Fifteen minutes; 900 seconds. Ready, set, go. Pediatrics 1987. Sick-child care. Well-child care. A few vaccines. Some anticipatory guidance. Mostly acute and episodic care. Such as earache, brief history, brief examination, prescription for amoxicillin, follow-up in 2 weeks. Much minutes to spare. Pediatrics today. Chief complaints, health maintenance, growth and development, anticipatory guidance, vision and hearing screening, injury prevention, violence prevention, abuse prevention, domestic violence screening, smoking cessation counseling for parents. Chronic disease management—asthma, obesity, attention-deficit/hyperactivity disorder, HIV, constipation, acne, behavior problems, depression, obstructive sleep apnea, eczema, allergies. Lead screening, anemia screening, cholesterol screening, diabetes screening, depression screening. Growth charts, body mass index calculations. Vaccine evaluation and update every patient every visit with numerous vaccines to give; asthma evaluation every patient with asthma every visit—peak flow monitoring, spirometry, asthma severity level determinations, action plans, self-management plans, teach medication delivery systems. Problem lists, medication lists. Nutrition counseling, obesity prevention counseling, sex education, risk prevention counseling, behavior advice. Advise on: car seats, booster seats, seat belts, air bags, back to sleep, smoke alarms, bike safety, bike helmets, scooter safety, skateboard and in-line skate protection equipment, hot water temperature recommendations, limit TV and GameBoy time, gun safety, Internet warnings. Apply fluoride varnish. Reach Out and Read promotion. Cultural competence. Prescriptions for medications. Provide immunization record to parent. Handouts. Videos. Referrals. Score attention-deficit/hyperactivity disorder rating scales. Laboratory tests—lead, hematocrit level, fasting lipid panel, fasting glucose level, fasting insulin level. Follow-up appointments. Notes for work, notes for school. Record medical encounter. Document, document, document . . . legibly. Complete billing form, ICD-9 diagnostic codes, modifiers, level of service . . . accurately. Check laboratory results, faxes, e-mail, voice mail, snail mail. Whew!!! Only 29 more patients to go. Effective? Exhausting? Time is of the essence. Time for change? Fifteen minutes just ain't enough. PS: Now try doing it in Spanish!! Corresponding author: David A. Waters, MD, Sixteenth Street Community HealthCorps, 1032 S Cesar Chavez Dr, Milwaukee, WI 53204 (e-mail: firstname.lastname@example.org).
Archives of Pediatrics & Adolescent Medicine
– American Medical Association
Published: Jun 1, 2004