Okay, let's talk about why having all the information – the whole picture – is just so crucial when we're dealing with kids and their teeth and jaws. I mean, we're talking about pediatric orthodontics here, and getting it right early can make a world of difference. And a big part of "getting it right" is sharing all that diagnostic data – the X-rays, the models, the photos, the whole shebang – between different specialists.
Think of it like this: you wouldn't want a mechanic to only look at your car's engine when trying to figure out why your brakes are squealing, right? Same thing applies to a child's mouth. Orthodontists specialize in correcting dental irregularities in kids Child-friendly orthodontic solutions thumb sucking. An orthodontist is primarily focused on alignment, but the way teeth fit together, the shape of the jaw, the health of the gums, even breathing patterns – it's all interconnected.
So, when a pediatric orthodontist has access to comprehensive data and then shares it with, say, a pediatric dentist, an ENT (ear, nose, and throat doctor), or even a speech therapist, that's when the magic happens. The pediatric dentist might spot early signs of decay that could impact orthodontic treatment. The ENT might identify airway restrictions affecting jaw development. The speech therapist might notice tongue thrusting habits that are throwing off the alignment.
Having all that information available allows everyone involved to develop a truly coordinated and holistic treatment plan. We can address the root causes of problems, not just the symptoms. It helps us avoid conflicting treatments, unnecessary procedures, and ultimately leads to better, more stable, and longer-lasting results for the child.
Plus, think about the parents. They want the best for their kids, and they want everyone on the team to be on the same page. Sharing diagnostic data just builds trust and confidence that everyone is working together towards the same goal: a healthy, happy smile and a well-functioning mouth for the child. It's simply the smart, collaborative, and ultimately, the right way to approach pediatric orthodontic care.
Sharing Diagnostic Data Across Multiple Specialists: Current Challenges
Okay, so picture this: you're a patient, right? You've got a thorny health issue, and you're bouncing between a cardiologist for your heart, a neurologist for those weird headaches, and maybe even a rheumatologist because your joints are acting up. Each of these specialists is brilliant in their own field, armed with cutting-edge diagnostic tools and a wealth of knowledge. Great, right? Except…are they actually talking to each other? Are they seeing the whole picture, or just their little corner of the puzzle?
That's where the current challenges in sharing patient information between specialists really hit home. We're not living in the paper-chart era anymore, thankfully. Most practices have embraced electronic health records (EHRs). But simply having an EHR doesn't magically solve everything. The big problem is often interoperability – or rather, the lack thereof. Different systems might not "speak" the same language, making it difficult to seamlessly transfer imaging studies, lab results, or even just basic notes. It's like trying to translate a complex scientific paper without a proper dictionary.
Then there's the issue of privacy and security. We all want our medical information protected, and rightly so. HIPAA is there for a reason. But sometimes, those very regulations, while crucial, can create hurdles. Specialists might be hesitant to share information, fearing they're inadvertently violating a privacy rule, even if it's in the patient's best interest. It adds another layer of complexity.
And let's not forget the human element. Time is precious for everyone, especially busy specialists. Hunting down records, deciphering someone else's notes, and figuring out how to integrate that information into their own workflow can be a real time-suck. It's an extra burden that can unfortunately discourage thorough collaborative efforts.
Finally, access plays a role. Not all specialists are part of the same hospital network or affiliated group. Getting access to records from an outside practice can sometimes feel like pulling teeth. There might be administrative hoops to jump through, faxes to send (yes, faxes still exist in healthcare!), and delays that can impact the speed and quality of care.
So, while we've made strides in medical diagnostics and technology, the simple act of sharing that diagnostic data effectively and efficiently between specialists remains a significant challenge. It's a challenge we need to tackle head-on, because ultimately, it's about ensuring that patients receive the most comprehensive and coordinated care possible.
Okay, let's talk about sharing diagnostic data, like x-rays, lab results, and scans, between specialists. It's a real game-changer when it's done right, and a centralized data platform is often the key to making it work smoothly. Think about it: without a central hub, you're relying on faxes, CDs, maybe even just verbal handoffs of critical information. That's slow, prone to errors, and frankly, frustrating for everyone involved, especially the patient.
