FEATURE
SEEING POSITIVES IN THE
Challenges of Pediatrics
Laleh Rezaei, MD
I
don’t have to look hard in my daily practice
of pediatrics to encounter many things in
health care that drive me crazy. I am proud
to report that we pediatricians have been
very successful in putting ourselves out
of business with all the wonderful preventive
vaccines that we are providing to our patients.
In my days of residency almost 20 years ago,
we had to perform spinal taps in many young children with fever
because of the overwhelming possibility of bacterial meningitis.
Very early during my residency training, I became an expert in
performing a so-called Champlain spinal tap perfectly. I imagine
that young physicians these days have fewer opportunities to fulfill
this requirement because of the decreased morbidity and mortality
for our children. In the era of vaccinations, bacterial meningitis is
not on top of our list in a fully vaccinated febrile child. What drives
me crazy is that I have to convince many parents that by refusing
vaccinations, they put their children as well as society at risk.
The bread and butter of pediatrics, however, is the treatment of
viral respiratory infections that we still don’t have effective vaccines
for. January is the busiest month of the year for pediatricians be-
cause of the wide variety of respiratory viruses marching through
the community. The Children’s hospital is often on diversion and
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LOUISVILLE MEDICINE
patients have to be cared for in the emergency department’s small
holding areas until a more convenient room becomes available.
On a cold January morning, I had a six-day-old patient in one of
these rooms waiting to be transferred. She was admitted for neonatal
jaundice, and her treatment involved phototherapy with UV light.
I entered this blue-lit room. Both parents were sitting on a recliner
chair turned into a bed. The young father, desperate to make his
family comfortable, was serving his wife from a hospital breakfast
tray. I masked my frustration and jokingly teased the young couple
to use their imaginations visualizing a romantic room service break-
fast in a cozy room lit with mysterious blue light. I was frustrated
because just a few years ago, pediatricians had the luxury of ordering
the phototherapy device to be delivered to patient’s home where
blood levels were drawn daily by a home health pediatric nurse,
and reported to the physician. Now the insurance companies refuse
to cover the outpatient treatment, but they would pay for the same
treatment in the hospital. I never understood the logic behind this
decision. What aggravated me was the inconvenience of returning
young mothers and their newborns back to the hospital, exposing
them to nosocomial infections. These mothers are still recovering
from Caesarian or vaginal delivery, have problems with breast feed-
ing, and are possibly dealing with postpartum blues; not to mention
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