Skip to content
  • About
  • Contact
  • Contribute
  • My Book
  • Careers
  • Podcast
  • Transcripts
  • Speaking
KevinMD
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • My Book
    • Careers
    • Podcast
    • Transcripts
    • Speaking
KevinMD
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • My Book
    • Careers
    • Podcast
    • Transcripts
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Be heard on social media’s leading physician voice
  • Contact Kevin
  • Custom enhanced author page pricing
  • DMCA Policy
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • KevinMD influencer opportunities
  • Opinion and commentary by KevinMD
  • Physician burnout speakers to keynote your conference
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Privacy Policy
  • Recommended services by KevinMD
  • Subscribe to the newsletter
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • Upgrade to the KevinMD enhanced author page

Pediatrics is full of uncertainty, not unlike the practice of parenthood

Claire McCarthy, MD
Physician
May 17, 2011
Share
Tweet
Share

Recently I wrote a blog about how the American Academy of Pediatrics (AAP) thinks that otherwise healthy children with ear infections should wait a couple of days before starting antibiotics, because many will get better without them.

Now there are two articles in the New England Journal of Medicine (here and here) saying that children with ear infections who are given antibiotics are more likely to get better, and to get better quickly, than those who aren’t.

Awkward.

To be fair to the AAP, the studies don’t refute their policy as much as it might seem. In both of the studies, lots of children got better without antibiotics. And since the AAP doesn’t say that kids shouldn’t get antibiotics, just that they should wait, what these studies seem to say is that if parents truly need to do everything possible to get their kids better fast (e.g. the child missing school, or the parent missing work, is a real problem), giving antibiotics is the way to go.

All the concerns the AAP had about side effects (indeed, in both studies diarrhea was common in the kids who got antibiotics) and increasing resistance to antibiotics (interestingly, in both studies the antibiotic used was something stronger, and more likely to cause resistance, than the antibiotic recommended by the AAP) still remain. Both studies acknowledge that more studies need to be done.

But the studies do put me in the position of rethinking, and possibly changing, the advice I give parents—the advice I gave rather publicly just a couple of months ago.

Like I said: awkward.

This actually happens all the time. Doctors rely on scientific studies to tell us how to practice medicine. The thing is, scientific studies are much less clear than people realize. The way a study is designed affects everything, as does how many patients were in it (lots of patients is always better, but it’s not always easy to get lots of patients in a study), how long it lasted, and lots of other factors.

A study can seem to show clearly that X is the best treatment for a condition, so we all start doing X…only to have the next study show that Y is much better than X…only to have the next study show that neither is a good idea and that we need to go back to the drawing board.

When I started being a pediatrician a couple of decades ago, we were taught that if a baby was at least 9 months old and weighed at least 18 pounds, it was okay to switch from formula to cow’s milk. Now we know that starting cow’s milk before 12 months can lead to iron deficiency, and would never give that advice. Another example: We used to tell parents that it was a good idea to get their baby boys circumcised, because it lowered the risk of urinary tract infections and penile cancer. Then specialists studied the issue and decided that the risks of the circumcision itself (like bleeding or other complications) just about equaled the risks of infection and cancer. So the advice changed: we told parents to make the decision based on personal or religious preference, because there wasn’t a good medical argument either way. Now, with more and more evidence that circumcision may help prevent HIV infection, we may change our advice again.

Parents want their doctors to be authoritative, to tell them exactly what to do. For what it’s worth, we doctors want to be authoritative. It’s much more comfortable and comforting to have The Right Answer than it is try to explain that medicine is art and shades of gray, influenced by an understanding of science that is always evolving. But The Right Answer can be elusive sometimes.

So cut us doctors some slack the next time we hesitate, or waver, or even contradict what we said last year or last week. Understand that it’s not that we don’t know what we’re doing—it’s just that we are learning new things all the time. When we offer you options, understand that the reason we’re doing that is not to confuse you, or to get out of making a decision, but because there truly are different options and the science can’t tell us yet which is best.

The practice of pediatrics is not unlike the practice of parenthood: full of uncertainty, impossible to understand completely and done best when the child is more important than anything else. We’re coming at it from different places, but we’re in this together.

