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F. Scott Fitzgerald wrote that the very rich are different from you and me, but how, exactly? Well, consider Queen Elizabeth II, who just had a new portrait of her great grandson Prince George installed in the sitting room of her Scottish Highlands estate. I mean, who has a portrait painted of a 1-month-old infant? Not pediatricians. We know that at 4 weeks, babies are still all splotchy.
More to the point, who has a room just for sitting? That’s how I’ll know I’ve finally made it in life -- I’ll sit down. In a room. Where that’s all you do. With a portrait of a newborn. Don’t worry, when the time comes, you’re all invited to take a load off; pull up a throne!
Blanket policy
Don’t you hate it when you get news and you’re not sure whether to be happy or upset? Like this week my daughter proudly told me she made the second-highest grade in her class on a math test? Which was 75? Pediatricians all over are struggling with how to feel over a new report in JAMA Pediatrics suggesting a new way to help mothers nurse their infants longer: co-sleeping. I know, right? “Yay! Wait a minute. Boo! But then again, yay?”
Dr. Fern Hauck and his team from the University of Virginia polled around 1,800 nursing mothers of infants from age 2 weeks to age 12 months, checking in with them a total of seven times and asking them a bunch of questions about supplemental feeds and when, whether, and why they stopped breastfeeding. Half of women who shared their beds with their babies continued to nurse for a full year, as recommended by the American Academy of Pediatrics. In contrast, breastfeeding rates were under 50% at 7 months of age among women who never slept with their infants, as recommended by the American Academy of Pediatrics.
Co-sleeping puts infants at dramatically increased risk of sudden infant death syndrome (SIDS). Breastfeeding significantly lowers infants’ risks of SIDS. Co-sleeping appears to encourage breastfeeding, but we can’t encourage co-sleeping, and, well, I need a nap. What we have here, of course, is a golden opportunity for a grant application: Someone with a slave army of graduate students needs to meta-analyze the various risk factors of co-sleeping and formula-feeding and churn out a statistical model that helps pediatricians know when to nod approvingly and when to roll our eyes and embark on some earnest counseling. Wake me up when you’re done.
Brace yourself
Practicing evidence-based medicine constantly makes me feel like the hard-boiled fictional detective Philip Marlowe. Just when I think I’m as cynical as I can get, someone tells me something that makes me feel as innocent as a newborn (if not as splotchy). Now a new study in the New England Journal of Medicine purports to show for the first time ever that back braces can slow the progression of scoliosis. You mean we didn’t know that already? I assumed this was a confirmed fact back in 1984 based on my repeated viewings of Sixteen Candles. Did we really make poor Joan Cusack suffer for pure clinical conjecture?
Apparently so, but not any more. Those confined to back braces since their invention in 1948 will be happy to learn that they did not wear them in vain. As it turns out, the study was stopped early when it became clear that 72% of brace-wearers were able to avoid invasive back surgery, compared with only 48% of those randomized to watchful waiting. Furthermore, there was a dose-related effect; the more hours each day subjects wore their braces, the better their chances of staving off surgery. Perhaps for the first time ever, one of my strongly held beliefs is confirmed by evidence!
Of course, we’re nowhere near done. Some back brace patients still go one to surgery, and no one knows how to tell which ones. I only hope that when we figure it out someone will let me in on it. In the meantime I’ll just continue stumbling blindly through life, at least until I get that sitting room.
Measure for measure
Some things are a lot better in theory than in execution, like, say, binge drinking. A new study from England suggests that these things should include physician pay-for-performance plans. The problem, as you may have suspected, is that there is almost no correlation between evidence-based measures of quality of care and patients’ satisfaction with the care they receive. This fact should be obvious to anyone who has ever spent twenty minutes explaining to a parent why green snot does not always warrant an antibiotic prescription.
Since patient satisfaction is often counted among the measures of physician performance, I’m very worried. To the extent that “good” medical practice corresponded to patient happiness, access to appointments and to preferred providers were the most influential measures. This means, of course, that the least popular doctors were the most popular, until they became too popular, making them unpopular. Fortunately for me, we’re still entrenched in a system in which physician pay depends solely on sheer volume, influenced neither by clinical quality nor by patient satisfaction. And that is why, if I ever want that sitting room, there’s no time to sit.
David L. Hill, M.D., FAAP is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.
