Paediatricians look for uncommon and important medical syndromes or illnesses. They focus on their detection and are very keen to avoid missing something. This leads to investigations, “just in case”, and treating, “just in case”.
GPs are trained to play the odds. The most common condition is suspected first and since most children have common short-lived complaints, GPs manage the family from this perspective. Only if there is something out of the ordinary, or special circumstances present, will the GP go looking for the rare condition.
The ‘Paediatrician’ or ‘Specialist’ approach creates more investigations and therefore more cost to the family and the system, and much more parental anxiety. As anxiety is increasing greatly among the newer generation of parents, a whole-of-family approach to investigation and treatment of children is much better.
The “just in case” model of care might make doctors more comfortable about not missing something, and generate repeat consultations, but it may not be in the family’s best interests.
For example, we perform ultrasounds for possible hip dysplasia on neonates and repeat them “just in case” at an alarming rate. Repeat ultrasound and specialist follow-up appointments are created to catch a very rare condition. However, doctors have not missed many cases in previous years through the tried and true process of thorough clinical examination and ultrasounds for those at greater risk e.g. breech.
So whose anxiety or needs are being treated, the doctor’s or the family’s?
Another example. Cow’s Milk Protein Allergy is rare when we keep to clear, proven diagnostic criteria, but many doctors (paediatricians and GPs) suggest this possibility to a mother with a crying baby with some gut symptoms. This “just in case” suggestion puts so many mothers on dairy free diets and increases the whole family’s anxiety.
Why not first make a diagnosis based on proven criteria? Why treat on hypothesis if the mental (and financial) health of the rest of the family may suffer, with little proven benefit for the child?
This enhances parental anxiety and reinforces the belief that parents should look for ‘what is wrong with my child’.
Perhaps we need to train our young paediatricians and GPs to care for the whole family; to be confident in their clinical knowledge and examination; to make decisions based upon diagnosis not hypothesis; and to focus on reduction of parental anxiety as a major goal.
References available on request.
Questions? Contact the editor.
Author competing interests: nil relevant disclosures.
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