The Integrative Pediatrics Council Commentary #1: On “Well-Child Care” by Dr. Matt Baral

This post introduces a new concept in “the whole child” forum. It is the first in a series of commentaries by other members of the Integrative Pediatrics Council.

The Integrative Pediatrics Council (IPC) is a soon-to-be non-profit foundation devoted to the transformation of children’s healthcare. The IPC’s mission is to enhance the health and development of children, families, and communities by boldly leading the evolution of pediatric healthcare toward integrative, high-quality, accessible care. I wrote an article titled “Integrative Pediatrics: Past, Present, and Future” published in the September issue of Explore: The Journal of Science and Healing detailing the IPC’s goals and values. Currently, our objectives include:

1) Coordinating the annual Pediatric Integrative Medicine Conference (Pangea: A Conference for the Future of Pediatric Wellness), recently held in Chicago and scheduled for October 25-26, 2007 in San Francisco.

2) Developing a network among leading clinical centers/providers in integrative pediatrics to share best practice information on management,

reimbursement, marketing, and clinical practices. This virtual association is currently made possible by the International Pediatric Integrative Medicine (IPIM) Network, an electronic listserv, and it will expand in 2007 to include a larger web-based component.

3. Gathering information from the research, clinical, and business experience of member organizations and make it available to the field through a web-based clearinghouse in integrative pediatrics. We are also developing a consulting service to aid individuals and institutions interested in starting integrative pediatric programs and practices.

4. Collaborating with other pediatric healthcare organizations in educating physicians and other healthcare professionals in integrative approaches to child health. This is being achieved via cross representation in various PIM/IM organizations too numerous to list here. We are interested in building bridges, not fortifying existing walls.

The IPC’s inaugural Board of Directors is a diverse, multinational group of individuals. Our first columnist for “the whole child” is Executive Committee member, Dr. Matthew I. Baral. Dr. Baral is a licensed Naturopathic Physician who received his medical degree from Seattle’s Bastyr University in 2000. For the past 8 years, he has worked in conjunction with pediatricians in both the Seattle and Phoenix areas, applying natural therapeutics to children and adolescents. In addition, Dr. Baral worked as a resident at a naturopathic medical clinic in Seattle for the year after he received his medical degree. He was a clinical investigator for the Research departments of the University of Washington and Bastyr University on the Pediatric Echinacea study. Dr. Baral is currently the primary investigator on the first DMSA chelation treatment study of children with autism. He is full time faculty at the Southwest College of Naturopathic Medicine (SCNM). At SCNM, he supervises student clinicians at the Southwest Naturopathic Medical Center, and serves as the Medical Director of the Hamilton Elementary School Clinic, a free pediatric clinic that provides integrative pediatric medicine to the underserved community. Dr. Baral teaches pediatrics in the didactic portion of the medical program at SCNM. He has a private practice in Scottsdale, Arizona in which he specializes in pediatrics.

Dr. Baral’s commentary discusses an article in November’s Pediatrics regarding pediatricians’ views of our current well-child care system. If you cannot access the text of the original article on-line, most medical libraries will have a copy. Due to copyright concerns, I cannot post it here.

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The November issue of Pediatrics includes a survey article titled, “Should Our Well-Child Care System be Redesigned? A National Survey of Pediatricians.” As a member of the Executive Board of the IPC, I felt it was important to give my commentary on this study. I do believe that some of the findings expressed in this article represent a failure of the healthcare system to do preventative medicine. There seems to be a trend in the conventional medical model that more and more responsibilities should be put on non-physician personnel for tasks that include direct interaction with the patients and parents. The last sentence of the article states: “…a majority of primary care pediatricians working in diverse settings think that a system of care that is less dependent on physicians and face-to-face office visits may enhance the effectiveness and efficiency of care.” Table 3 shows that while 76% of pediatricians surveyed believe that they should be the main provider of physical examinations, 46% or less thought that the pediatrician should be the person doing anticipatory guidance, developmental screening and psychosocial screening. This brought up a question for me. At what point in time is the pediatrician doing preventative medicine? Shouldn’t the “excellent care” that 97% of the respondents believe that they are providing include talking with parents about diet and lifestyle? On average, I spend 20 minutes of a well-child visit educating parents about preventative methods that will keep their children healthy. In my opinion, the goal of a well-child visit is not only to assess whether the child is healthy in this moment but also to ensure that they will be in the future. The model of an effective and efficient system should not simply be measured by how quickly I can get the family in and out of the door. On the contrary, the impact that I have had on the family to make more healthful decisions in their life now and in the future is the most important task at hand.