Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Protecting children from bad medical care

Martin C. Young, MD
Conditions
November 24, 2022
15 Shares
Share
Tweet
Share

Unfortunately, at least from where I sit, suboptimal medical care seems to abound. And every encounter of my family members with the health care behemoth is an opportunity for them to become a recipient of it.

When it comes to shielding them, I have had some failures in the past — it took a minor stroke in my father, who lived in England, for me to realize that he had never been anticoagulated for his atrial fibrillation, despite regular visits to his GP. Nor was I able to prevent my youngest daughter from getting a bill for several thousand dollars from the ER she visited with a dislocated thumb.

Doctors and nurse practitioners delivering bad care are to be found in every specialty, but in my experience, one tops them all. That would be pediatrics.

Now, I can say this because I am, in fact, a pediatrician.

Over my 30-odd years of practice, I have seen my fellow pediatricians screw up time and time again. In fact, I amused myself by imagining that the gold standard textbook of pediatrics, Nelson’s Textbook of Pediatrics, came in two versions, one a very limited accurate edition given to chaps like me, and the other — a repository of disinformation —given to the rest.

Now, I am not alone, in my opinion. Another pediatrician was so annoyed by the poor standards he encountered that he was motivated to write a book about it. The author, Dr. Palmieri, titled it “Suffer the children: Flaws, foibles, fallacies and the grave shortcomings of pediatric care.”

In its review, one of my favorite websites called it a “gem of a book.” The review is quite extensive, and you can get a good feel of the book’s contents from that alone. Otherwise, it is available on Amazon. Read it and weep.

Pediatrics is particularly dangerous in this respect because of the frequent visits made by children. Even if a child is never sick, there are a slew of “well visit” encounters, all providing an opportunity for inadvertent harm.

Well, my two children are grown, so I don’t need to protect them from the pediatrician, but I am still on duty for my two grandkids, aged three years and six months.

Fortunately, their mother typically calls me first if there is a medical issue and then again after seeing the pediatrician. This typically results in me doing the classic facepalm maneuver and then explaining to my daughter that what she was told is wrong. This has happened so often that I suspect she thinks I am somehow aberrant in the world of pediatrics, a fringe oddball, perhaps. So I make sure I send her links to online articles on the issue so she can see that I am compos mentis.

The latest round came yesterday. She sent me a text stating that the pediatrician had diagnosed the youngest as being allergic to several foods, including sesame (wittily, I texted back, “Hummus and baba ghanoush are off the menu then?”) and wheat, amongst a slew of others.

The background to this is that the boy had his first bite of egg a month ago and immediately flushed and developed an urticarial rash. He responded promptly to some diphenhydramine. Pretty good story for genuine egg allergy, I think.

I was unaware that my daughter had decided to take junior to the pediatrician as a result. And what did he do? Allergy tests, of course. A blood-specific IgE panel, to be exact (what old timers like me still like to call RAST testing).

Mega facepalm. Here we go, down the rabbit hole again.

In my opinion, no pediatrician should ever order this test. This is something for the trained allergist to do. Current recommendations also support selective IgE testing based on history rather than blunderbuss testing, as was done here.

There is much that could be discussed, but I want to focus on the major error — the fact that my daughter was told her son is allergic to several different foods based on the results of the testing.

This is absolutely wrong.

The child is sensitized to certain foods but not proven to be allergic. The guidelines for diagnosing and managing food allergy from the National Institute of Allergy and Infectious disease clearly state this.

In fact, the RAST is well known to have a very high “false positive” rate; the test is often positive when a genuine allergy is absent. Only a food challenge can prove allergy.

Misinformation like this can have devastating consequences, as parents believe their child to be allergic to foods and, as a result, remove them from the diet, something my daughter was poised to do until I intervened (wheat exclusion is particularly onerous and a surprising range of products contain sesame).

As a 2015 paper in the Journal of Pediatrics concluded, “Food allergy panel testing often results in misdiagnosis of food allergy, overly restrictive dietary avoidance, and an unnecessary economic burden on the health system.”

Too true, alas.

There have been several studies of children placed on restrictive diets on the basis of panel testing showing that the majority do not have true allergies and can tolerate the “forbidden” foods just fine.

Due to unnecessary diet restrictions, some children have experienced severe malnutrition, including kwashiorkor and zinc deficiency.

In my opinion, my grandson should never have been “allergy tested” at all. But if, as a physician, you are going to order it, please have the decency to understand the test and counsel appropriately.

Fortunately, this child had a grandfather who was educated in this matter and able to prevent the harm that might have resulted. Other kids are not so lucky. This physician’s actions fell foul of two important maxims that I feel all should follow: firstly, don’t order a test unless you properly understand it. Secondly, understand that a positive test does not always indicate the presence of the disease it is testing for. And, of course, it fell foul of the ultimate maxim, “Primum non nocere.”

Oh, and yes — because what I told my daughter stood in stark contrast, I was sure to send her links to articles on the topic. If you’re interested, just google “food allergy misdiagnosis” and take your pick. There’s plenty to choose from.

Now, if you’ll excuse me, I have to get back to the watchtower.

Martin C. Young is a pediatric endocrinologist.

Image credit: Shutterstock.com

Prev

Top questions doctors ask health care attorneys [PODCAST]

November 23, 2022 Kevin 0
…
Next

PTSD after medical education

November 24, 2022 Kevin 1
…

Tagged as: Allergies & Immunology, Pediatrics

Post navigation

< Previous Post
Top questions doctors ask health care attorneys [PODCAST]
Next Post >
PTSD after medical education

More by Martin C. Young, MD

  • Breaking the cycle of childhood obesity

    Martin C. Young, MD
  • Don’t neglect the power of clinical examinations in modern medicine

    Martin C. Young, MD
  • Where have all the pediatric beds gone? The consequence of strict admission criteria.

    Martin C. Young, MD

Related Posts

  • When celebrities attack children with food allergies

    Lianne Mandelbaum
  • Why medical students need more continuity of care training

    Nathaniel Fleming
  • Does socialized medical care provide higher quality than private care?

    Peter Ubel, MD
  • What makes health care workers superhuman

    Eric Tian
  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • Major medical groups back mandatory COVID vaccine for health care workers

    Molly Walker

More in Conditions

  • Lazarus: the dead man brought back to life

    William Lynes, MD
  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Changing the pediatric care landscape: Integrating behavioral and mental health care

    Hilary M. Bowers, MD
  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • The teacher who changed my life through reading

    Raymond Abbott
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...