Mirror, Mirror on the Wall, Which Friday is Blackest of Them All?

By Vandana Bhide MD, FAAP

I’m in a panic because it is November and I have already missed the “first” Black Friday and now am about to miss the “second” Black Friday of the holiday season. I am fascinated by the marketing phenomenon of this year’s “early” Black Friday. “Traditional” Black Friday (I am waiting for the greeting card industry to get in on this one so I have yet another card I have to send during the year) is, of course, as every smart American shopper knows, the day after Thanksgiving. (Another requirement for a greeting card, I rest my case.)

Last year, a few “genius” manufacturers decided to advertise an “early” Black Friday and they scored a home run in sales. In response, this year, many retailers, desperate for business in difficult economic times, started “early” Black Friday advertising (AKA “sales” and “deep discounts”) as early as July.

No wonder parents feel like a pawn in the endless sea of toy and electronic gadget advertising, aimlessly trying to determine which toys will be “the IT toy” of the holiday season. (Hint: Cabbage patch dolls ARE NOT hot this year!). Not necessarily the most fun toy, but the item that one “must have.” Kids are still determining which toys they “must have” from Santa this year while manufacturers jockey for position to be the “ultimate number one” toy to have in 2010. (Ta Da!)

I am embarrassed to say that as a pediatrician and a parent, I too have succumbed to the pressure of finding the “IT” toy before the item “runs out” and I have to buy it online for ten times the suggested retail price. Of course, suggested retail price is a relative term, determined primarily by the phenomenon of the “sale” price. I’d rather spend $30 on a toy that is “slashed” from the suggested retail price of $60 than actually buy an item that costs the suggested retail price of $30. And if I can find a coupon for $5 off, well, I am in parents’ retail heaven.

Whew, I am sweating at the mere thought of not being able to get the “right toy” so that my child is not an outcast at school for getting that “educational” holiday present (AKA books or “reading material”). Parents (AKA “consumers”) are now used to the annual ritual of fighting for a small supply of the most popular toys (which will surely be determined by a multitude of manufacturing experts writing online articles now that the first two “early” Black Fridays are over so that one may prepare for the “original” Black Friday, followed by the “late” Black Fridays of the holiday season.) Parents are forced by manufacturers to believe that a toy can’t be valuable unless it is in short supply. The aura of a holiday present is not quite the same unless your Santa gets it when other kids’ Santas were unable to find it in time for the holidays! (Of course finding a coupon and a “drastic reduction” in price helps. None of us wants to admit going overboard on holiday presents!).

Of course the unknown deciding factors this year are the holiday movies geared toward children and teenagers. Can one really accurately determine the “best toys of 2010” until after the movies have come out? (Surely they will be released on what will be known as the third and fourth “early” Black Fridays of this year.) That’s a lot for parents to think about (along with internet safety, bullying and underage drinking)!

How is a parent to deal with all of this? Well go on the Internet of course! Right after each Black Friday, there will be plenty of retail “experts” writing Internet articles telling us which items are the “official” “must have” items for 2010. I have already read ten “Top Ten Toys of 2010” lists online in the time it took me to write this blog post!

For a second there, I toyed with the idea of dawdling enough to get presents at the “the last and final early Black Friday” of 2010, also known as the “day after Christmas sale,” which I now believe will be called “the first earliest Black Friday of 2011.” Nah…

Hats off to the Professor

By Don Shifrin, MD FAAP

It wasn’t so long ago that Robert Preston played the legendary flim-flam man, Professor Harold Hill in the 1962 movie, The Music Man. In it he envisions a way to profit from the paranoia he creates by sensationalizing the threat to River City’s youth from the local pool hall. In the movie’s seminal scene he sings to the parents of the ‘troubles’ hanging around the pool hall will cause:

“Well, either you're closing your eyes
to a situation you do not wish to acknowledge
or you are not aware of the caliber of disaster indicated
by the presence of a pool table in your community.
Ya got trouble, my friend, right here,
I say, trouble right here in River City.

Now, I know all you folks are the right kinda parents.
I'm gonna be perfectly frank."

Flash forward 48 years to the concept that the newest “threat” to our youth might be media overexposure. Could it be real, or as exaggerated as the Professor’s theory regarding pool halls?

