Stories about: Pediatric Dose November 2015

The unvaccinated: To treat or not to treat?

doctor hands behind back unvaccinated children
(Dan Kosmayer/Shutterstock)

The debate continues — should a provider treat an unvaccinated patient? In a 2012 statement, the AAP recommended that pediatricians should not refuse unvaccinated children. A new survey published this month in the journal Pediatrics, however, found that 21 percent of pediatricians do so anyway, “often or always” dismissing families from their practice for refusing at least one infant vaccine.

Ronald Samuels, MD, MPH, associate medical director of Boston Children’s Primary Care at Longwood, is not surprised at the results of the survey. “We see ourselves as a safety net provider and do not feel we can or should turn any patient away, but we worry about the increased risk unvaccinated children present to other patients in the practice. I have very mixed feelings about this.”

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Medical simulation makes its mark in Milford

_GEP1897 Weeks before the Meehan Family Pavilion at Milford Regional Medical Center opened its doors to a new Emergency Department on October 28, a few special patients had already been treated. There was a woman who went into premature labor, a child who accidentally overdosed on medication, and a man with a bacterial infection, among others.

All of these patients were in fact only actors playing their part in a SIMTest, a service provided by Boston Children’s Hospital Simulator Program (SIMPeds) that helps expose unanticipated safety issues and avoid mistakes before they arise in real-life settings. Medical simulation has grown in popularity over the past ten years, as studies show that the practice can result in “safer and more efficient care for patients, providers, and systems.”

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Material, financial hardships common among families with a child in cancer treatment

little girl empty bowl hardship childhood cancer

Doctors and nurses do all they can to manage the medical and emotional trials of childhood cancer treatment. What they may be less aware of, though, are other hardships families face while their child is being treated, particularly when it comes to meeting basic needs.

A recent study in Pediatric Blood and Cancer provides a disturbing snapshot into those difficulties. In it, Kira Bona, MD, MPH, a pediatric oncologist with Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, reveals that up to one-third of families with a child in cancer treatment experience food, housing or energy insecurity within six months of their child’s diagnosis; one-quarter lost more than 40 percent of household income.

Because the study looked only at families seen at Dana-Farber/Boston Children’s, Bona worries that her findings may just be the tip of the iceberg.

“What it says is that even at a well-resourced, large referral center, about a third of families are reporting food, housing or energy insecurity six months into treatment,” she said in a statement. “If anything, the numbers in our study  are an underestimate of what might be seen at less well-resourced institutions, which was somewhat surprising to us.”

But there is a silver lining to the news. Because government agencies and philanthropic groups can help families get food and housing, clinicians may be able to help families address these kinds of material hardships more readily than financial ones.

“If household material hardship is linked to poorer outcomes in pediatric oncology, just like income is, then we can design interventions to fix food, housing and energy insecurity,” Bona said. “It’s not clear what you do about income in a clinical setting.”

Read Bona’s study to learn more.

The patient’s bedside is no place for the passive voice

boy holding hands over his ears passive voice medical communications

Read a medical journal, guideline or progress note and most often you will find yourself reading sentences in the passive voice. “The infant is placed in the lateral decubitus position.” “The catheter should be removed as soon as it is no longer necessary.” “The treatment options were explained to the patient.” These snippets are typical examples of how the medical community has been taught to write, purportedly serving to protect anonymity and set an impassive, professional tone.

While this stylistic standard may have its role in formal medical writing, it introduces a host of concerns at the bedside. Compared to the active voice, the passive voice tends to be less interesting, less forceful and most importantly for patient safety and quality of care, less clear. …Read More