Wednesday, July 12, 2006


Any day now a new issue of the medical journal Pediatrics is going to arrive, and itwill be chock full of articles related to my specialty. I recently received my monthly copy of Journal of Pediatrics, another journal loaded with information relevant to me. Every three months I receive an issue of Clinics in Perinatology, containing a few hundred pages of usually neonatal information. The latest edition of the Neonatal Resuscitation Textbook just arrived - I'd better be up on that. And every week a new issue of the New England Journal of Medicine shows up in my mail slot. It doesn't have a lot of neonatal stuff, but plenty of other interesting medical information I'd like to know.

I like to keep up with what's new in neonatology and to some extent with medicine in general, but it can be really hard to do. The volume of information out there and available to read is astounding. I have to pick and choose the things most relevant; there is no way I can read everything related to neonatology. I find myself hoping that the new issue of Pediatrics or Journal of Pediatrics won't have many neonatal articles, just so there will be less to read that month.

And I'm in a subspecialty. People in broader fields, such as general pediatrics or internal medicine, have an even tougher time. A general pediatrician has to keep up with topics as varied as infant meningitis, school problems, and birth control. Then there's the family practitioner. Keeping up with everything in medicine seems just impossible.

In fact - and I'll probably take some criticism for this - I'm not sure that family practice as a specialty should continue to exist. Medicine is complicated, and it will only get more complicated. There's a huge explosion of information, and it's pretty important that a doctor knows the right information. I simply don't think one person, a family practitioner, can keep up with it well enough.

Instead of family practitioners, I think there should be family clinics. The kids could see a pediatrician there, the adults an internist or obstetrician, and so on. No offense to my family practice colleagues, but I think a pediatrician does a better job taking care of kids than they do, and the same is probably true for an internist regarding adults.

This could be a big topic, but I'd better stop here. Besides, I should probably be reading a journal instead of blogging....


Blogger Trax said...

You're gettin no bites here, looks like everyone is caught up in your debacle! Alas, I am with you on the phasing out of family practice docs, even though I still go to one, although I don't use him for my kids or my OB-GYN stuff...I think he's an excellent internist and probably would do fine w/the other stuff too, but you're right there is just too much info out there to keep up on.

8:27 PM  
Anonymous Anonymous said...

It doesnt help that they get paid a pittance. So the best residency candidates usually choose not to go into FP, thus compromising the quality of the FP physician pool

8:41 PM  
Blogger Jen said...

I pay tribute to my daughter's neonatologist. She had a prolonged direct bili number for more than 2 weeks. This peaked his interest so he called in a ped. gastroenterologist to do a work up on my peanut. It turned out that one simple blood test and a sonogram of her liver resulted in a diagnosis of Alpha-1 Antitrypsin Deficiency with a ZZ genotype. Ever heard of that? The occurence is approx. 1 in 3000 births per the Alpha-1 Foundation.

I agree that family practice doctors couldn't possibly keep up on everything so I'm for specialists. I'm happy that our neo realized he wasn't sure was going on and made the referral for a GI consultation. This may be just an every day occurence actions for you, but his may help my daughter protect her liver and lungs from unnecessary damage from smoking, bad air quality, and excess alcohol usage. She'll grow up knowing that these things aren't good for her. (I know that the teenage and college years may bring unexpected results from my perspective!)

There are no guarantees in life, but I feel good knowing about her diagnosis in advance of serious complications which mostly show up in early to mid adulthood.

Bravo specialists!

10:15 PM  
Anonymous Anonymous said...

How about some RSS feeds into an RSS reader...the technology is immature, but available.

10:24 PM  
Blogger Ex Utero said...

Well, you got your wish with regards to Pediatrics. It's pathetic this month with regards to neonatology articles, so that should give you some free time.

I agree that pediatricians are better than FPs for kids (although not necessarily for adolescents), but these days even pediatricians are losing their skills when it comes to newborns. I don't want it to get to the point where neonatologists are doing well baby care.

1:29 AM  
Blogger Flea said...

I disagree. Pediatricians are sub-specialists too. That was our original role, and as the disease burden of children continues to drop and chronic conditions such as asthma and obesity take over, we fleas ought to retreat to the hospitals from whence we came and hand the kids back to the GPs (now FPs) from who we took them.

As you said, ND, this is a big topic that deserves a more thorough development of the the argument. If I have not already blogged on this I will. There will certainly be more posts on the subject in the future.