The list of negative outcomes from media overexposure grows longer each day: from early sexuality, smoking, poor nutritional choices, sleep problems, attention issues, cyber-bullying, violence, decreased family time, and potential academic underachievement.

I accede to the positive aspects of media for children and teens to connect, form peer-related communities, heighten political awareness, and hyper-accelerate learning.

I am not looking for profit, like Professor Hill, but note that in respect to learning. Michael Kirst, an emeritus education professor at Stanford, estimates that 60 percent of incoming community college students and 30 percent of incoming freshman at 4 year schools need remedial reading and math courses. ( Newsweek 9/13/2010)

While elementary schools are making progress academically, high schools have stagnated. Is it the teachers, courses, rigor, or failure to engage academic curiosity? Or is it media time, content and depth, or constant multitasking that is one of the biggest factors in disincentivizing students to “not like school”?

The US high school drop out rate is now 1 student every 26 seconds (7000/day). There are nearly 2000 high schools in the US where 60% of the students entering do not graduate. I can guarantee you, however, that those who drop out are all very media aware across a multitude of electronic devices.

Is there a carry-forward? I suspect strongly that tweens and teens are “tuning in, turning on”, and possibly then ‘dropping out” of the traditional educational process. (Apologies to Timothy Leary circa 1965 urging people to embrace change by using LSD to remove their cultural and conventional norms.)

Can we not say that media is now the primary peer of our digital generation and cajoles them in similar ways: incessantly glamorizing, sensationalizing, and normalizing behaviors for them to emulate?
I want to bring us back to the reality of digital immersion: it is not going to vanish, unlike an obsession with billiards. Sixty-four percent of adults in 2004 thought that owning a TV was ‘necessary’. In 2010, that number dropped to 42% indicating that other devices are supplanting TV as a primary media source.

So the digital footprint moves quickly. This Professor thinks that the greatest risk for our children would be NOT to grant them access. And the second greatest risk would be to grant them unlimited access without guidance.

In my view their social, cultural, academic and economic future will be digitally integrated. Tools are being developed to change the school paradigm from classical appointment education in a classroom, to anytime, anywhere digital learning.
Soon tablets, interactive textbooks, super fast anywhere download speeds, educational games, voice processing, and Avatar model learning systems will come online.

Who will mentor children in this brave new world? Through multiple media outlets children are repeatedly exposed to questionable ethical behavior and morals. If left to sift through the world of reality TV, talk shows, political pundits, etc. without supervision, can we expect them to emulate the values we intend them to have?

Therefore, like Professor Harold Hill I now urge parents to “Heed the warning before it's too late!
Watch for the tell-tale sign of corruption!”
That may be a little too bombastic for this topic, but parent’s need to “turn on” and tune in” to the fact that the daily media exposures of 7+ hours (Kaiser Family Foundation Jan.2010) has essentially “dropped them out” of their role as the family’s primary value filter and educator.

Without sensationalizing the topic any further please encourage your parents to answer two questions:

1) Does your child have unsupervised and unlimited electronic access on his/her various devices, especially in the bedroom?
2) Has your child’s use of media changed his or her behavior(s), academic or social, or sleep habits, or his/her connection with your family?

If their answers are inconclusive, perhaps a song from the Professor might be appropriate.

Turnoff Week - September 19th-25th

By Corinn Cross, MD FAAP

Next week, September 19-25th, is National Turnoff Week. Parents are encouraged to use this upcoming week as a seven-day hiatus from televisions, video games, web surfing etc. Instead, families are encouraged to spend a screen-free week together.

Turnoff Week is supported by the American Academy of Pediatrics and the Council on Communications and Media. The most recent statistics show that the average American child spends over 1000 hours a year watching TV and playing video games. To put that in perspective, they only spend 900 hours a year in school. Television, video games, computers and now cell phones are becoming an increasing part of everyday life for the American child. Although there may be many advantages of living in such a technological era, there are well-documented detriments as well.

America is quickly becoming a nation of overweight individuals, and obesity is highly correlated with increased screen-time. Studies have shown that children who spend 4-6 hours a day in front of screens have a higher risk of being obese. All this screen-time is at the expense of less time spent playing sports, doing outdoor activities, reading and having family time.

