one can afford it.
  12. Children’s time playing outside is dwindling while time in front of screens has become the major activity in their lives.
  13. Obesity and complications of obesity are being seen more commonly and at younger ages than ever before. Effective treatment and prevention remains elusive.
  14. Videos and photos on cell phones are everywhere and can be great diagnostic helpers.
  15. While rates of severe autism haven’t really changed, we’re now recognizing that many kids have milder forms of this disorder that can be recognized and treated effectively if caught early on.
Photo: Comstock

Posted by: Roy Benaroch, MD, FAAP at 3:07 pm

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