Letters from Maine

Getting Out of the Office


There are two societal phenomena that frustrate me to the point of hanging up my stethoscope and converting my garage into a boat-building shop. The first of these is the expanding collection of behavioral dysfunctions among America's children that are often mislabeled attention-deficit disorders. The other is the overweight epidemic among those same children.

In both cases, we pediatricians have accepted a hefty share of the challenge to fabricate medical solutions for what are primarily societal problems.

We didn't invent television, fast food, divorce, or overscheduled two-income families, but because the tsunamis generated by these realities are threatening to drown a generation of children, those of us committed to their welfare are logically viewed by ourselves and others as front-line soldiers.

But do we pediatricians have the weapons to wage these wars?

And where should the battles be fought?

One of the lead stories in last month's PEDIATRIC NEWS suggested that we can learn to counsel and administer behavioral treatments in our offices that will be effective against obesity (“Getting Through to Overweight Kids,” p. 1).

The pediatricians in the article may be making a difference for some of their patients, but I am skeptical about the applicability of their techniques for the rest of us, who are accustomed to the much higher success rates typical of asthma and pyelonephritis.

Only 37 of 73 families completed the counseling program, and the investigators admitted they didn't know how many families were initially asked to participate but declined.

Although I'm sure I could learn to do a better job of counseling, I have been talking—and listening—to parents about obesity and inactivity for several decades using similar techniques and have had frustratingly few successes.

But before I pack it in and retreat to my workshop, I feel I should give the challenge of obesity one more try.

Robert E. Holmberg Jr., M.D., a member of the American Academy of Pediatrics' task force on obesity, wrote in a recent editorial that, to be effective against the overweight phenomenon, we pediatricians must venture out of our offices and “embrace the community pediatric perspective and methods” (AAP News, July 2005, p. 32).

As one would expect from the clear-thinking, common-sense pediatrician from Maine that he is, Bob offers nine specific ways that a physician can “work with the community to develop projects to improve physical activity, nutrition and prevent [my italics] overweight in our children.”

I really like the concept of prevention because my attempts at mopping up the damage aren't working. Furthermore, I am pleased that his first suggestion is to “focus locally,” because I'm a think-small kind of guy.

But he also suggests that I form a “small steering group” and then a “community coalition” and eventually participate in my “coordinated school health council.” Whoa! Bob!

This is beginning to smell like a whole mess of meetings. You must not be reading my column very closely. I don't do meetings.

I knew that getting out of my office to battle obesity was going to take me away from what I do best, but this is sounding very uncomfortable.

Am I going to have to listen patiently while other concerned citizens voice their occasionally lame ideas?

Does this mean that instead of writing orders and prescriptions that are carried out without question, I might be writing grant applications that someone will edit and someone else might deny?

Bob, Bob, I'm all for a community team approach, but can't I please still be the captain?

I'm afraid I already know the answers. But damn it, the overweight crisis has really gotten to me, and I don't want anyone to accuse this old dog of not being able to learn a few new tricks.

Since I'm getting paid diddly-squat for counseling in the office anyway, I might as well go forth and embrace that community pediatric perspective at a few meetings out of the office where I won't get paid anything.

That wood I bought for the new boat should probably season in the garage for a few more years anyway.

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