Pediatrics, the art of healing children, is undergoing a tremendous transformation in the COVID 19 days. The basic elements of the profession – listening to the mother, inspecting the child the moment he enters the examination room, checking his ears, putting a hand on his belly – all these seem now to belong to the past. These days, parents prefer not to come to the clinic, fearing that they might catch the virus either on the way to the clinic or while waiting for their appointment in the doctor’s office. In many countries now there are containment decrees that forbid citizens from leaving their homes unless for it is for very urgent reasons.
All the above have posed a unique challenge: how can it be possible to examine children who may suffer from routine conditions like pneumonia or otitis media if they do not show themselves in the clinics? In children the situation might seem even more challenging than in adults, since we usually in this profession rely on subjective parental reports and in many times, we cannot obtain history from the patients themselves?
The solution to this challenge lies in adopting new techniques of communication with the families. Telemedicine has already been around for a couple of years now. However, it got its main boost in these Corona days. Instead of listening to the mother we hear the symptoms in a phone call. Inspecting rashes has been replaced by photos, cellphone still pictures or video clips. Growth charts are sent by email for our impression and documents are being exchanged between families and doctors by email, WhatsApp or any other technological means. These dramatic changes have already affected the practice of the usual pediatric examination. The AAP has published guidance on implementing telemedicine clinics here, but it may be of limited value outside the US.
The treatment in many of these pediatric telemedicine visits has also been transformed. Due to the inherent uncertainty accompanying the diagnostic process, the range of prescribed medications has been widened. Antibiotics, inhalations and steroids are more frequently prescribed, to prevent possible complications of common upper respiratory infections. Another reason for this therapeutic strategy is also to try to minimize any possible need for an ER visit these days.
Technology has also a very important role in executing the chosen treatment. In Israel, and possibly in many other countries, prescriptions can be sent directly to the pharmacies by digital means, leaving the families only the task of collecting the medications from a nearby pharmacy. Other referrals for laboratory tests, X ray, ER can also be sent electronically to all the relevant places, saving the need to physically attend the doctor’s office to just in order to collect the documents.
There are two essential elements that are critically necessary to enable this “new” pediatrics. Not surprisingly, these two elements lie deep in the roots of the “old” pediatrics: knowing the families before the visits and close follow up of the child following the visit. We know that in pediatrics it is not only the child who needs care, but the entire family – mother or father – is looking for our help. Therefore, in these days more than in the past, the treatment option in many situations is influenced by the unique character of the family – is it an anxious family? Can we rely on their compliance with the medicine we prescribe? The close follow up is also of extreme importance. We direct the families to contact us the day after or even in the afternoon of the same day, just to make sure that the child is getting better.
Will any of these dramatic changes in the profession stay with us after COVID 19 is gone? There are many thoughts around this issue, but I cannot yet foresee the future of this revolution. Time will tell…
About the author
Zachi Grossman (Israel) – is the Scientific Director of EAPRASnet. He is a Paeditriain in the Paediatric clinic, Maccabi Healthcare Services, Tel Aviv.