PHM Session: Um, Dr. Dancel, We Don’t Do That Anymore
Presenters: Jennifer Fuchs, MD, UNC Children’s Hospital, Chapel Hill, N.C., Steve Weinberg, MD, UNC Children’s Hospital, Chapel Hill, N.C., Eric Zwemer, MD, UNC Children’s Hospital, Chapel Hill, N.C., and Ria Dancel, MD, University of North Carolina, Chapel Hill, N.C.
Drs. Fuchs, Weinberg, and Zwemer, with contributions from Dr. Dancel, presented nearly a dozen commonly taught and widely accepted clinical tenets. They disproved these long-held dogmas using primary literature and provided evidence-based recommendations for various commonly encountered pediatric hospital medicine diagnoses.
The presenters also took time to review some alterations to our medical lingo in advocating for a shift away from using eponymous terms. Whether bestowing honor on historically dishonorable individuals, not accurately identifying all contributors (many of whom are female or non-white), or simply not accurately describing the finding or disease at hand, the teaching and use of such terms are falling out of favor.
After summarizing their amendments to the previously described doctrines, the presenters invited the audience to share other longstanding beliefs that evidence has invalidated, continuing the information sharing aimed at optimal patient outcomes.
- Medical knowledge and research are ever evolving; new evidence might change our practices at any time, no matter how ingrained a belief might be.
- Lumbosacral dimples (located above the gluteal cleft) may require investigation, even if you can “visualize the base.”
- Vancomycin is superior to metronidazole for treating C. difficile, but fidaxomicin may be the future.
- Refeeding syndrome is exceedingly rare in otherwise healthy term infants and toddlers hospitalized for failure to thrive.
- The first-line treatment for anaphylaxis is epinephrine, not H1 or H2 blockers, and not steroids.
- Eponyms can be insensitive or uninformative. Try to avoid using them.
- Not all newborns will be back to their birth weight by 14 days. Use the newborn weight tool, available at https://newbornweight.org/ to check their progress.
- Children hospitalized for respiratory syncytial virus have an increased risk of asthma in the future.
- Hip clicks are insignificant. The Ortolani maneuver is most important in assessing for developmental dysplasia of the hip.
Dr. Ballis is a first-year PHM fellow at the Medical University of South Carolina in Charleston, S.C., where he completed his pediatrics training as well as a chief year.