Pediatrics

Are pediatric hospitals ready to embrace value-based payment models?

Policy
July 30, 2019

Although pediatric (children’s) hospitals are not yet mandated (as are their general population counterparts) to participate in value-based contracts (VBCs), as competitive medical institutions they are very cognizant of the market changes toward value-based payment models while tirelessly seeking to increase value in pediatric health care delivery.

The push towards better alignment of payers and hospital systems continues to change the landscape of competitive health care. Children’s hospitals “are the backbone …

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The scourge of the pediatric urgent care fellowship

Physician
July 19, 2019

I am one of those lucky souls who actually likes their job. Since I completed my pediatrics residency two years ago, I have been working in urgent care settings. What’s not to like? I get to see a wide variety of patients, I’m always learning something new, and I get to finish my encounters with a high-five from an overeager toddler. If you’re a general pediatrician like me, that’s the …

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What to do with disparaging doctors

Physician
July 5, 2019

Doctors who disparage, or even ridicule, what parents tell them are, fortunately, rare. Nevertheless, sometimes parents may infer from what the doctor says or how he acts that he does not value what they are telling him, even though he did not mean to imply such a thing. All physicians have had the experience of overly touchy parents inappropriately assuming from our questions that we do not respect their ability …

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What to do with physicians who don’t explain

Physician
June 29, 2019

How doctors treat patients’ need for information has changed significantly over the past decades. Sixty years ago medical practice was much more paternalistic than it is now, although some would say it continues to be so in important ways. Still, not too long ago it was common for doctors to tell patients or their families next to nothing about what was going on. The presumption always was: the doctor knows …

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Are antibiotics needed for your child with an ear infection?

Conditions
June 22, 2019

The common practice in this country (although not everywhere — Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. …

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Bottle-feeding grandmothers vs. breastfeeding daughters: advice from a pediatrician

Conditions
June 10, 2019

Recently, a friend’s mother asked me how to best support her daughter’s decision to breastfeed her first grandchild.  The new grandmother questioned her ability to encourage her daughter’s decision because she had not breastfed her own child, and this lack of experience made her feel unqualified to provide support.  With mixed emotions and a lingering sense of guilt, this new grandmother wanted to learn, from a pediatrician friend, how best …

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No, the HPV vaccine isn’t optional

Meds
May 19, 2019

A lot of parents ask me about the HPV vaccine, “Isn’t that the optional one?” Well, let me walk you through why my answer to that question is a hard “no.”

Human papillomavirus (HPV) is a virus that causes warts and several types of cancer. There are over 200 different strains of HPV, some of which tend to cause warts on the hands, feet, or face. Other strains …

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Thank you for letting us be a part of your child’s life. You truly are the heroes of medicine.

Physician
May 3, 2019

The following is something I wrote for our annual memorial service for children who have died at our Children’s Hospital. But these same thoughts are with me every day.

It’s an honor to be here with you to celebrate the lives of our patients. Thank you for being here. Thank you for sharing your children’s lives with all of us. Speaking for the staff of the children’s hospital, thank you for …

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The truth and challenges of being a doctor mom

Physician
April 25, 2019

Being a doctor mom is a beautiful paradox of feeling like a badass one moment and a frazzled I-don’t-know-what-the-heck-I-am-doing mess of a person. Being a female physician, the majority of us feel there is a societal and cultural pressure to be perfect all the time in every sphere of our life: as a professional, parent, and person. Obviously, expecting perfection is a bit unrealistic.

Among doctor moms, there are some common …

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Important new information in the tragic cases of child abuse

Conditions
April 9, 2019

Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …

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It’s time to acknowledge the developmental behavioral pediatric workforce

Conditions
March 26, 2019

There are roughly 15 percent of the nation’s children who suffer from a developmental-behavioral condition or about 1 in 6 children. Unfortunately, many of those children often do not get the help they need.

Children with developmental and behavioral challenges can easily be missed, especially when the behaviors are more subtle or impacts on function are not evident daily, such as with a …

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Adverse childhood experiences: How changing a child’s environment can help

Conditions
March 21, 2019

Some children present to me with complex problems or multiple problems that fail to resolve after the typical interventions.

I recall a child with severe abdominal pain. He had tried numerous medicines and had had scopes and studies galore. It had reached the point where he was being scheduled for exploratory surgery to try and see the cause of his pain. I lost track of his case when I rotated elsewhere …

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A pediatrician’s tips for your kids’ snacking habits

Conditions
March 15, 2019

Parents often ask me about snacks for their children once they are eating table food. Should they even give them snacks? If so, what kinds are good for them, and how often? In general, after age one I recommend three kid-size meals and 1 to 2 snacks to help them get their daily nutritional requirements. Try not to stress or obsess at each feeding about them eating all that you …

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The consequences of celebrity endorsements in health care

Meds
March 14, 2019

“Try this,” whispers Kate Winslet as I wander past the Lancôme counter. “Your glowing skin will thank you.”

The consequences of a celebrity endorsement are seemingly harmless when it comes to revamping a makeup routine, but what happens when this type of advertisement seeps into the world of health care? It has been proven many times that celebrity endorsements influence decisions about specific political candidates, issues or parties, and the positive …

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Does work-life balance really exist for young mothers pursuing medical careers?

Education
March 14, 2019

As our society’s awareness of mental-health issues increases, the idea of balancing personal and professional life has become a central topic of conversation. It cannot be disputed that finding a healthy equilibrium is especially important for mothers who enter the professional world, medical or otherwise. As a student in an accelerated post-baccalaureate pre-health program and a mother of a 3-year-old girl and a 10-month-old boy, I have made many strides …

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Motrin vs. Tylenol for children: A pediatrician explains

Meds
March 12, 2019

As a pediatrician, I am asked by worried parents about what they should give their child with a fever, Motrin (ibuprofen), or Tylenol (acetaminophen) to bring down the temperature daily.

This question always requires more than a one-word response to the choice between anti-fever medications. An explanation of medication even being necessary for the fever and to clarify many long-standing fever phobia misconceptions.

Mainly, it is not necessary to treat the number …

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To parents who have lost children: We never forget your children

Physician
March 7, 2019

Her name was Callie (identifying information changed). She was four years old. She loved glitter and princesses and anything sparkly. She was affectionate and silly, and I fell hard for her. She was a patient, my patient, on the pediatric oncology unit during my very first ward rotation intern year.

On my first day, I was as scared as any person can be, palms sweating, heart pounding, faced with these tiny, …

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The clinical and financial life of a pediatrician

Physician
February 14, 2019

Most doctors well into their tenure of medical already have a general idea about how other specialists spend their days (except for radiation oncologists, where no one else knows what they do).  However, as a medical student, I had incredibly limited insight into the variety of means to practice medicine. Even as an attending physician, I am still discovering how creative some medical specialties allow one to be.  For instance, …

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How to say “no” to kids

Physician
February 6, 2019

Do you feel like you’re always saying “no” to your child and not getting the response from them that you are looking for? Do you end up repeating yourself over and over, so frustrated you begin to yell or just given in to your toddler’s demands? Unfortunately, I hear this way too often from moms, so I wanted to give some tips on the art of saying “no” that will …

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How an insurance company auditor tried to destroy a physician’s career

Physician
February 6, 2019

It’s no secret that in today’s health care market, insurance companies are calling the shots. As a pediatrician in private practice for almost two decades, I’ve seen insurance companies transform into perhaps the single most powerful player in today’s health care landscape — final arbiters whose decisions about which procedures or medications to authorize effectively end up determining the course of patient care.

Decisions made by insurers, such as MassHealth, have …

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