I have spent the past week covering most of my colleagues for March Break, including four out of eight nights on call for psychiatry at the Children’s Hospital of Eastern Ontario. For reasons that are not entirely clear to me, whenever I spend a lot of time at CHEO, I find myself thinking about the degree to which I do not believe that pediatricians should be engaged in the primary medical care of healthy children and adolescents. I hesitate to speak about this since “primary care pediatrics” is very popular among parents and pediatricians in my community.
My first reason for this belief is that I believe that a family gets better care when a family physician has the care of everyone in the family. As a family therapist, I like to see as many members of a family in sessions as I can – it provides access to more information and the more information a family therapist has, the better care he or she can provide. I suspect this is true in family medicine also. My own family doctor cared for three generations of my family and I believe that this gave him an advantage since he knew very well what the family history of illness was.
The second reason that I question the value of pediatricians doing primary care is that I feel that their skills as a consultant and caregiver to children with complex and chronic illnesses is too vital and that as much of their time as possible should be devoted to ensuring the best management of children with illnesses that will affect them all of their lives.
Finally, as someone who spends many days caring for children who are living outside of their own families, or whose families are struggling to manage being a family, I would like to find a way that pediatricians could be a resource to these parents and families. The evidence tells us that the children in these families are at much higher risk of illness and here there might be a role for the assistance of a pediatrician providing additional care to what would normally be provided by a family doctor.
I have worked with many parents and, even when they are poor and struggling to parent, they want to do what’s best for their children. Childhood is when we are most likely to develop habits: of what we eat, how much we exercise, how we spend our recreational time. Pediatricians are often the best advocates for early intervention in chronic illness and children and parents are eager learners and usually keen to do what is right. More pediatricians involved in public health might well ensure that marginalized children grow up healthier than is predicted by virtue of their socioeconomic status and the educational level of their parents.
Now that I’ve said what I thought pediatricians should do, perhaps they have some comments about child psychiatrists!