Pediatricians can help parents by encouraging families to take part in Turnoff Week. As pediatricians, we can discuss the challenges of implementing a screen-free week and provide families with tools to help make the week successful.

1. Have a plan for each day in order to help keep children occupied.
2. Encourage outdoor play.
3. Schedule a family game night.
4. Involve children in dinner. Allow them to create a menu and help with the cooking.
5. Go on a family outing. Fall is a great time to go apple picking or to a pumpkin patch.
6. Plan a trip to the library.

These are just a few ideas of ways to pass seven days without a television. As the Turnoff slogan goes, "Turn off TV. Turn on life."

“My Baby can learn, but not through TV”

By Jeff Hutchinson, MD FAAP

There are two truths that we as pediatricians should accept. The first is that television and video entertainment is here to stay. The second is that parents who use video entertainment don’t want to feel guilty about using it. In October 2009, the Disney Company conceded that the Baby Einstein product line was misrepresented as educational and offered parents a refund. This offer has since expired and the number of parents who took advantage of the refund is difficult to find. I suspect that Disney did not lose much and may have gained supporters by showing honesty and concern.

The American Academy of Pediatrics continues to discourage TV viewing for children under two because developmentally it teaches them only how to watch TV and likely causes harm in language development(Arch Pediatr Adolesc Med. 2009;163(6):554-558). The 2001 AAP policy statement on Children, Adolescents and Television recommends, “Discourage television viewing for children younger than 2 years, and encourage more interactive activities that will promote proper brain development, such as talking, playing, singing, and reading together.” However a 2003 Kaiser Family Foundation survey “Zero to Six” reported 68% of children under two use screen media on a typical day. This demographic of toddler television viewers has inspired the creation of products directed at parents who want educational screen time.

One product , the “Your Baby Can Read” series, claims that these instructional videos will teach your baby to read. Wouldn’t that be a parent’s dream? Plop the kids down in front of the TV and go about your business. When you return, your baby can read.

None of the educational products claim to work that way. They emphasize that the screen is a teaching device for the parent. Calling the products educational tools and comparing the videos to a teaching aid may quiet some critics, but even a die hard videophile knows that interaction is the most important aspect of development. The reality of life is that interaction with a TV screen and child often takes a back seat to laundry, dishes, meals, bills and the thousand other tasks that a parent has to do. A book forces interaction while a screen allows the caregiver to step away.

As pediatricians and parents we have to acknowledge that parents need breaks. Organized and fortunate parents get those breaks during naps. Many parents do not. Just as we talk about second hand smoke and the health benefits of quitting, we should also discuss video exposure and the benefit of stopping exposure under 2 years old. We should discuss it with the same non-judgmental but research proven emphasis we give tobacco exposure, along with the recommendation to limit exposure at all other ages. We as pediatricians can discuss if parents believe that babies and children learn from TV. We should be ready to acknowledge the need for a distraction but discourage the fantasy that TV alone has any place in early development.

Social Media and the Private Practice

By John Moore, MD FAAP

Over the past ten years, Americans’ usage of electronic media has exploded. The Internet has gone from a novelty to an essential part of our personal and professional lives. I check my email and Facebook wall before I finish my first cup of coffee in the morning, and I know I’m not the only one! A recent survey of pediatricians (2009 Periodic Survey of Fellows) found that over 85 percent of us use the internet for news and CME. Over 60 percent of younger pediatricians also use social networking sites like Facebook or Sermo.

A small but growing number of practices are starting to use social networking sites as marketing tools as well, communicating directly with patients and families. As I began to investigate starting our own practice Facebook page, however, I quickly realized this is a very complicated issue with a lot of pros and cons.

There are many positive aspects to social media. It is a free way to communicate directly and instantly with a highly receptive audience. The sites are easy to construct, free to establish, and require minimal time to maintain - all of which are in stark contrast to conventional websites. In addition, the communication between administrator and patients is instant. Finally, you are able to communicate your message directly to patients and families who register with you - targeting the most interested audience. Facebook pages can provide a convenient portal to correspond with patients and families, transmitting not only office information and policies but also overall pediatric news.

