When I graduated from medical school, I was told that the half-life of medical knowledge was about five years—in other words, about half of what we graduating physicians were taught as the "truth" of medical care would be updated, disproved, or found irrelevant within five years. At such a rate of change, physicians require rigorous attention to the advances made in both medicine and in medical care.
What we were never taught, however, was that the prime focus within medical care—the doctor-patient relationship—would also undergo dramatic advances. In the middle of the 20th century, the doctor-patient relationship was rather one-sided and paternalistic—the doctor gave the patient options and recommendations for treatment, and the patient almost always accepted the doctor's sage counsel. But by the mid-1980s, that reality gave way to a new catchphrase: shared decision making.
The idea of shared decision making includes three key tenets: sharing uncertainty, sharing potential foibles, and sharing responsibility for the decision.1 However, given the asymmetry found within this health-care information exchange (that is, the doctor had the majority of the medical knowledge while the patient depended on the physician for this knowledge), this process invari
1 Katz, J. The Silent World of Doctor and Patient. New York: Free Press, 1984. p. 166.
2 Vuong, M. "Online health sites a key resource." Seat tle Post-Intelligencer. July 17, 2003. Available online. URL: http://seattlepi.nwsource.com/health/131213_ onlinehealth17.html. Accessed July 17, 2003.
ably resulted in little more than an affirmation of consent for the doctor's recommendation.
Yet within the last 10 years, a new and powerful force has emerged within health care: the informed consumer. Between the informationsharing opportunities of the Internet and the movement to empower patients to take control of their own health, consumerism has found a place within health care. While many physicians remain undecided about the ultimate impact of giving health-care consumers access to medical information, the genie is out of the bottle. Although more and more Americans go online when they need health information,2 one can never be sure about the quality of the information obtained.3
That's where this book comes in. We know that readers want to know more about children's health. (If you did not, you would not be looking at this book!) That being the case, we have gone out of our way to provide you with a reference that is accessible, readable, understandable, and current (within the limitations and constraints of the publishing industry). We want you to be both an empowered consumer who can find the information you are looking for and an active and knowledgeable partner in the care of your child. If, in providing you this credible information, we can
3 Mettle, M. "The Healthwise Communities Project: Where Healthcare is Practiced by All." In Connecting with the New Healthcare Consumer Defining Your Strategy, edited by D. B. Nash et al. New York: McGraw-Hill Health Education Group, 2000. pp. 375-396.
ease your fears, allay your anxieties or point out pertinent facts, then we will have accomplished what we set out to do.
Since my graduation from medical school nearly 18 years ago, I've seen a lot of changes. I sincerely hope that the information found in this book provides you with the ability to change your child's health for the better.
I wish you and your child good health, positive parenting, and effective empowerment.
—Albert Tzeel, M.D., F.A.A.P. Milwaukee, Wisconsin
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