The beauty of a centralized platform is that it creates a single source of truth. All the diagnostic data, neatly organized and accessible, lives in one place. Specialist A, looking at a patient's MRI, can instantly see the results of Specialist B's blood work. No more waiting, no more chasing down reports, just instant access to the full picture.
This has huge benefits for collaborative care. It empowers specialists to make more informed decisions, faster. They can spot potential interactions between medications, identify subtle changes over time, and ultimately, develop a more comprehensive and effective treatment plan. It also facilitates better communication. Instead of playing phone tag, specialists can review the same data together, discuss nuances, and arrive at a shared understanding of the patient's condition.
Beyond efficiency and accuracy, a centralized platform can also significantly improve the patient experience. Imagine not having to retell your medical history to every new doctor, or not having to undergo the same tests multiple times because the results are lost in the shuffle. A centralized system reduces redundancy, minimizes delays, and empowers patients to feel more confident in their care.
Of course, security and privacy are paramount. Any centralized platform needs robust safeguards to protect sensitive patient data. But when done responsibly, the benefits of sharing diagnostic data across multiple specialists through a centralized system are undeniable. It's about creating a more connected, coordinated, and ultimately, more effective healthcare system for everyone.
Okay, so we're talking about sharing diagnostic data between doctors, right? And the thing is, what one specialist considers vital might be totally different from what another one focuses on. It's not like everyone's looking at the same picture. So, what kind of diagnostic records are we actually talking about that are relevant to, say, a cardiologist and a rheumatologist?
Think about it. Imaging is huge. X-rays, MRIs, CT scans – they're almost universally useful. A cardiologist might be looking at the heart's structure and function, while a rheumatologist might be scrutinizing the same images for signs of inflammation in the joints or potential complications arising from autoimmune diseases affecting the heart. Then you've got lab tests. Blood counts, inflammatory markers, genetic tests… these can tell a story that resonates across multiple specialties. Elevated inflammatory markers, for example, could signal a heart condition or an autoimmune flare-up. Genetic predispositions for certain conditions, like familial hypercholesterolemia or specific types of arthritis, are obviously relevant to both.
Beyond that, there are more specialized tests that become important depending on the specific clinical scenario. An echocardiogram, primarily used by cardiologists, could reveal clues about systemic diseases that affect the heart muscle. Conversely, a muscle biopsy, typically within the realm of rheumatology or neurology, might offer valuable insights into cardiac conditions linked to muscular dystrophies or inflammatory myopathies.
Electrocardiograms (EKGs) are pretty universally useful, too. While obviously key for cardiologists, the patterns on an EKG might flag up electrolyte imbalances or other systemic issues that are relevant to, say, an endocrinologist managing diabetes. And don't forget the patient's history! A detailed account of symptoms, past illnesses, and family history is often the most crucial diagnostic record of all, providing context for all the other tests and guiding specialists toward the right diagnoses, regardless of their individual areas of expertise. Because at the end of the day, it's all about piecing together the puzzle to see the whole picture of the patient.
Sharing diagnostic data between specialists shouldn't feel like navigating a bureaucratic maze. Imagine a scenario: a patient needs input from a cardiologist, neurologist, and endocrinologist. Each specialist runs their own tests, generating valuable data. But if this data is trapped in different systems, speaking different "languages," the process becomes clunky and inefficient. That's where streamlining comes in.
Think of interoperability as the universal translator. It's the ability of different systems – different electronic health records, imaging software, lab databases – to seamlessly exchange and use information. Standards are the common grammar and vocabulary that enable this translation. They ensure that everyone understands the data in the same way, regardless of the system that generated it.
By embracing interoperability and adhering to established standards, we can break down data silos. Specialists can access a comprehensive view of the patient's diagnostic history, leading to more informed decisions, reduced redundancy in testing (saving time and money!), and ultimately, better patient care. It means the cardiologist can easily review the neurologist's MRI results, and the endocrinologist can understand the cardiologist's EKG findings, all without having to request and manually review paper reports.
This isn't just about technology; it's about improving collaboration and communication among healthcare professionals. It's about putting the patient at the center and empowering clinicians with the information they need to provide the best possible care. Streamlining data sharing through interoperability and standards is essential for a more efficient, effective, and patient-centered healthcare system.
