Pediatricians, Family Docs
Treat Kids Differently
Excerpt By Alison McCook, Reuter's Health

NEW YORK (Reuters Health) - Pediatricians and family physicians appear to adopt different approaches to treating children, according to new study findings based on doctors' responses to imaginary scenarios.

The scenarios were designed so that no one response is correct, study author Dr. Ann K. Boulis of the University of Pennsylvania in Philadelphia told Reuters Health. However, she noted, a pattern clearly emerges: in most cases, family physicians are more likely than pediatricians to use more resources when treating children, such as scheduling extra procedures or visits with a specialist.

Although the reasons behind these differences are not clear, Boulis suggested that they may stem from the fact that family physicians, due to the nature of their jobs, do not get as much experience treating children as do pediatricians. And if you are not up on the recent literature and are unsure how to handle a patient's problem, it's better to be safe than sorry and order more tests and doctors' visits, Boulis said.

"It's much easier, cognitively, to err on the side of action than inaction, if you're uncertain," she noted.

However, she stressed that these results do not suggest that pediatricians treat children better than family practitioners do or vice versa; only that the two types of doctors often have different approaches to treating the same patient.

The differences between the treatment choices of doctors will more likely have implications for cost, not the quality of treatment patients receive, Boulis explained. In that respect, parents have options, she said: ordering more specialists and tests will likely add to the cost of the treatment, but might save time by expediting the child's recovery. "This is really more about non-medical implications," Boulis noted.

Boulis and her co-author, Dr. Judith Long, base their findings on an analysis of responses of a nationally representative sample of 1,735 pediatricians and 1,267 family practitioners to six scenarios. In each story, the patient was a child with a problem that could be treated in multiple, equally correct ways.

Reporting in the December issue of the Archives of Pediatric & Adolescent Medicine, Boulis and Long discovered that family practitioners are more likely than pediatricians to call for a number of additional tests or doctors visits. For instance, family doctors were more likely to recommend drug treatment for a bed wetter, ask a child to come to the office after reports of fever and stuffy nose, and advise an x-ray for a child who had signs of the croup and symptoms such as coughing up phlegm and quick breathing.

In addition, family doctors also tended to refer children to specialists more often than pediatricians did, such as to an allergist for a patient with asthma or allergy, and to an ear, nose, and throat doctor for a patient with recurring ear infection.

However, the pattern was not consistent, for pediatricians were more likely than family physicians to order a test for a potentially deadly blood infection for children with a fever that exceeded 100 degrees Fahrenheit, or 38.3 degrees Celsius.

In an interview, Boulis said she believed these results would be no surprise to the medical community. Doctors who take on different specialties receive different training, she said, and people who choose one specialty over another often have certain qualities that draw them to that specialty, which could also distinguish them from other types of doctors, she added.

Boulis said that in non-urban areas, family physicians often are able to treat an entire family, which is the role they were intended to have. This can be an extremely useful way to provide medical care, she said, for it allows the doctor to get a more holistic picture of a patient's environment. "There should be some benefit of one provider taking care of the entire family," she said.

SOURCE: Archives of Pediatric & Adolescent Medicine 2002;156:1210-1215.

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