Letters from Maine

Don’t screen, just listen


A recent study published in the journal Academic Pediatrics suggests that during health maintenance visits clinicians are giving too little attention to their patients’ sleep problems. Using a questionnaire, researchers surveyed patients’ caregivers’ concerns and observations regarding a variety of sleep problems. The investigators then reviewed the clinicians’ documentation of what transpired at the visit and found that while over 90% of the caregivers reported their child had at least one sleep related problem, only 20% of the clinicians documented the problem. And, only 12% documented a management plan regarding the sleep concerns.

I am always bit skeptical about studies that rely on clinicians’ “documentation” because clinicians are busy people and don’t always remember to record things they’ve discussed. You and I know that the lawyers’ dictum “if it wasn’t documented it didn’t happen” is rubbish. However, I still find the basic finding of this study concerning. If we are failing to ask about or even listen to caregivers’ concerns about something as important as sleep, we are missing the boat ... a very large boat.

Dr. William G. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years.

Dr. William G. Wilkoff

How could this be happening? First, sleep may have fallen victim to the bloated list of topics that well-intentioned single-issue preventive health advocates have tacked on to the health maintenance visit. It’s a burden that few of us can manage without cutting corners.

However, it is more troubling to me that so many clinicians have chosen sleep as one of those corners to cut. This oversight suggests to me that too many of us have failed to realize from our own observations that sleep is incredibly important to the health of our patients ... and to ourselves.

I will admit that I am extremely sensitive to the importance of sleep. Some might say my sensitivity borders on an obsession. But, the literature is clear and becoming more voluminous every year that sleep is important to the mental health of our patients and their caregivers to things like obesity, to symptoms that suggest an attention-deficit/hyperactivity disorder, to school success, and to migraine ... to name just a few.

It may be that most of us realize the importance of sleep but feel our society has allowed itself to become so sleep deprived that there is little chance we can turn the ship around by spending just a few minutes trying help a family undo their deeply ingrained sleep unfriendly habits.

I am tempted to join those of you who see sleep depravation as a “why bother” issue. But, I’m not ready to throw in the towel. There are things that we as clinicians can do to help families address poor sleep hygiene. Even simply sharing your observations about the importance of sleep in the whole wellness picture may have an effect.

One of the benefits of retiring in the same community in which I practiced for over 40 years is that at least every month or two I encounter a parent who thanks me for sharing my views on the importance of sleep. They may not recall the little tip or two I gave them, but it seems that urging them to put sleep near the top of their lifestyle priority list has made the difference for them.

If I have failed in getting you to join me in my crusade against sleep deprivation, at least take to heart the most basic message of this study. That is that the investigators found only 20% of clinicians were addressing a concern that 90% of the caregivers shared. It happened to be sleep, but it could have been anything.

The authors of the study suggest that we need to be more assiduous in our screening for sleep problems. On the contrary. You and I know we don’t need more screening. We just need to be better listeners.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at pdnews@mdedge.com.

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