Okay, let's talk about something that's genuinely exciting in the world of medicine: how sharing diagnostic data between specialists can actually lead to better outcomes for patients. Think of it as a team effort, where everyone's got a piece of the puzzle, but only by putting those pieces together do you get the full picture. And that full picture? That's what leads to improved outcomes.
We've all heard horror stories, or maybe even experienced them ourselves, where a doctor only sees a tiny fraction of the information. They might focus on one specific test, or one particular symptom, without realizing it's connected to something else entirely. Now, imagine a scenario where a radiologist's report, a cardiologist's findings, and a neurologist's observations are all instantly available to each other. Suddenly, patterns emerge. Subtle clues become glaringly obvious. The 'aha!' moment becomes more frequent.
These "aha!" moments are the foundation for case studies highlighting improved outcomes through shared diagnostic insights. Consider a patient presenting with seemingly unrelated symptoms: fatigue, dizziness, and intermittent chest pain. Individually, these could point to a dozen different conditions. But by sharing the data – perhaps an abnormal EKG reading alongside an MRI showing subtle neurological changes – specialists can collaboratively identify a rare autoimmune disorder affecting both the heart and nervous system. This faster, more accurate diagnosis allows for earlier intervention and significantly improves the patient's prognosis.
These aren't just hypothetical situations; they're real-world examples of how breaking down the silos in healthcare can revolutionize patient care. The key is creating systems and protocols that facilitate secure, efficient, and standardized data sharing. It's about making it easier for specialists to connect the dots, to build a complete and accurate picture of the patient's health. The result? Fewer diagnostic delays, more personalized treatment plans, and, ultimately, better lives for the patients we serve. The beauty of sharing diagnostic data is that it amplifies the expertise of each specialist, creating a collective intelligence that's far greater than the sum of its parts. And that's something worth getting excited about.
Sharing diagnostic data between specialists sounds like a no-brainer, right? More eyes, better insights, faster diagnosis – everyone wins! But before we start flinging around sensitive patient information like confetti, we have to talk about privacy and security. It's not just a legal requirement, it's about respecting the people behind the data.
Think about it. That MRI scan, those lab results, that doctor's note – that's incredibly personal stuff. We need to make sure it's only being seen by the people who need to see it, and that it's being protected from prying eyes, whether those eyes belong to malicious hackers or just someone who's a bit too curious.
So how do we do that? Well, for starters, we need strong encryption. Basically, scrambling the data so that if it does fall into the wrong hands, it's just gibberish. We also need strict access controls, meaning only authorized specialists can access the data, and maybe even only specific parts of it. Think need-to-know basis, like a super secret mission.
And then there's the human element. Training for everyone involved is crucial. They need to understand the importance of privacy, the potential consequences of a breach, and how to use the security systems properly. It's like teaching them how to handle fragile glass – carefully and with respect.
Finally, we need to be transparent with patients. Let them know why their data is being shared, who it's being shared with, and give them the option to opt-out if they're not comfortable. It's about building trust and empowering them to be in control of their own health information. Because at the end of the day, it's their data, and we need to treat it with the care and respect it deserves. Sharing diagnostic data can do a world of good, but only if we prioritize privacy and security every step of the way.
Future Directions: AI and Machine Learning in Diagnostic Data Integration. Sharing Diagnostic Data Across Multiple Specialists
Imagine a future where your entire medical history, all those scans, lab results, and doctor's notes, are seamlessly and securely accessible to every specialist involved in your care. No more fax machines, no more frantic calls chasing down reports. That's the promise of integrated diagnostic data, and AI and machine learning are poised to make that promise a reality.
Right now, sharing diagnostic data across specialists can be a real headache. Information silos are everywhere. A cardiologist might not have easy access to the detailed neurological assessment that a neurologist performed, even though both impact the patient's overall health. This lack of integration can lead to delayed diagnoses, redundant testing, and even conflicting treatment plans. It wastes time, costs money, and, most importantly, can negatively impact patient outcomes.
