Pediatrics has been defined as the Art (derived from the beliefs, judgements, and intutions we could not explain) and Science (derived from the knowledge, logic and prior experience we could explain) of treating Childhood Illnesses. In as much as stress has been laid on Preventive Pediatrics, emergence of pediatrics subspecialties have equally revolutionized the management of even rare conditions in pediatric practice. So, a pediatrician of today, has a dual role to play viz., community counseling and management of childhood illnesses at the clinic and health care facility. Ethics for pediatric practice should evolve around not only ethical practice but also about self discipline, self determination and above all self confidence. Updating and upgrading knowledge through continuing medical education in conferences, seminars, symposia, etc. have since become a compelling necessity.
Whether in office or hospital practice a pediatrician has to be familiar with all aspects of growth, development, newborn care, immunization, management of common illnesses including the recent advances and also equip himself with the knowledge of rare conditions, syndromes, etc. Communication disorders have first to be recognized by him for appropriate referrals and remedial follow-up action. The standard protocols for management of common childhood illnesses laid down by the World Health Organization from time to time have to be familiarized by each and every practicing pediatrician.
Rational use of drugs and more so of anti-microbials have become the order of the day. Caution should be exercised to avoid banned drugs. Adverse events following drug/vaccine administration should be brought to the notice of the Regional Health Authority concerned and appropriate follow-up action taken. Professional bodies like the American Academy of Pediatrics, British Pediatric Association, Canadian Pediatric Society, Indian Academy of Pediatrics to name a few, have come out with consensus statements for management of common childhood illnesses and ample guidelines have been outlined. Equally important is to avoid prescribing irrational fixed drug combinations.
As observed earlier, pediatricians of today whether in Government service or in Private practice have to play a dual role of “One foot in the hospital and the other in the community”. There are several National Child Health Programs, which need active coordination and cooperation of pediatricians. To mention a few the post independence Maternal and Child Health (MCH) Program, the Expanded Program on Immunization (EPI), the Universal Immunization (UIP) Program, the Acute Respiratory Infections Control (ARI) Program, the Acute Flaccid Paralysis (AFP) Surveillance Program, the Diarrhea Disease Control (DDC) program, the Child Survival and Safe Motherhood (CSSM) Program, the Reproductive and Child Health (RCH) Program and the WHO strategy of Integrated Management of Neonatal and Childhood Illnesses(IMNCI), etc. needed the practicing pediatricians active support for their implementation. Their successful implementation with active participation and cooperation have recorded phenomenal success in reducing neonatal mortality, infant mortality, under 5 mortality and improved the nutritional and immunization status of under 5 children. Newer concepts in oral rehydration therapy (ORT) have significantly reduced morbidity and mortality following dehydration due to Acute Watery Diarrhea (AWD). Short course IV fluid therapy has equally revolutionized the concept of intravenous fluid therapy in diarrheal illness.
Another area, which needs the attention of a practicing pediatrician today, is the Consumer Protection Act (COPRA) and related issues. Gross negligence by a practitioner is now punishable under law and basic minimum facilities for cardiopulmonary resuscitation (CPR) are mandatory even in office practice. Professional bodies have come out with insurance schemes for their members. Nevertheless gross omissions and commissions are being viewed seriously. One has to be familiar with the sections of COPRA and avoid unnecessary ‘Commissions and Omissions’.
The medical profession in general today, is under heavy criticism by public for ‘converting?’ a noble profession into a ‘profit making business so to say, because of some commissions by few doctors?; the entire profession has become under strict ‘Public Surveillance’. Gone are the days when doctors were considered as Demi-Gods or equated with Gods. Today a pediatrician has to satisfy the parents of his child patient who pose a volley of questions (both wanted and unwanted or legitimate and illegitimate) patiently despite the constraints of his pressure on work and other commitments. So much so, health education becomes an integral part of the management of any illness especially so if it is a preventable illness. Whether in hospital or office practice the pediatrician has a moral responsibility to explain to the parent about the 3cause of diseases, its probable course, prognosis, management and follow up advice with appropriate preventive and nutrition counseling.
Let us, therefore, redefine our responsibilities as a responsible pediatrician: dedicate ourselves to the Hippocrates oath we have pledged at the time of our graduation; discharge our duties with compassion and competence; dissociate ourselves from any activity that may invite criticism or comments and thus contribute our mite to the welfare of future citizens of our great country, whose care and nurture are in our hands.
BIBLIOGRAPHY
- Carol Bellamy: The state of the World's Children 2003: The Executive Director's Office: United Nation's Children's Fund, UNICEF House, 3 UN Plaza, New York, NY 10017, USA.
- Report on the meeting of under 18 delegates to the UN special session on children. 5–7 May 2002 – UNICEF Publication, New York, October 2002.