Letters

My partners may consider excommunicating me, but I agree with you!

Preston Herrington, M.D.

Farmington, N.M.

Annual checkup is essential

I am a pediatrician in Brookline, Mass., and have been in practice for 18 years. I am a huge fan of your column. While I completely agree that at first glance, the annual pediatric checkup doesn’t seem to add much to our patients’ health, I believe it is essential. It is part of the process of building a relationship so that when those angst-filled teen years come along, the patients feel as if you have known them forever. And perhaps they will tell you their concerns before they admit them to any other adult. Or that’s the hope, anyway.

I think if kids viewed their doctor only as "the strep throat person," it would diminish the role we play in their lives, and quite frankly, vice versa.

Susan Laster, M.D.

Brookline, Mass.

Fostering better relations

Let me start by saying I am a fan of your column, and have been for years. I am a (slightly) younger than you (based on your updated photo) general pediatrician, and I generally agree with your homespun, sensible advice regarding patients, practice, and pediatrics. I have to disagree with your column on reassessing the value of well visits for older well children.

I certainly don’t find a lot of earth-shattering exam findings at these visits (although there are some rare surprises that need to be dealt with). I think the benefit of these appointments is found in the myriad of questions and concerns a parent has about raising their child in this modern era. I think that gentle reassurance from me that a mother is handling behavioral/school/social media situations properly, or (hopefully) gentle prodding from me if mom is off base, is valuable, even to the parents of the healthiest child. I always have tried to maintain all well-child visits with my own patients – I practice in a midsize (nine-provider) group.

I think that over time, the better a family gets to know me as I help them with little problems, the more likely they are to follow my advice when bigger problems crop up. Time constraints will always be with us, but I don’t think giving up on the "well visits" is the right way to grease the wheel.

Tim Welby, M.D.

Dickson City, Pa.

Pediatrician as preventative

I usually agree with your Letters from Maine column, but I don’t agree with your latest one entitled "Heresy." I certainly agree with you that TV, the Internet, and social media sites are powerful communicators to children, and that is exactly why I strongly disagree with your position.

The pediatrician can and must be a source of correct advice and information, and is in the best position to counteract a lot of false information the child may be receiving. As pediatricians, we are in the prevention business, and the annual checkup is when we can best do our work, and is probably the only time.

Certainly the preteen and teen years must be carefully monitored. Doing away with the yearly visits would only lead to disaster.

Alvin N. Eden, M.D.

Forest Hills, N.Y.

Mostly agree

I truly appreciate your broaching this topic of "heresy," particularly in your neck of the woods where the stakes have been quite high.

That being said, I do agree with you for the most part. I have been doing my pediatric thing in Michigan for 38 years, and have probably come up with as many startling findings on a well-child exam after age 5 years as you have. It is also true (like it or not) that our newly acquired "business model" mentality drains significant time and energy out of all of us, and our lives can be much better spent not doing well exams in the well population.

However, I still worry about kids in their latency period, because I believe that still waters run deep. I hate it when someone shows up at age 15 with a significant drug problem who has not seen us for 5 years.

I strongly believe these kids should not be shelved. Their psychosocial development is important and can be addressed, as it is in just about every other country, by physician extenders. As issues of "turf" are well ingrained in us, who controls this (health department, practice) could be a topic for another Letter from Maine.

Arthur N. Feinberg, M.D.

Department of Pediatrics

Western Michigan University School of Medicine

Kalamazoo

Most schools not adequate