© 2011 Roy Benaroch, MD
Suffer the Children: Flaws, Foibles, Fallacies, and the Grave Shortcomings of the Medical Care of Children by Peter Palmieri. Reviewed: Kindle edition, March, 2011. $3.99.
It’s rare to see such an insider’s view of his own profession, especially one that so eloquently and caustically exposes widespread systemic flaws. This isn’t a book for the faint-of-heart, or for those who wish to blithely continue to obey the experts in whom they’ve trusted their children’s care. It is a tome designed from the first page to open eyes and change thinking.
Palmieri, a board-certified pediatrician, has worked in both office-based and hospital settings, and has the experience to back up his claims. His book begins by criticizing pediatricians’ inability to even handle the simple stuff correctly—“missing layups”, metaphorically—and continues to pierce the troubling mystique that has shrouded the “magic” performed by doctors, preventing parents from being able to separate good care from bad.
The beginning of the book concentrates on examples of poor care: medicine that doesn’t live up to modern scientific guidelines. Lay readers especially will be surprised to learn that many assumptions about medical problems, like green snot or a diagnosis of “bronchitis” both require antibiotics, are pure myth. These myths are propagated by physicians, despite their being disproved time and again over decades of research. Palmieri’s first point is well-made: many doctors handle even easy problems poorly.
The middle third of the book may be a little harder for lay readers to grasp, but it is very much worth the effort. Palmieri, through anecdotes and explanations, illustrates several “mental illusions” that prevent all of us from perceiving events and illnesses in the most objective way. Though some of these mental mistakes have fancy, intimidating names (eg. post hoc ergo proctor hoc) Palmieri does a good job explaining these concepts, illustrating that cognitive errors and biases have in many ways replaced clear thinking in the medical field. This has lead to a sort of “physician groupthink” where outdated and just-plain-false ideas are so pervasive that they begin to seem true.
An individual chapter on the misuse of tests may be the weakest part of Palmieri’s work, in part because illustrating these concepts without relying on more-explicit mathematical equations is difficult. Palmieri’s point is that the basic physician’s tools of a careful history and physical exam are far more reliable than tests in most cases, and that parents and physicians can be deceived when they do not appreciate the pitfalls of medical tests.
Parents and pediatricians may find the “Money matters” chapter creates the most discomfort. We imagine physicians to be above greed, doing only what’s best for their patients. Palmieri’s personal examples illustrate that pediatrics is just another business. However, it’s worth noting that in many communities, physicians do not own the hospitals, laboratories, and other health facilities—so may not have their own hidden agendas in making referrals.
Further along, Palmieri exposes a new “disease,” called “Munchausen by Doctor”. Physicians may inadvertently rely too much on diagnostic labels, and fuel worry and anxiety by ordering too many tests and medications. Parents may be quite vulnerable to becoming convinced that their child is terribly ill, leading to a co-dependence on their “savior,” the very doctor who has helped create the illusion of ill-health. It’s troubling to believe that pediatricians may, in a sense, be creating as much disease as they are curing.
The strongest part of Palmieri’s book is the closing chapter, in which he reviews specific suggestions for parents, doctors, and medical educators. It’s one thing to throw stones; it’s quite another to think these problems though and come up with genuine, workable solutions. How many parents will want to read about the shortcomings of their child’s physician, and how many pediatricians will be willing to look into such a dark mirror and make genuine changes in the way they practice?
Palmieri’s book is a quick read. It’s lively, and has plenty of good examples and patient stories to anchor the text. There are quite a few good, recent references (though these are not necessarily specifically keyed to sections of text, a nitpicky criticism.) The book should be read by parents and pediatricians alike—if they’ve got the nerve.
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