However, social networking pages are not without risks for physicians. Pediatricians need to keep some basic rules in mind before opening their pages for business. Patient privacy is a real and major concern. Posts on walls that contain specific identifiers and privileged information may run afoul of federal law and thus may constitute a HIPAA violation.

Pediatricians who maintain a social media presence also need to monitor their pages regularly. Patients may treat those portals as an extension of our offices and expect the same level of communication they receive through more conventional methods. While no legal precedents have been set, it is reasonable to assume that we are as liable for social media communications as we are for all other platforms. Finally, pediatricians need to keep copyright, libel and slander laws in mind - social media are not immune from conventional legal standards and violations are more public and more permanent!

We also need to consider which features make social networking sites effective. Marketing and business leaders have identified several key components of successful platforms. Sites should be interactive, drawing readers in and soliciting their comments. People like to feel included - successful sites encourage interactions between patients and the moderators. The more “viral” the site becomes, the more effective it is. Furthermore, sites should be updated frequently with interesting, entertaining and useful content, practice information and changes, links to pediatric or community-specific events, or even commercially available data (as copyright-applicable!).

The decision to open a practice-specific social networking page is a difficult one. For many of us who are “quick adapters”, these pages are a natural extension of our personalities. We are more than willing to embrace the unknowns in order to engage our patients in conversations. For others, however, the concerns more than outweigh any perceived benefits. Whatever your personal opinion on social networks, however, they are inescapable part of modern life and a growing part of many pediatricians’ daily practice.

The Perfect Pitch:

By Alanna Levine, MD FAAP
Developing a pitch for a television segment is not an easy task. You have one chance to pitch the segment to a producer, so it pays to make it a strong one. Producers scan through hundreds of emails every day-some they read and some they don’t even open. How do you make your pitch stand out, get read, and ultimately get picked up?

I have been pitching stories to the media for three years. I have developed relationships with many producers and have been lucky enough to get feedback from them on my pitches. The following are tips I have picked up along the way that help maximize the chance that my pitch will become a segment.

1. Develop a one line ‘tease’: Try to create the headline for the show in the pitch. What would the hosts say is coming up after the commercial break to keep people interested and prevent them from turning the channel? For example, “Spring Break Safety Tips: 5 things every parent should know to keep their teens safe while away on Spring Break” or “Is your baby safe in the car? A new study shows that only 20% of babies are buckled in properly. Find out how to make sure your baby is protected”
2. Be succinct: Producers don’t have that much time to spend on any one pitch. Put the most important points in the first lines of the pitch. Limit the pitch to one paragraph or a few bullet points. If they are interested, you can always provide more information later.
3. Give the story a hook: Why should it be in today’s news? Relate it to something that happened recently. For example, the week Michelle Obama launched the “Let’s Move” campaign was a great time to pitch a story about the importance of diet and exercise in kids’ lives. If a child was recently injured in a sledding accident, pitch a story about guidelines parents should follow to make sure their kids are protected.
4. Make sure the segment is timely: Pitch backpack segments just before back to school time; pitch segments about the importance of flu vaccines in the fall when they hit doctors offices; pitch fireworks safety just before July 4th.
5. Pitch when the pitch will be best received: Do not send your pitch to a producer while the show is live on the air, or during the hour it tapes-it will only get buried in his/her inbox. Try to find out the producer’s schedule. For example, the CBS Saturday Early Show's medical producer is off Mondays. Each week early Tuesday morning, I scan the health news headlines and send him a pitch before 10 am. He usually emails back feedback within the hour. Catching a producer at the right time can make all of the difference.

And lastly, don't be shy about pitching. Remember, producers cannot come up with all of the segments on their own. They rely on experts to present them with great ideas.

Violence In The Media - A Topic To Include in The Well-Child-Care Visit?

By Corinn Cross MD, FAAP

In the new movie Kick-Ass, the 11 year-old heroine both doles out and is the recipient of heinous acts of violence. This violent comic book inspired movie comes on the heels of two horrendous incidences of real violence meted out on children by children. There was the shocking story of Michael Brewer burned alive by his classmates and now of middle schooler Josie Lou Ratley who was kicked repeatedly in the head by a boy wearing a steeled-toe boot.

