Reply to: Referral to subspecialists

Abstract

ReplyMany of the points made by Dr. Schneider are well taken. I hope that he may agree, however, that pediatric residents can be taught child development by others than child neurologists. Some of the referrals by “pediatricians” may have been made by other subspecialists involved in the care of the children. The problem, I believe, is that many pediatricians allow the skills gained in residency to atrophy as a result of disuse. The combined pressures of a busy practice, concern about missing a diagnosis, and fear of malpractice suits lead to many referrals for consultation. If we have properly educated a specialist for children, he or she should not find it necessary to refer every child with a heart murmur to a cardiologist, every child with diabetes mellitus to an endocrinologist, or every child with developmental delay to a neurologist. The same pediatricians who complain about the lack of challenge in general pediatric practice are often the ones who send every time-consuming patient to a subspecialist. In the era of managed care, pediatricians may find it necessary to continue to exercise the skills and judgment taught them by specialists like Dr. Schneider, and refer only those problems that require special knowledge and expertise.The Residency Review Committee has continued to modify the training requirements for pediatrics, and to deemphasize critical care so that more time can be given to problems like delayed development. This may be an excellent time for child neurologists to reassert their roles in the training of pediatricians.9/35/69135 ReplyMany of the points made by Dr. Schneider are well taken. I hope that he may agree, however, that pediatric residents can be taught child development by others than child neurologists. Some of the referrals by “pediatricians” may have been made by other subspecialists involved in the care of the children. The problem, I believe, is that many pediatricians allow the skills gained in residency to atrophy as a result of disuse. The combined pressures of a busy practice, concern about missing a diagnosis, and fear of malpractice suits lead to many referrals for consultation. If we have properly educated a specialist for children, he or she should not find it necessary to refer every child with a heart murmur to a cardiologist, every child with diabetes mellitus to an endocrinologist, or every child with developmental delay to a neurologist. The same pediatricians who complain about the lack of challenge in general pediatric practice are often the ones who send every time-consuming patient to a subspecialist. In the era of managed care, pediatricians may find it necessary to continue to exercise the skills and judgment taught them by specialists like Dr. Schneider, and refer only those problems that require special knowledge and expertise.The Residency Review Committee has continued to modify the training requirements for pediatrics, and to deemphasize critical care so that more time can be given to problems like delayed development. This may be an excellent time for child neurologists to reassert their roles in the training of pediatricians. Many of the points made by Dr. Schneider are well taken. I hope that he may agree, however, that pediatric residents can be taught child development by others than child neurologists. Some of the referrals by “pediatricians” may have been made by other subspecialists involved in the care of the children. The problem, I believe, is that many pediatricians allow the skills gained in residency to atrophy as a result of disuse. The combined pressures of a busy practice, concern about missing a diagnosis, and fear of malpractice suits lead to many referrals for consultation. If we have properly educated a specialist for children, he or she should not find it necessary to refer every child with a heart murmur to a cardiologist, every child with diabetes mellitus to an endocrinologist, or every child with developmental delay to a neurologist. The same pediatricians who complain about the lack of challenge in general pediatric practice are often the ones who send every time-consuming patient to a subspecialist. In the era of managed care, pediatricians may find it necessary to continue to exercise the skills and judgment taught them by specialists like Dr. Schneider, and refer only those problems that require special knowledge and expertise. The Residency Review Committee has continued to modify the training requirements for pediatrics, and to deemphasize critical care so that more time can be given to problems like delayed development. This may be an excellent time for child neurologists to reassert their roles in the training of pediatricians. 9/35/69135