AI offers some exciting solutions. Machine learning algorithms can be trained to identify relevant information within vast datasets of diagnostic data. Think about it: a machine learning model could sift through hundreds of pages of medical records, highlighting key findings from different specialists that might be relevant to a new consult. This would drastically reduce the burden on the specialist, allowing them to focus on interpreting the data and making informed decisions.
Furthermore, AI can play a crucial role in standardizing data formats. Different hospitals and labs often use different systems and terminologies, making it difficult to share data seamlessly. AI can help translate and harmonize this data, ensuring that information is consistent and understandable, regardless of its source. Imagine an AI-powered "translator" that automatically converts data from one format to another, paving the way for truly interoperable systems.
The future also holds the potential for AI to proactively identify potential problems based on integrated diagnostic data. By analyzing patterns and correlations across multiple specialists' findings, AI could flag subtle indicators of disease that might otherwise be missed, leading to earlier and more effective interventions.
Of course, there are challenges to overcome. We need to address concerns about data privacy and security, ensuring that patient information is protected. We also need to ensure that AI algorithms are fair and unbiased, avoiding perpetuation of existing health disparities. And perhaps most importantly, we need to build trust in these technologies, demonstrating their accuracy and reliability to both clinicians and patients.
Despite these challenges, the potential benefits of AI and machine learning in diagnostic data integration are immense. By breaking down data silos and empowering specialists with comprehensive, readily accessible information, we can create a healthcare system that is more efficient, more effective, and ultimately, more patient-centered. The future of diagnostic data sharing is bright, and AI is the key to unlocking its full potential.
Part of a series on Patients |
Patients |
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Concepts |
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Consent |
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Rights |
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Approaches |
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Abuse |
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Medical sociology |
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A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider.
The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering', and akin to the Greek verb πάσχειν (paskhein 'to suffer') and its cognate noun πάθος (pathos).
This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in shared decision-making about their care.[1]
An outpatient (or out-patient) is a patient who attends an outpatient clinic with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, their attendance is still registered, and the provider will usually give a note explaining the reason for the visit, tests, or procedure/surgery, which should include the names and titles of the participating personnel, the patient's name and date of birth, signature of informed consent, estimated pre-and post-service time for history and exam (before and after), any anesthesia, medications or future treatment plans needed, and estimated time of discharge absent any (further) complications. Treatment provided in this fashion is called ambulatory care. Sometimes surgery is performed without the need for a formal hospital admission or an overnight stay, and this is called outpatient surgery or day surgery, which has many benefits including lowered healthcare cost, reducing the amount of medication prescribed, and using the physician's or surgeon's time more efficiently. Outpatient surgery is suited best for more healthy patients undergoing minor or intermediate procedures (limited urinary-tract, eye, or ear, nose, and throat procedures and procedures involving superficial skin and the extremities). More procedures are being performed in a surgeon's office, termed office-based surgery, rather than in a hospital-based operating room.
An inpatient (or in-patient), on the other hand, is "admitted" to stay in a hospital overnight or for an indeterminate time, usually, several days or weeks, though in some extreme cases, such as with coma or persistent vegetative state, patients can stay in hospitals for years, sometimes until death. Treatment provided in this fashion is called inpatient care. The admission to the hospital involves the production of an admission note. The leaving of the hospital is officially termed discharge, and involves a corresponding discharge note, and sometimes an assessment process to consider ongoing needs. In the English National Health Service this may take the form of "Discharge to Assess" - where the assessment takes place after the patient has gone home.[2]
Misdiagnosis is the leading cause of medical error in outpatient facilities. When the U.S. Institute of Medicine's groundbreaking 1999 report, To Err Is Human, found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year,[3] early efforts focused on inpatient safety.[4] While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical errors are even more likely to happen in a doctor's office or outpatient clinic or center.[citation needed]
A day patient (or day-patient) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for day surgery.
Because of concerns such as dignity, human rights and political correctness, the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include health consumer, healthcare consumer, customer or client. However, such terminology may be offensive to those receiving public health care, as it implies a business relationship.
In veterinary medicine, the client is the owner or guardian of the patient. These may be used by governmental agencies, insurance companies, patient groups, or health care facilities. Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors.