Media, through TV, movies, music, video games and the Internet, is having an increasingly larger impact on children, while at the same time, society's standards as to what is appropriate for mainstream marketing both toward children and adults seems to be becoming more and more lenient. One has to wonder with the release of increasingly violent video games and movies along with a relaxation of television standards, "Are our children becoming immune to violence and what are the consequences?"

Twenty years ago, it was fairly easy for parents to limit exposure to violence. There was no Internet, TV sitcoms were held to a much more stringent standard, and video games consisted of Pac-Man, Donkey Kong and Super Mario Brothers. Duck Hunt was as violent as it got.

But the children of that generation are now parents in a media laden world. The parenting techniques and guidelines they were subject to as youngsters are insufficient for raising their own children in this media saturated society. Today's parents have no past experience or tried and true advice to draw upon in these rapidly changing times.

As pediatricians, we are the champions of preventative guidance and parental education. Assessing the level of violence our patients are exposed to and its effect on them as well as helping parents set appropriate limits, is a useful service that we can and should provide at our well-child-care visits.

The best way to approach this topic may be to start when children are very young before media influence has even become an issue. We often discuss limiting young children's exposure to television with our patient's parents. In these early conversations, we can start to convey the message that the content of the television that a child watches is just as important as the amount of television.

For school age children, we already discuss Internet use. We advise parents to move computers to common rooms of the home and monitor their children's use of them. This conversation can also include touching base with parents about age appropriate media exposure.

For the middle schoolers, we start to discuss sex education, bullying, and Internet dangers. Again, this is a very easy segue into sex and violence exposure through all media venues.

For teenagers, a formal HEADSS exam should be done at every well-child-care visit. The HEADSS exam can seamlessly incorporate questions on exposure to violence through media.

With older children, it is also important to assess what effect exposure to media violence may be having on them. This can be evaluated with questions directed at what types of behavior the patient feels is appropriate when he or she is angry.

For most pediatricians, the framework for these conversations already exists within the well-child-care visit. It is simply a matter of becoming aware that this is an increasingly important issue in our patient population and incorporating an age-appropriate discussion consisting of questions, advice and parental resources into these visits.

When Can a Child Use Facebook?

By Bryan Vartabedian, MD FAAP
Assistant Professor of Pediatrics at Texas Children's Hospital/Baylor College of Medicine

This is a question parents are beginning to ask. If they don’t ask their pediatrician, it’s a question they will inevitably ask themselves and their friends. As the prevalence of social media increases, the issue of social media use by teens has become a legitimate concern and one that may not be on the radar of most practicing pediatricians.

Social networking is evolving at an extremely rapid pace. What’s popular today may not be in a year or two. As parents and pediatricians, we need to be less concerned with the particular method of communication and instead focus on instilling basic core values of privacy and personal boundaries in our children and patients. These same values will apply whether a child is using MySpace, Facebook or Twitter, whether they are texting or uploading photos of themselves.

Here are a few things to consider in our dialog with parents surrounding teen social media use:

A parent’s capacity to protect is limited
There are two basic truths that parents and pediatricians need to accept in this new digital age:
• Online social activity is inevitable.
• A parent’s ability to control what teens say and do is limited.

It’s important to recognize that as children get older, our ability to protect them, online or off, is greatly reduced. Digital socialization is not a fad or a gimmick. It represents a generational shift in how we engage one another. To suggest that our patients will grow and develop socially exactly as we did is fantasy. Digital culture is changing that.

Instead of trying to create an environment where online activity can be avoided, we need to help children develop a construct, or framework, for appropriate engagement in this new digital world.

Parents set an example
Perhaps the greatest framework for a child is the behavior of his or her parent. What parents do and how seriously they take their online engagement is noted and potentially adopted by tweens and teens. Modeling may be an important first-step in helping children identify what’s healthy and what isn’t.

Teens are digital and invincible
The trademark of teens is their ability to detach themselves from situations with the belief that they can’t get hurt. This narcissistic grandiosity affects the way teens evaluate risk and makes them more likely to engage in risky behavior. Unfortunately, just as what happens at a party or behind the wheel of a car can cause lasting damage, so too can online behavior.

