Is the ethos of medical practice in community paediatrics compatible with that in public health? | Archives of Disease in Childhood

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Is the ethos of medical practice in community paediatrics compatible with that in public health?

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Community paediatrics - a misnomer
Ashok Nathwani
Published on: 9 January 2022

Published on: 9 January 2022
Community paediatrics - a misnomer
- Ashok Nathwani, Consultant Paediatrician, Community Child Health
Dear Editor:
Stewart-Brown's paper on the compatibility of medical practice in community paediatrics with that in public health[1] is a superlative effort. This is more so as it has come at a time when community paediatrics is being actively discussed by the RCPCH (UK Royal College of Paediatrics and Child Health) for a variety of reasons but, perhaps, most importantly because it does not seem to attract enough...
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Dear Editor:
Stewart-Brown's paper on the compatibility of medical practice in community paediatrics with that in public health[1] is a superlative effort. This is more so as it has come at a time when community paediatrics is being actively discussed by the RCPCH (UK Royal College of Paediatrics and Child Health) for a variety of reasons but, perhaps, most importantly because it does not seem to attract enough specialist registrars.
It can be argued that all paediatricians (just not community paediatricians) can and do play an important role in child advocacy issues at various levels. From the clinical perspective the community paediatric role in immunisation and child health surveillance is the most important.
Trainees in paediatrics need to recognize that child public health is a small (albeit important) role of the community paediatricians. The bulk of community paediatricians are neurodevelopmental specialists. Many have an important role in child protection. Some community paediatricians are developing a behavioural paediatric interest in their clinical practice.
Most districts in the UK need their community paediatricians to look after families with children with disabilities. Some districts (like ours) need them to offer outpatient epilepsy services as well. With increasing prevalence of behavioural problems in children, many community paediatricians have trained (or retrained) themselves to cater to this need. Useful links with child psychiatric and psychology colleagues have been forged. In fact, our counterparts in the US are called developmental and behavioural paediatricians and their core curriculum reflects the depth of training offered for both these domains.[2]
There is no doubt, therefore, that the term “community paediatrics” is a misnomer and may not offer confidence to the budding specialist registrar who may find being a neurologist or an oncologist a better bet. There is increasing specialism within community paediatrics, and the job title needs to reflect that expertise.
It is very possible that a small minority of (community) paediatricians may chose to train with a major public health interest. It may be helpful to know that the American Acdemy of Pediatrics has a section for paediatricians with this interest.[2] The bulk should continue (to train and practice) with a major clinical interest and that should be an important selling point for community paediatrics. Hopefully job titles in the future will reflect the clinical expertise. This will not only help trainees but also purchasers, referers and the families we serve.
This letter is not meant to be in any way critical of Dr Stewart-Brown’s paper which, in fact has highlighted the importance of public health medicine for (community) paediatricians. Health promotion is indeed a skill that can be applicable easily in clinical practice.
Dr Ashok Nathwani
Consultant (Community) Paediatrician
Portsmouth, UK
References
(1) Stewart-Brown S. Is the ethos of medical practice in community paediatrics compatible with that in public health? Arch Dis Child 2000;83:101-3.
(2) Section on Community Pediatrics, American Acdemy of Pediatrics, http://www.aap.org/commpeds/ [accessed 3 Aug 2000].
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Conflict of Interest:
None declared.
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