25 Years of Changes

It was recently pointed out to me that this summer marked 25 years that I have been practicing pediatrics in the Staunton, Augusta, and Waynesboro area. A recent discussion with a younger colleague who has never seen a case of chicken pox got me thinking about the things that have changed in the past 25 years. Many of the changes are unquestionably positive while some of the others are not.

Chicken pox used to be common but I have not seen a case locally in years thanks to the vaccine which was introduced early in my career. In the past we sometimes had children hospitalized for complications of chicken pox and I once had a patient with a complication called acute cerebellar ataxia – a condition which has hopefully been relegated to the dustbin of diagnostic history forever.

The bacteria Streptococcus pneumoniae (also known as pneumococcus) was a formidable foe which often kept me up with worry at night. It caused bloodstream infections, meningitis and nasty pneumonias which could fill the chest cavity with pus. Early in my career there was robust debate about the proper timing for inserting a tube into a child’s chest to drain the fluid around the lung caused by pneumococcal pneumonia. And it wasn’t unusual to do a spinal tap in the office on a baby to rule out meningitis. But again, with the introduction of a pneumococcal vaccine, I have not done a spinal tap on a baby in years and have not needed to ponder the pros and cons of chest tube placement in a child with pneumonia for a very long time.

Rotavirus was a common wintertime intestinal infection which often led to dehydration needing hospital admission for IV fluids. It was common enough that our pediatric nurses in the hospital could often correctly diagnose it by the smell of a patient’s stool before we had lab results back. Again, after introduction of a vaccine for it, this disease has almost disappeared.

I have also not seen a case of meningococcal disease (an awful, often fatal illness) in years. You may have guessed by now that a vaccine for this was also introduced since I started practicing.

Of course, we did not have COVID when I started out and that has obviously been a huge change. In a way it was not too surprising because the folks who study these things have been warning us for a long time that it was not a matter of if, but when the next global pandemic would occur. However, I did not have a coronavirus on my Bingo card as the likely culprit, though SARS should have been a warning. And apparently, we now need to keep polio in mind as a possibility, even though it was almost entirely eradicated from the entire world not that long ago.

The number of anxious children and adolescents seems to have increased exponentially in the past 25 years. COVID and its downstream effects have clearly been a factor in this increase, but anxiety was already increasing before any of us had heard of COVID. There is evidence which points to the role of social media and ubiquitous smart phones as part of the cause of this increase.

On a positive note, many parents are now aware of the downsides to overuse of antibiotics and there is much less pressure to prescribe them when they are not indicated. I now occasionally find myself in the awkward position of thinking antibiotics are needed and having the mother not want to use them. I do not recall that ever happening 20-25 years ago.

The way pediatrics is practiced has also changed. Although it took longer to become the case here than in many more populated areas, pediatric practice is now largely divided between outpatient and inpatient practice. We used to do it all. I might have fielded a middle-of-the-night phone call about a patient, seen them in the office the following day and then admitted them to the hospital and provided their hospital care as well. Now those different functions would fall to different people. While it certainly makes life more livable for us to not be chronically exhausted, I think something is lost in the disconnect of not having the continuity of care from one’s own doctor. And I do miss providing inpatient care. On the other hand, sometimes a new set of eyes can pick up on something that may not have been noticed if the same doctor was providing all the care.

I remember early in my career feeling like I was in a good rhythm and that I would just do what I was doing for 35 or 40 years and then retire. I had no idea how much would change over the years but I guess that is how life works.

Thank you to all who have allowed me to be part of your lives for the past 25 years. Maybe I will be at it long enough to someday reminisce about how things were in 2022.