TY - JOUR
AB - This is a delightful book of 600 pearls gleaned during 43 years of practice by William Wadlington, MD, clinical professor of pediatrics at Vanderbilt University School of Medicine, Nashville, Tenn. Clifton Meador, MD, clinical professor of medicine at Vanderbilt and author of The Little Book of Doctors' Rules is editor. The two are friends and colleagues, dating back to their early days at Vanderbilt, when Meador was a junior medical student and Wadlington senior resident in pediatrics. The pearls are pithy statements, almost proverbs, succinct and full of wisdom. Wadlington relates that they were learned from years of experience working with children, parents, and families, by direct observation and by listening to other physicians who also have been keen observers. He makes no claim that the pearls are his alone, and many have been absorbed from the published literature. The uniqueness of the book is in the selection and in Wadlington's ability to organize, summarize, and transform teaching material into proverbial formats and mnemonics. Wadlington has a holistic philosophy concerning the health of infants, children, and adolescents, which has emotional, mental, and spiritual, as well as physical, components. Disease may be associated not only with transmission of dysfunctional genes or organ dysfunction acquired through various pathological mechanisms but also with exposure to adverse environmental factors. These include poor parenting, extreme poverty, excessive television viewing, and exposure to violence. Early smoking leads in turn to a variety of problems, including abuse of other drugs. Inadequate diet and exercise lead to obesity, which results in physical and psychosocial adjustment problems. The book is ideally for the younger or less experienced pediatrician or other healthcare professional who treats children. The details become relevant to the reader as the various problems and scenarios are experienced on a regular basis in the context of a pediatric practice. All the pearls are valuable for the pediatrician and in general may be categorized in several areas. One area is how to get along with and best to relate to infants, children, adolescents, parents, resident physicians, partners in practice, office staff, nurses, other physicians in the community, pharmaceutical representatives, hospitalized patients, managed care organizations, and pharmacists. There is also advice on medical records and lawsuits, medical schools and the need for curriculum changes, telephone use in the office and after hours, and dealing with noncompliant families. In the realm of skills, personal problem solving, self exploration, and improvement, the author suggests that the pediatrician develop some subspecialty area of interest to keep up with preferentially, which will make office practice more interesting. Sources of medical tips for the health professional are mentioned, including Pediatric Notes (monthly), Year Book of Pediatrics, and monthly tapes from the Audio-Digest Foundation. Sources are given for parents for help with behavior problems, child advocacy, parenting skills, and discipline; these include books, hotlines, and web sites. Other pearls cover the diagnosis and differential diagnosis of most common problems and a large number of less common problems that eventually are seen in most every practice. There are no page numbers, but the 600 pearls are numbered and are listed on approximately 200 pages in a conveniently small book. An excellent 26-page index features on average three pearls per topic, from "abdomen, abscess of " to "zidovudine, perinatal, use of." To give an idea of the detail, nine different pearls are indexed under the topic of abdominal pain: abscess, ultrasound evaluation of the acute surgical abdomen, black-widow spider bite-related, chronic, colicky, idiopathic hypercalciuria-related, Crohn disease-related, hematocolpos-related, and "navel pointing in." A fun exercise is to read the 600 pearls, then look up a topic in the index and try to recall the complete pearl—the pearls are much more inclusive than the index entries. The reader can learn much by performing this exercise, which can be completed in only a few hours, and the breadth and depth of the pearls will shine through. Dr Wadlington has a special interest in working with adolescents to improve lifestyles and in education in areas of drug, alcohol, and tobacco abuse, violence and gun-related deaths, and control of obesity. Under the topic of adolescents are about 30 indexed pearls, such as the excellent PACES for Teenagers mnemonic teaching tool (pot, alcohol, cigarettes, education and future goals, and sex). Smoking has about 15 separate pearls, with some surprising associations. For example, there is an increased risk of attention deficit hyperactivity disorder (ADHD) among mothers who smoke during pregnancy, and there are more smokers among adolescents with ADHD than among those without ADHD. Useful information on other subjects is imparted. The top nutritional problem among children in the United States is obesity and not starvation. Eighty percent of children born to two obese parents will become obese compared with 14% of children born to normal-weight parents. Studies comparing weights of adoptees with weights of biological and adoptive parents indicate that genetic factors are responsible for only 33% of the variance in weight. By the time today's child reaches age 70 years, he or she will have spent 7 years watching TV. By age two years, US kids spend an average of 27 hours per week in front of the television. The television is used too much as a baby-sitter. The American Academy of Pediatrics advises parents to limit television time to one to two hours per day (with careful selection of what is watched). I have been in the field of pediatrics for 33 years, and I agree with at least 95 percent of Pearls From a Pediatric Practice I. It would be useful as a gift to all residents as they graduate from pediatric programs and of great benefit to pediatric nurse practitioners. Most pediatricians and family physicians who care for a significant number of children need to read it. There are two ways to acquire the wisdom in this small book. The usual way is to assimilate it firsthand over a lifetime of practice. A much more reasonable way is to buy the book, meditate upon the proverbs, and become wise ahead of your time.
TI - Pediatric Pearls: Pearls From a Pediatric Practice I
JF - JAMA
DO - 10.1001/jama.281.20.1956-JBK0526-4-1
DA - 1999-05-26
UR - https://www.deepdyve.com/lp/american-medical-association/pediatric-pearls-pearls-from-a-pediatric-practice-i-xn9NU70BMU
SP - 1956
EP - 1957
VL - 281
IS - 20
DP - DeepDyve
ER -