F. Scott Fitzgerald wrote that the very rich are different from you and me, but how, exactly? Well, consider Queen Elizabeth II, who just had a new portrait of her great grandson Prince George installed in the sitting room of her Scottish Highlands estate. I mean, who has a portrait painted of a 1-month-old infant? Not pediatricians. We know that at 4 weeks, babies are still all splotchy.
More to the point, who has a room just for sitting? That’s how I’ll know I’ve finally made it in life -- I’ll sit down. In a room. Where that’s all you do. With a portrait of a newborn. Don’t worry, when the time comes, you’re all invited to take a load off; pull up a throne!
Blanket policy
Don’t you hate it when you get news and you’re not sure whether to be happy or upset? Like this week my daughter proudly told me she made the second-highest grade in her class on a math test? Which was 75? Pediatricians all over are struggling with how to feel over a new report in JAMA Pediatrics suggesting a new way to help mothers nurse their infants longer: co-sleeping. I know, right? “Yay! Wait a minute. Boo! But then again, yay?”
Dr. Fern Hauck and his team from the University of Virginia polled around 1,800 nursing mothers of infants from age 2 weeks to age 12 months, checking in with them a total of seven times and asking them a bunch of questions about supplemental feeds and when, whether, and why they stopped breastfeeding. Half of women who shared their beds with their babies continued to nurse for a full year, as recommended by the American Academy of Pediatrics. In contrast, breastfeeding rates were under 50% at 7 months of age among women who never slept with their infants, as recommended by the American Academy of Pediatrics.
Co-sleeping puts infants at dramatically increased risk of sudden infant death syndrome (SIDS). Breastfeeding significantly lowers infants’ risks of SIDS. Co-sleeping appears to encourage breastfeeding, but we can’t encourage co-sleeping, and, well, I need a nap. What we have here, of course, is a golden opportunity for a grant application: Someone with a slave army of graduate students needs to meta-analyze the various risk factors of co-sleeping and formula-feeding and churn out a statistical model that helps pediatricians know when to nod approvingly and when to roll our eyes and embark on some earnest counseling. Wake me up when you’re done.
Brace yourself
Practicing evidence-based medicine constantly makes me feel like the hard-boiled fictional detective Philip Marlowe. Just when I think I’m as cynical as I can get, someone tells me something that makes me feel as innocent as a newborn (if not as splotchy). Now a new study in the New England Journal of Medicine purports to show for the first time ever that back braces can slow the progression of scoliosis. You mean we didn’t know that already? I assumed this was a confirmed fact back in 1984 based on my repeated viewings of Sixteen Candles. Did we really make poor Joan Cusack suffer for pure clinical conjecture?
Apparently so, but not any more. Those confined to back braces since their invention in 1948 will be happy to learn that they did not wear them in vain. As it turns out, the study was stopped early when it became clear that 72% of brace-wearers were able to avoid invasive back surgery, compared with only 48% of those randomized to watchful waiting. Furthermore, there was a dose-related effect; the more hours each day subjects wore their braces, the better their chances of staving off surgery. Perhaps for the first time ever, one of my strongly held beliefs is confirmed by evidence!
Of course, we’re nowhere near done. Some back brace patients still go one to surgery, and no one knows how to tell which ones. I only hope that when we figure it out someone will let me in on it. In the meantime I’ll just continue stumbling blindly through life, at least until I get that sitting room.
Measure for measure
Some things are a lot better in theory than in execution, like, say, binge drinking. A new study from England suggests that these things should include physician pay-for-performance plans. The problem, as you may have suspected, is that there is almost no correlation between evidence-based measures of quality of care and patients’ satisfaction with the care they receive. This fact should be obvious to anyone who has ever spent twenty minutes explaining to a parent why green snot does not always warrant an antibiotic prescription.
Since patient satisfaction is often counted among the measures of physician performance, I’m very worried. To the extent that “good” medical practice corresponded to patient happiness, access to appointments and to preferred providers were the most influential measures. This means, of course, that the least popular doctors were the most popular, until they became too popular, making them unpopular. Fortunately for me, we’re still entrenched in a system in which physician pay depends solely on sheer volume, influenced neither by clinical quality nor by patient satisfaction. And that is why, if I ever want that sitting room, there’s no time to sit.
David L. Hill, M.D., FAAP is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.
F. Scott Fitzgerald wrote that the very rich are different from you and me, but how, exactly? Well, consider Queen Elizabeth II, who just had a new portrait of her great grandson Prince George installed in the sitting room of her Scottish Highlands estate. I mean, who has a portrait painted of a 1-month-old infant? Not pediatricians. We know that at 4 weeks, babies are still all splotchy.