5:25 AM  
Blogger That Girl said...

Sort of off-topic: What ARE the new guidelines for infant CPR since they changed regular CPR? I would love to know.

6:17 AM  
Blogger Dream Mom said...

I think the volume of information that is out there is astounding for all professions so I can feel your pain.

Having seen many specialists for Dear Son, I have to agree with you with regards to the FP. Even with regards to specialists today, I find myself going on-line and selecting the specialist based on one who does research in the particular area that I am seeking treatment for Dear Son; it's not enough just to seek out a pediatric specialist in a particular area. I need a pediatric specialist with a sub speciality in the area he needs. With all of the new genes being identified today, I can't imagine how difficult it must be to keep up as well.

I have learned too, that the major academic medical centers are typically the best places to diagnose and treat difficult or rare diseases. When you go locally, they just don't have enough experience treating those kinds of things. I have a simple rule of thumb that I created when seeking treatment for Dear Son-it goes like this-Dear Son can't be the worst patient the specialist sees in his practice or the worst patient he sees that day, or we are not in the right place. The reason being, is that they just won't have the experience and the expertise to deal with his issues.

12:04 PM  
Anonymous Anonymous said...

I gotta say, I am all for the family practitioners. Of course I am so glad that specialists exist, but for normal, run-of-the-mill sorts of illnesses and injuries I prefer to take my family to a FP. If we had serious or complicated issues then I would prefer to see a specialist in whatever area. There is something great though about my kids seeing the same doc I see and my husband sees, the same one who may have caught my kids at their births.

I can understand what you are saying though about a FP trying to keep up on all information, it must be close to impossible to do that for all age groups and so many different areas. I would just hope that my wonderful FP would refer me to a specialist in a certain area if there was a problem that he felt he couldn't keep up with.

2:56 PM  
Anonymous Anonymous said...

I just want thoughtful curious thorough docs. I've seen FP docs who fall into this category and specialists who are quick to think they're sure what's going on. It would be helpful as well if we could have an overhaul on the healthcare system in general, so my docs have more time to spend with me and to keep up on all that new info coming in and not have to see so many patients, etc. Could yu get to work on that for me?

9:47 PM  
Blogger neonataldoc said...

Thanks, all. I think the last anonymous has it right: Thoughtful, curious, thorough doctors are probably the best.

Flea, interesting point. I think many pediatricians would like to be specialists/consultants for kids, but is it that way in reality? Most general pediatricians I know do a lot of well child care, etc.

7:45 PM  
Blogger Fat Doctor said...

The argument for family docs is a long one, and I won't make it here, but you've just inspired me to mull it over for a future entry on my own blog. By the way, we prefer the term family MEDICINE to family PRACTICE. Just a little thing.

12:27 PM  
Blogger Borneo Breezes said...

The issue is more than what specialty can do it best. Most of the real health issues facing us today transcend traditional disciplinary boundaries and reductionist approaches. The challenge for all of us is to keep the big picture in focus.

9:01 PM  
Anonymous Anonymous said...

Here's why my (basically healthy) family wound up using a family practice for years:

The new baby had ear infections.

The toddler had a UTI.

The six year old (me!) had a really badly infected hangnail.

So did dad.

Mom had mastitis.

Different doctors were seeing mom, dad, and the kids.

Mom switched us to a family practitioner, who brought us all in, said "you're passing one bug around the whole family," put us all on penicillin, and we were fine in a week (OK, dad and I each lost a fingernail, but they grew back in a couple of months).

Our uncle the specialist tried to convince mom that she was doing us a disservice, not sending us to a pediatrician, but mom wouldn't hear it. Especially since none of us ever got badly sick...

2:38 PM  
Blogger my4kids said...

A little late on this topic but I have to disagree. My whole family sees an FP that is not just me, my kids and spouse, but also my parents, brother and even more recently my best friend and her kids! I find having so much of our family seeing the same dr brings a different insight into our health care. He may be able to see something comming with one of my children and know to look out for it because say I have it. My son may be developing an issue with his spine (suddenly can't remember the name but similar to scoliosis) and my dr is right on top of it because my husband has it also. It is suttle now but he knows to keep a close eye on it because he truly knows the family history that he may not have as much knowledge of had he not known my husband as a pt. Also having the same dr take care of my kids who took care of me while inside is kind of comforting to me....

8:12 PM  

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