“It’s the best possible time to be alive, when almost everything you thought you knew is wrong.”
-Tom Stoppard, Arcadia
Welcome to Hospital Pediatrics. I am happy to present you with the newly reincarnated version. We are now an official AAP journal, publishing peer-reviewed, original research as well as synthesis, commentary and news.
As I worked on preparing this issue, I also plugged away at my usual clinical workload. And, during this time I had a brush with “everything I thought I knew” being wrong in the way that I think Stoppard meant in the well-known play. I had a patient with fairly severe mastoiditis and an associated venous sinus thrombosis. Luckily, the patient made a rapid recovery and I was casually commenting to my resident team that you’d never know she had a thrombus, when over my shoulder someone said, “You are anticoagulating her, aren’t you?” And, well, no, I wasn’t. She’d only been in the hospital 24 hours, so I wasn’t really ignoring the problem, but the truth was that it hadn’t been on my list of things to do. Oops. Back in the day (read: the 1990s), I wasn’t taught to anticoagulate kids with venous sinus thromboses. There was the perception of risk outweighing the benefits and a lack of data on the practice in children. But it turns out that the benefits (probably) outweigh the risks. So, after digging through a few papers and two consensus statements and, of course, a hematology consult, we anticoagulated the patient. But, did I ever feel left behind - flat on my feet at the starting line, with the rest of the racers rounding the first turn. And yet, on some level, what fun to be wrong and to have the opportunity to change, to re-enter the race, to revise my practice and to keep up.
I suspect that feeling is only going to become more common in our field. We are beginning to turn our collective attention toward the questions that matter to us, those questions which have emerged out of our personal experience practicing pediatric hospital medicine. We ask these questions, often without protected research time, mentorship or even funding as you’ll read about in the survey by Dr. Bekmezian in this issue. Yet, we are still asking our questions. And, in the answers to just a few of these questions presented in this issue, I know you’ll find information that informs your practice of hospital medicine. Must reads include Dr. William’s contribution to our understanding of when it’s safe to send home an infant with pertussis, and Dr. Lintzenich’s examination of our willingness to prescribe controller medications after an asthma hospitalization. And, by the way, how good are you at convincing the patient to actually fill that prescription?
I distinctly remember my first experience “pitching” a research idea to a mentor as a newly minted pediatric hospitalist. I’d already had hours of coursework in statistics and study design, and mastered the sketchy art of power analysis. I’d even gotten a small grant, so I was pretty sure my idea was going to sail right past this skeptical mentor. Well, needless to say, the mentor, a pulmonologist, was unimpressed. It seemed his objections included even my study question which related to the impact of pulse oximetry on hospital length of stay in bronchiolitis. I believe the comments ran toward: “Well, that’s just utilization work, it’s not really research.” Somehow, I kept from crying, and I went on to other things, but I kept getting the same reaction to the topics I was really interested in – “Why would anybody want to study that?” Finally, I adopted an official research motto (cribbed from Samuel Beckett): “Try again, fail again, fail better.”
In this issue, you’ll read articles by pediatric hospitalist researchers who, I suspect, have experienced their share of failure. And, that’s great. Yeah, I said great. It’s great because none of those authors gave up and walked away from their work. They kept working and they found their audience. As an emerging specialty, we’ve all had similar experiences with people who just don’t get it. “What is it you do again?” And my personal favorite, “So, what do you do when you’re not on service?” Well, here’s what we do when we’re not on service – we ask questions that matter to us and then we answer them. We look for ways to improve our practice and, in doing so, we discover new questions and new priorities. So, I hope this issue galvanizes the fellows and young hospitalist researchers out there. Ask the questions that move you and persevere when you meet initial rejection. Your audience is waiting.
- Copyright © 2011 by the American Academy of Pediatrics