In nursing homes and assisted living facilities, the term resident is generally used in lieu of patient.[5] Similarly, those receiving home health care are called clients.
The doctor–patient relationship has sometimes been characterized as silencing the voice of patients.[6] It is now widely agreed that putting patients at the centre of healthcare[7] by trying to provide a consistent, informative and respectful service to patients will improve both outcomes and patient satisfaction.[8]
When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible.[9] Incidents, such as the Stafford Hospital scandal, Winterbourne View hospital abuse scandal and the Veterans Health Administration controversy of 2014 have shown the dangers of prioritizing cost control over the patient experience.[10] Investigations into these and other scandals have recommended that healthcare systems put patient experience at the center, and especially that patients themselves are heard loud and clear within health services.[11]
There are many reasons for why health services should listen more to patients. Patients spend more time in healthcare services than regulators or quality controllers, and can recognize problems such as service delays, poor hygiene, and poor conduct.[12] Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect',[9] that are difficult to capture with institutional monitoring.[13]
One important way in which patients can be placed at the centre of healthcare is for health services to be more open about patient complaints.[14] Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn about and improve patient experience.[15]
![]() A pediatrician examines a neonate.
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Focus | Infants, Children, Adolescents, and Young Adults |
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Subdivisions | Paediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below) |
Significant diseases | Congenital diseases, Infectious diseases, Childhood cancer, Mental disorders |
Significant tests | World Health Organization Child Growth Standards |
Specialist | Pediatrician |
Glossary | Glossary of medicine |
Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth until the age of 18.[1] The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25.[2][3] Worldwide age limits of pediatrics have been trending upward year after year.[4] A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παá¿–ς (pais "child") and á¼°ατρÃÂÂÂÂÂÅ’ς (iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties (e.g. neonatology requires resources available in a NICU).
The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus, published in the fifth century B.C., and the famous Sacred Disease. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus, Soranus of Ephesus, Aretaeus, Galen, and Oribasius, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.[5] Already Hippocrates, Aristotle, Celsus, Soranus, and Galen[6] understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men").[7] Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya.[6]
Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. Sushruta Samhita, an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics.[8] Another ayurvedic text from this period is Kashyapa Samhita.[9][10] A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics.[11] Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field.[6] The Byzantines also built brephotrophia (crêches).[6] Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children.[12][13] Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.[14][5] In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.[6]
While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.[15] It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.[5] The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,[16][17] while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject".[18] However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.[19]
The term pediatrics was first introduced in English in 1859 by Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."[20] Jacobi is known as the father of American pediatrics because of his many contributions to the field.[21][22] He received his medical training in Germany and later practiced in New York City.[23]
The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage.[24] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[25] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the nearby Necker Hospital, founded in 1778.[26]
In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now WrocÅ‚aw), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.[24] The first Children's hospital in Scotland opened in 1860 in Edinburgh.[27] In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).[28] Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.[29]
The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.[30]
Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults.[30][31][32] Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.[30]
Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.[31][30][32] Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.[31]
Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.[31][32]
Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.[31][32] Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.[31]
Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin.[31] Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.[31][30]
Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.[30]
Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.[31] Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.[31][32] Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.[30]
Drug elimination is primarily facilitated via the liver and kidneys.[31] In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine.[32] In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.[30][31] Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.[31]
A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.[citation needed]
The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic.[33] Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.[34]
In ancient times, society did not view pediatric medicine as essential or scientific.[35] Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.[5] As a result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors.[35] Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.[5]
In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.[34]
The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family, argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights.[36] The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.[37]
In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.[37] Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults.[38] Hence, continuing the discussion on whether children are capable of making important health decisions until this day.
According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.[37]
Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions.[39] Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.
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The examples and perspective in this section deal primarily with United States and do not represent a worldwide view of the subject.(September 2019)
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Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.[citation needed]
In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.[40]
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The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".
Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and the degree of specialization.
In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.[41]
In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of 'pediatric organizations (see below) rather than universities and depends on the jurisdiction.
Subspecialties of pediatrics include:
(not an exhaustive list)
(not an exhaustive list)
By writing a monograph on 'Diseases in Children' he may also be looked upon as the father of paediatrics.
Rosen von Rosenstein.