Pediatric Health Maintenance in the 21st Century: A View From the Trenches

There have been quite a few articles in Pediatrics lately on the general topic of well-child care.1–8 At the risk of seeming presumptuous, I would like to join the discussion from the viewpoint of a private pediatrician. It often seems that many of the authors on pediatric health maintenance concepts these days are academic behavioral pediatricians. I suppose this behavioral approach to health maintenance is appropriate, because the “new morbidity” is now the only morbidity many of us have ever known. But, when all is said and done, it is the general pediatricians, family practitioners, and nurse practitioners who struggle to provide quality well-child care. Actually, I can write with some semblance of authority. I have been in private-practice pediatrics for close to 25 years, and I am honored to be a member of the Bright Futures Users Panel. Looking at pediatric health maintenance and how best to perform it has long been of interest to me. As I see it, we have 4 things to accomplish. We need to spend enough time during the encounter to be thorough and complete. We must do it all in the allotted period of time so as not to keep other families waiting. Yet, we must see enough patients to be productive—pay the bills and make a bit of a profit. Finally, we want to work at a comfortable enough pace that we stay calm and friendly through it all. To do any 3 at the expense of a fourth may be quite feasible, but achieving all 4 can be a profound challenge. Thus, any suggestions toward enhancing pediatric health maintenance become challenges at best and intrusions at worst. The possible topics we can cover for anticipatory guidance can be daunting. I once mentioned to another member of the Bright … Address correspondence to Bruce Bedingfield, DO, FAAP, 2500 W Higgins, #440, Hoffman Estates, IL 60195. E-mail: drbrucebed{at}aol.com