Claire McCarthy is a primary care physician and the medical director of Children’s Hospital Boston’s Martha Eliot Health Center.  She blogs at Thrive, the Children’s Hospital Boston blog.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

A tough disposition is required to endure physician training

May 17, 2011 Kevin 6
…
Next

Doctors should know how much lab tests cost

May 17, 2011 Kevin 24
…

Tagged as: Patients, Primary Care

< Previous Post
A tough disposition is required to endure physician training
Next Post >
Doctors should know how much lab tests cost

ADVERTISEMENT

More by Claire McCarthy, MD

  • Sometimes, talking to strangers is necessary

    Claire McCarthy, MD
  • Maybe God made teenagers difficult so we can let them go

    Claire McCarthy, MD
  • 4 mistakes parents make in the pediatrician’s office

    Claire McCarthy, MD

More in Physician

  • A hard week is not a verdict on a physician’s career

    Sofia Dobrin, MD
  • Who are you when the white coat is off?

    Seleipiri Akobo, MD, MPH, MBA
  • Why resident mistreatment puts patient care at risk

    Anonymous
  • Wealth inequality is a clinical problem, not political

    Sameen Farooq, MD
  • Professional identity in medicine has been hollowed out

    Ronald L. Lindsay, MD
  • Why is women’s mental health in psychiatry so overlooked?

    Jincy Rajan, MD
  • Most Popular

  • Past Week

    • When men falling behind unravels families and futures

      Osmund Agbo, MD | Physician
    • Generalist physicians and AI are a comparative advantage

      Jeremy Fish, MD | Health Technology
    • 1 in 12 medical billing companies just vanished

      GetPracticeHelp | Physician Finance
    • The health care workforce crisis we keep ignoring

      Narinder Singh Parhar, MD | Health Policy
    • Why a malpractice lawsuit follows you after you win

      Tim Brocklehurst, MBA | Conditions and Diseases
    • Patients are turning to AI because doctors lack time

      Arthur Lazarus, MD, MBA | Health Technology
  • Past 6 Months

    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • Polycystic ovary syndrome is more than ovarian

      Oluyemisi Famuyiwa, MD | Conditions and Diseases
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • Metrics got you into medicine and are making you unhappy in it [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 fixes for primary care access in the ChatGPT era

      Payam Zamani, MD | Health Technology
    • The residency personal statement is an identity problem

      Kathleen Muldoon, PhD | Medical Education
  • Recent Posts

    • A hard week is not a verdict on a physician’s career

      Sofia Dobrin, MD | Physician
    • Underage gambling thrives on offshore betting sites

      Kayvan Haddadan, MD | Conditions and Diseases
    • Who are you when the white coat is off?

      Seleipiri Akobo, MD, MPH, MBA | Physician
    • The emotional weight of choosing food allergy treatment

      Amanda Whitehouse, PhD | Conditions and Diseases
    • How to use patient wearable data in cardiology visits

      Tarpan Patel | Health Technology
    • How AI is reshaping applied behavior analysis care

      Brad Smith, PhD | Conditions and Diseases

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • When men falling behind unravels families and futures

      Osmund Agbo, MD | Physician
    • Generalist physicians and AI are a comparative advantage

      Jeremy Fish, MD | Health Technology
    • 1 in 12 medical billing companies just vanished

      GetPracticeHelp | Physician Finance
    • The health care workforce crisis we keep ignoring

      Narinder Singh Parhar, MD | Health Policy
    • Why a malpractice lawsuit follows you after you win

      Tim Brocklehurst, MBA | Conditions and Diseases
    • Patients are turning to AI because doctors lack time

      Arthur Lazarus, MD, MBA | Health Technology
  • Past 6 Months

    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • Polycystic ovary syndrome is more than ovarian

      Oluyemisi Famuyiwa, MD | Conditions and Diseases
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • Metrics got you into medicine and are making you unhappy in it [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 fixes for primary care access in the ChatGPT era

      Payam Zamani, MD | Health Technology
    • The residency personal statement is an identity problem

      Kathleen Muldoon, PhD | Medical Education
  • Recent Posts

    • A hard week is not a verdict on a physician’s career

      Sofia Dobrin, MD | Physician
    • Underage gambling thrives on offshore betting sites

      Kayvan Haddadan, MD | Conditions and Diseases
    • Who are you when the white coat is off?

      Seleipiri Akobo, MD, MPH, MBA | Physician
    • The emotional weight of choosing food allergy treatment

      Amanda Whitehouse, PhD | Conditions and Diseases
    • How to use patient wearable data in cardiology visits

      Tarpan Patel | Health Technology
    • How AI is reshaping applied behavior analysis care

      Brad Smith, PhD | Conditions and Diseases

MedPage Today Professional

An Everyday Health Property Medpage Today

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Pediatrics is full of uncertainty, not unlike the practice of parenthood
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...