Online engagement creates a trail that we call one’s digital footprint. This trail can follow teens into the college admission process and even into the workforce influencing how potential employers view them in their quest for jobs.

Parental monitoring of a child’s public ‘brand’ is evolving as a new responsibility in 2010. Parents can begin by impressing upon their children the emphasis that a digital footprint can have on their future. Although teens do view themselves as invincible, starting around 16 years of age they are also very concerned with the concept of a reputation and personal image. Once teens become aware of how online behavior can affect that image for years to come, they may be more apt to protect their online reputation.

The responsibility of pediatricians
If as pediatricians we don’t advise parents, they will turn to their own devices and their own networks for advice. Personal networks are part of parenting, but we should not surrender our role as child health advocates in the sphere of social engagement.

Helping parents navigate the territory of online socialization should fall under the responsibility of the pediatrician. Just as parents have to rethink the way they raise children, pediatricians collectively need to rethink anticipatory guidance. Our worldview of how we advise parents needs to evolve.

The Children's Television Act: An Update

By Vandana Y. Bhide, MD, FAAP, FACP
The Children's Television Act (CTA) was passed by Congress in 1990 with the goal of providing educational programming to children that "furthers the positive development of the child in any respect, including the child's cognitive/intellectual or emotional/social needs¹."
Subsequent modifications of the Children’s Television Act required that:

1. Television stations provide a minimum of three hours per week of educational and informational shows targeted to children under the age of 16 during their prime viewing hours of 7 AM to 10 PM. Commercials were limited to 10 minutes an hour on weekends and 12.5 minutes an hour on weekdays.

2. Educational/informational children's shows had to show the "E/I" label on the television screen the entire length of the show.

3. As television transitioned from analog to digital, broadcasters, who can have up to six channels of programming in digital instead of one channel in analog, were required to provide the commensurate amount of children's educational/informational programming.

The FCC is also required to consider whether a television station has served children’s educational needs during the station’s license renewal process. In return for providing such educational programming, broadcast stations were given free access to public airwaves.
So twenty years after the Children’s Television Act was first passed, has it achieved its mission of promoting educational programming for children? Unfortunately, the answer is no.
For example, broadcasters once labeled the The Jetsons educational because it dealt with the futue and The Flintstones informational because it dealt with history. Although the show GI Joe had violent content, it was described by television stations as educational due to its pro-social themes. Networks also labeled Leave it to Beaver as educational because it had pro-social messages.
Children Now, a nonpartisan children’s research and advocacy organization, evaluated educational shows broadcast by the four major networks from 1997-2008. Children’s Now determined that in 2007-2008, only 13 % of programming described by networks as educational and informational was determined to be of high educational quality. 63 % of shows were found to have moderate quality and 23 % minimal quality.
Health and nutrition messages, especially those that addressed childhood obesity prevention, were "extremely rare." ² The report concluded that current television programming does not meet the original intentions of the Children's Television Act.
The Senate Commerce, Science and Transportation Committee concurs. On July 22, 2009, Senator Jay Rockefeller, D-W.Va., Chairman of the committee, convened a hearing called "Rethinking the Children's Television Act for a Digital Media Age." The Senator said he planned to introduce legislation to regulate children's media content, citing his "grave concerns about violence and indecency in the media."
Clearly the Children’s Television Act has failed to increase educational children’s programming in a meaningful way. Even more discouraging is the fact that there have been a number of lawsuits filed by broadcasters in federal courts as well as before the FCC in an attempt to avoid their obligations to provide educational programming as stations convert from analog to digital.
What can pediatricians do to help parents when typically only three hours per week of television programming on a particular station is educational?
First, we can talk to our patients and parents about the educational programming requirements of the act, and what the “E/I” symbol means. Encourage parents to watch programs with their children to evaluate the educational value. Parents and pediatricians can notify the FCC about programming that lacks educational quality.
The FCC is generally responsive to parents who object to programming. For example, in 2007, the FCC entered into a consent decree with Univision to resolve petitions by children's and media organizations to deny the broadcaster's license renewal applications. It was alleged that Univision's children's programming did not comply with the educational requirements of the CTA. Univision voluntarily paid $24 million and developed a plan to comply with the rules of the Children's Television Act.
It is clear that most broadcasters adhere only to the minimum educational programming requirements of the Children’s Television Act. Therefore, the only way to encourage more educational television programming is to encourage the FCC and Senator Rockefeller’s committee to increase E/I programming requirements that stations must provide in order to continue to access the public airwaves for free.
References:
1. "Policies and Rules Concerning Children's Television Programming Memorandum Opinion and Order," Federal Communications Commission Record 6,(1991): p.2114.
2. Executive Summary: Educationally/Insufficient? An Analysis of the Availability & Educational Quality of Children's E/I Programming. Children Now. Htttp://www.childrennow.org/eireport.