More to the point, who has a room just for sitting? That’s how I’ll know I’ve finally made it in life -- I’ll sit down. In a room. Where that’s all you do. With a portrait of a newborn. Don’t worry, when the time comes, you’re all invited to take a load off; pull up a throne!
Blanket policy
Don’t you hate it when you get news and you’re not sure whether to be happy or upset? Like this week my daughter proudly told me she made the second-highest grade in her class on a math test? Which was 75? Pediatricians all over are struggling with how to feel over a new report in JAMA Pediatrics suggesting a new way to help mothers nurse their infants longer: co-sleeping. I know, right? “Yay! Wait a minute. Boo! But then again, yay?”
Dr. Fern Hauck and his team from the University of Virginia polled around 1,800 nursing mothers of infants from age 2 weeks to age 12 months, checking in with them a total of seven times and asking them a bunch of questions about supplemental feeds and when, whether, and why they stopped breastfeeding. Half of women who shared their beds with their babies continued to nurse for a full year, as recommended by the American Academy of Pediatrics. In contrast, breastfeeding rates were under 50% at 7 months of age among women who never slept with their infants, as recommended by the American Academy of Pediatrics.
Co-sleeping puts infants at dramatically increased risk of sudden infant death syndrome (SIDS). Breastfeeding significantly lowers infants’ risks of SIDS. Co-sleeping appears to encourage breastfeeding, but we can’t encourage co-sleeping, and, well, I need a nap. What we have here, of course, is a golden opportunity for a grant application: Someone with a slave army of graduate students needs to meta-analyze the various risk factors of co-sleeping and formula-feeding and churn out a statistical model that helps pediatricians know when to nod approvingly and when to roll our eyes and embark on some earnest counseling. Wake me up when you’re done.
Brace yourself
Practicing evidence-based medicine constantly makes me feel like the hard-boiled fictional detective Philip Marlowe. Just when I think I’m as cynical as I can get, someone tells me something that makes me feel as innocent as a newborn (if not as splotchy). Now a new study in the New England Journal of Medicine purports to show for the first time ever that back braces can slow the progression of scoliosis. You mean we didn’t know that already? I assumed this was a confirmed fact back in 1984 based on my repeated viewings of Sixteen Candles. Did we really make poor Joan Cusack suffer for pure clinical conjecture?
Apparently so, but not any more. Those confined to back braces since their invention in 1948 will be happy to learn that they did not wear them in vain. As it turns out, the study was stopped early when it became clear that 72% of brace-wearers were able to avoid invasive back surgery, compared with only 48% of those randomized to watchful waiting. Furthermore, there was a dose-related effect; the more hours each day subjects wore their braces, the better their chances of staving off surgery. Perhaps for the first time ever, one of my strongly held beliefs is confirmed by evidence!
Of course, we’re nowhere near done. Some back brace patients still go one to surgery, and no one knows how to tell which ones. I only hope that when we figure it out someone will let me in on it. In the meantime I’ll just continue stumbling blindly through life, at least until I get that sitting room.
Measure for measure
Some things are a lot better in theory than in execution, like, say, binge drinking. A new study from England suggests that these things should include physician pay-for-performance plans. The problem, as you may have suspected, is that there is almost no correlation between evidence-based measures of quality of care and patients’ satisfaction with the care they receive. This fact should be obvious to anyone who has ever spent twenty minutes explaining to a parent why green snot does not always warrant an antibiotic prescription.
Since patient satisfaction is often counted among the measures of physician performance, I’m very worried. To the extent that “good” medical practice corresponded to patient happiness, access to appointments and to preferred providers were the most influential measures. This means, of course, that the least popular doctors were the most popular, until they became too popular, making them unpopular. Fortunately for me, we’re still entrenched in a system in which physician pay depends solely on sheer volume, influenced neither by clinical quality nor by patient satisfaction. And that is why, if I ever want that sitting room, there’s no time to sit.
David L. Hill, M.D., FAAP is the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012). He is also vice president of Cape Fear Pediatrics in Wilmington, N.C., and adjunct assistant professor of pediatrics at the University of North Carolina at Chapel Hill. He serves as Program Director for the AAP Council on Communications and Media and as an executive committee member of the North Carolina Pediatric Society. He has recorded commentaries for NPR's All Things Considered and provided content for various print, television, and Internet outlets.