Suffer the children: Flaws, foibles, fallacies and the grave shortcomings of the medical care of children by pediatrician Dr. Peter Palmieri is a difficult book to read. I don’t mean that the writing is hard to understand or filled with jargon, but rather that this is a book that will make you feel uncomfortable. It will challenge some things you are sure you know about medicine and point out some of the myths and crap you believe to be true.
I know this, because that’s the effect it had on me. “What do you mean you shouldn’t alternate Tylenol and Motrin when your kid has a fev–oh. Right. Yeah. Um. Never mind.”
(Darn it, I really believed that particular myth, but it turns out there can be some bad side effects to giving both meds to a kid, besides the possibility of overdosing on one or both. Not to mention that, as we’ve discussed here before, it’s not good to eliminate fever entirely.)
And did you know that the traditional BRAT diet (bananas, rice, applesauce, toast) for vomiting and diarrhea, as well as the liquid diet for a sick kid, are totally wrong? I didn’t. ::sigh::
Dr. Palmieri believes that there are some fundamental problems in the education of pediatricians. They are not taught to think scientifically, but rather learn in something that more closely approaches the old master-apprentice setup of old.
Sure, they memorize a lot of facts of biology and physiology, but when it comes to understanding what disease looks like, they go out on a residency and the first patient they see with that disease becomes their measure. That’s great…except that diseases don’t necessarily present the same way in every patient, so that makes it easy for doctors to miss a diagnosis.
And just as in days of yore, older doctors pass on their wisdom to younger doctors. Which sounds good until you realize that this includes a lot of what my mother would refer to as bubbe meises. (That’s “old wives’ tales” for you non-Yiddish-speakers.)
For example, some pediatricians rush patients with mild dehydration to the hospital for IV fluids, because at one point they were told that it was the most effective treatment. Unfortunately, the science shows that oral rehydration is better and IV fluids (with their subsequent risks of infection) should be kept as a backup in case the patient doesn’t improve.
In addition, Dr. Palmieri believes our system of reimbursement for services is creating serious problems in the provision of health care for kids. And he makes an extremely compelling case, I might add.
While he is careful to note that there are many excellent doctors out there, the way our health care system is set up, doctors who give the most ethical care—that is, the care that uses the fewest tests and medicines to achieve the best results—will receive the least reimbursement.
And between the lack of skill at diagnosis and the monetary incentives, a great many doctors are using tests such as the CBC (complete blood count) improperly. The book includes a very interesting section on the TB test and why it should not be used as a broad screening tool for children with no risk factors, as well as a beautifully clear explanation of false positives and false negatives.
Some of you will wince when I say the book is self-published, but he did an admirable job. Yes, there are a few typos and some occasional infelicitous phrases, but on the whole, Dr. Palmieri has an admirably clear style and an enviable ability to explain scientific and medical concepts so that anyone can understand them.
Besides those minor technical issues, my only minor quibble with the book is that I’d like the author to have described some of his own errors along with those of other doctors. I know it wasn’t his intention but after the millionth anecdote of another doctor screwing up on referral, he started to sound arrogant, which I believe wasn’t his intention.
This is an excellent book that every parent and pediatrician should read and take to heart. Even if it makes us all uncomfortable, this is a conversation we need to be having in order to give our children the best medical care possible.
The link at the top of this post goes to Amazon, but if you want it electronically in non-Kindle form, you can find it on Smashwords in many formats, or in print form at Wordclay. Personally, I recommend the very inexpensive e-book format.
Also, a tip of the ol’ hat to Harriet Hall of Science-based Medicine, who reviewed this book a week ago. I don’t know if I’d have heard of it otherwise.