AMERICAN
ACADEMY
OF
PEDIATRICS
151
PRESIDENT’S
MESSAGE
PEDIATRIC
PRACTICE:
A.
THE
PEDIATRICIAN
AS
A
SPECIALIST
T
lIE BOLE of time pediatrician in thetotal-ity of medical practice in timis country
undergoes close scrutiny; panels and papers imave dealt witim it. Pediatric educators are vitally concerned timat timeir teaclming
pro-grams be tailored to future needs; official interest of the American Academy of Pe-diatrics lmas been expressed througim its
Corn-timittee on Medical Education and
Sub-comnmittee on Postgraduate Education . Now time Academy, jointly witim the American Pediatric Society, time Society for Pediatric Researcim, the American Board of Pediatrics, and time Pediatric Section of the A.M.A.,
co-sponsors a study of Pediatric Research, Ed-ucation and Practice (PREP) under time di-rection of Dr. Alex Steigman.
I speak now for time practicing
pedia-trician. Time experiences and philosopimy ac-quired from a tlmird-centuny devoted to
pe-(liatnic I)ractice, spanning time lifetime of time Academy, may he of value to timose
con-cerimed with time future of time specialty. Not content to rely on aim individual judgment, I imave submitted time outline of my thougimt
to 20 friends of my generation for timein opiimiolms of its validity, timeir experiences afl(l ideas. Timeir responses, entimusiastic and
often detailed, enhance and embellisim my
oi)servations.
Time compositioim of timis group is
im-portant, since my timesis relies on timeir ap-proval and added experiences. They
prac-tice in 17 states from New England and Florida to California aimd Hawaii; timey live in cities and towns from time size of New York and Cimicago to as small as 2.5,000 on 35,000 population. All are long-time
mciii-bers of time Academy; many, hut not all, imave held office or served on committees of timis organization. All imave been primarily
involved in practice, but many imave had
part-time teaciming experience in university
or hospital; a few are known for clinical re-searcim and publisimed articles. This is not a cross-section of pediatrics but a selected panel of timougimtful practicing pediatricians wimo imave an intense interest in time
pro-fession and are willing to express timeir ideas.
I have not felt qualified to speak for time pediatricians of Canada, Mexico, and the
other countries of the Americas, althougim I know many wimose experiences and be-liefs parallel ours. I imope timat my observa-tions will stimulate expressions from these several countries. I am certain, after listen-ung to discussions at time X Intennatiotmal
Congress of Pediatrics in Lisbon, timat time stronghold of individualized pediatric
prac-tide, as distinguished from time coimcept of collective pediatrics, resides in time
Amen-cas.
The practicing pediatrician, as I imave known him over the years, is primarily a
specialist in time knowledge and care of in-fants, children, and adolescents. Out of a background of intensive training, postgrad-uate education, and experience, he is able
to handle most of time problems of acutely ill cimildnen. He can decide rapidly wimetimer time child can be cared for at imome, witim
less emotional disturbance and less expense to time family, or vimetimen imospital treatment
is needed. He knows the details of hospital care for acute medical illnesses; he is versed in fluid and electrolyte replacement; ime is skilled in applying to time infant and child dozens of diagnostic and therapeutic pro-cedures which may be difficult or impos-sible for physicians who are accustomed to adults.
The pediatrician is depended upon by time surgeon for early diagnosis of acute surgical
152 PRESIDENTS MESSAGE
problems. He is consulted by and consults with specialists in general surgery, neuro-surgery, otolanyngology, orthopedics,
urol-ogy and other surgical fields. His advice is
sougimt coimcerning pre-operative and post-operative medication, nutrition, and fluid i)alance of timese surgical patients. This is less urgeimt tlman in former years because of time trelmmen(lOus a(lvances in pediatric sun-gerv, l)tit even in large medical centers best
results come timrough time collaboration of pediatric surgeon and pediatrician. More-over, time American Academy of Pediatrics Directory lists members iii 1,520 communi-ties in time United States, and tlmere are well
traiimed pediatricians in many others, where-as only some 300 cities imave medical schools or Imospitals with approved pediatric nesi-dencies around which time subspecialties are
likely to be imighly developed.
I cannot agree with a recent visitor (For-far,
J.
0. : Pediatrics in America-Impnes-siolms of a Visit. Amer. J. Dis. Child., 104:1, 1962) that in time American system thepe-diatnician, wimo “may Imave only limited con-tact with time lmospital, can often admit and look after imis patient timere” and “working 1)redOm inaimtly outside imospital and spend-ing nmost of his time on well-baby care and
umunor ailments of cimildlmood must find it difficult to maintain an experience and
fa-cility in modern metimods of diagnosis and treatnment comparable to timat of a pedia-trician working wholly or predominantly in
Imospital.” The pediatricians whom I know
are in imospital daily, imave patients in
lmosi-pital almost constantly, must and do attend imospital conferences and pediatric or gen-eral staff meetings regularly, and spend ap-proximately half of timeir professional time with ill patients or diagnostic problems. One of time great strengtims of American
pedi-atnics is tlmat between 9,000 and 10,000
pe-The pediatrician in this country is able to take care of the majority of accidents among his patients or has the knowledge
of the kind of specialized care for wimich they should be referred. Time Academy imas taken a leading position in accident
preven-tion and poison control among cimildren. Patients are referred to time pediatrician as a specialist by general practitioners, other pediatricians, and otimer specialists. As imis practice and reputation grow, referrals come on advice of his patients’ families.
Referral of newborn infants by
obstetri-cians and co-operation between obstetni-cians and pediatricians in averting on
han-dung the problems of the neonate have been medical advances of time past quarter century. Pediatric attendance at cesarean sections, deliveries expected to be difficult, or of diabetic on Rh-incompatible motimens, attests to the skill of the pediatrician in Imandling these problems. He is trained to differentiate rapidly between the normal
and the abnormal, to assure for the prema-tune the best opportunity for survival, and to handle neonatal emergencies vitimout
de-lay.
Specialized knowledge enables time pe-diatrician, with skill and assurance, to
su-penvise the normal growth, nutrition, and de-velopment of infants, children, and adoles-cents in his practice. Experience teacimes him a special skill in helping parents to
ma-ture.
Many pediatricians have developed par-ticulan interests in such areas as pediatric
allergy, cardiology, neurology, dermatology, diabetes, endocrinology, on beimavional pnob-lems. To some extent, problems in all of
COMMUNICATION
general practitioners who are partially-trained iim pediatrics seem likely or desirable
vitimin time foreseeable future.
In timis role of pediatric specialist many
lmave conducted clinical or even 1)asic
re-searcim in connection with timeir practices or in imospital or university affiliation. Time list of practicing pediatricians wimo imave con-tnii)uted to “time search for truth” is long. Of
:iw 20 correspondents one is widely known for studies of measles and its prevention, anotimer for studies in allergy, a third in scimool imealtim, and one in imanclicapping con-ditions. Some ‘ears ago a partner and I,
IJy pooling our observations with timose of colleagues in our city and otimen parts of time
country, outlined oime of the clinical mani-festations (3-day fever) of Coxsackie
in-153
fection. The present era of imighly organized research vihl not obviate time need for care-ful clinical observation. Nor will industry
research or governmental supervision re-move from time pediatric practitioner the burden of assessing time value or danger of drugs and equipment designed for time in-fant and child.
It is my concept that iii timese ways, and many others not mentioned, time pediatri-cian fulfills imis function as a simeci1hist. In tlmis role, lie has had general public and pro-fessional acceptance.
d&tew
judegt
1560 Line Avenue
