Is there a Need for “Primary Care Pediatrics”?

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!

2 thoughts on “Is there a Need for “Primary Care Pediatrics”?

  1. I read your blog about the role of pediatricians. Don’t you think you are casting the net too narrowly? My view is that we need to rethink the role of all doctors and really figure out the value proposition. What are doctors actually doing day to day and do you require as much training as they have for most of the tasks? The American and the Brits have de-bundled a lot of the work that used to belong exclusively to physicians and given it to Physician’s Assistants, Nurse Practitioners and mid-wives. People who are trained to do lots of things but not what docs get trained for which then frees up the doctors to do their thing. Now lets think about what “their thing” should look like. Who is the quarterback of each person’s health care? Who looks at the whole person? Should someone be in charge, connecting all the dots and calling in specialists for support as needed but also requiring those specialists to talk to each other. And should doctors focus less on immediate symptoms exclusively and more on the whole history of the person? Maybe we take an Andrew Weil view of integrating all branches of medicine, like traditional Chinese Medecine, Homeopathy, Naturopathy etc…? I take your point, but as a consumer, I feel like we are not really talking about how to provide full health care in a sustainable way that we can afford and that truly helps people. Anyway, if you are ever in a situation where you need a consumer’s perspective on the future of healthcare in Canada, please count me in. Supporting your view of pediatricians is just my starting place!

  2. I have another point to add here. I worry that after they lose their pediatrician, young adults will never take the time to find another primary care provider. This is also happening at a critical time in their life when they are potentially moving out to go to school or just starting their independent lives for the first time.

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