Why Pediatricians Need to Discuss Texting and Driving In Our Offices

By John Moore, MD, FAAP

As part of my daily commute from my home to my office and back, I spend about thirty minutes per day driving on Interstate 81 through central Virginia. That commute has allowed me the fascinating and frightening opportunity to observe first-hand the recklessness and aggression of the modern American driver. Over the last seven years, I have seen drivers of cars, trucks, motorcycles, and vans doing almost everything imaginable except paying attention to the road. I have witnessed people been drinking coffee, scolding their children, applying makeup, and even flossing their teeth.

While hard data on the numbers of drivers texting or surfing while driving are not available, anecdotal and observational studies are very concerning. A recent survey by Nationwide Insurance estimated that twenty percent of drivers either send or receive text messages while driving. That number of people who drive while texting reaches a staggering sixty-six percent when limited to 18-24 year-olds.

The exact impact of texting on automobile safety is impossible to gauge. No reliable data exists to associate texting, distracted driving and accidents. However, anecdotal data continued to accumulate and the potential impact may be staggering. Several recent, dramatic deadly crashes in New York and Florida have been associated with drivers sending and receiving text messages.

Fourteen states, including Virginia, New Jersey, and Washington DC, have taken action to address that issue. In July of this year, police in Virginia began fining drivers caught texting while driving. The penalty for those caught is only $20-$50, but the psychological impact may be more profound. Hopefully, the new legislation in Virginia and other states will make motorists think about their messages and exactly how important that text really is.

As pediatricians, we are faced with the task of helping our patients navigate the complex path from childhood to adulthood as smoothly as possible. We know that teens are at significantly increased risk of automobile accidents. In addition, teens are the quickest adaptors of new, exciting, and dangerous technology. In the case of texting and driving, that combination has proven to be deadly in several well-documented cases. If we can get one teen to ignore their phone and concentrate on the road a little closer, we have made immeasurable difference in their lives. In my opinion, the ability to make huge differences in lives is why we all became pediatricians in the first place.

When Patients Google for Medical Advice

By Jennifer Shu, MD FAAP

If you’ve been practicing in the 21^st century, I’m willing to bet you’ve had patients come into your office armed with the latest “research” they’ve found on the Internet about condition X and either want to know what you think or demand the treatment recommended on the Web. I can’t say that I blame them for trying—after all, the Internet is open 24/7 and is often easier to access than the doctor’s office or nurse advice line. Since the Internet is here to stay, I believe physicians would do well to embrace this relatively new influence on our patients’ health literacy and channel our energy into helping them find the most accurate and reliable information out there.

I had the opportunity to present my views on finding credible healthcare information online at the BlogHer 2009 conference, a meeting of women (and some men) bloggers all over the country who make a living or hobby out of sharing their thoughts with online readers. As a member of a panel of experts moderated by our own Dr. Gwenn O’Keeffe, we had an audience outside of the usual realm of conferences geared toward medical professionals. I hope that by providing Googling-guidance to bloggers seeking health information, this information will then trickle down to their readers, who likely include healthcare consumers such as our patients’ parents.

I’m including some of the tips we provided and hope you’ll share your ideas too:

Look for .gov sites. Governmental sources are credible and reliable. Some great resources are http://medlineplus.gov and http://www.cdc.gov.

Visit medical organization pages. Professional associations such as the American Academy of Pediatrics www.aap.org offer accurate information. Also, consider www.medem.com (which contains a collection of information from multiple medical societies). The American Medical Association www.ama-assn.org and your state or local medical society may also provide helpful resources.

Check into a hospital site. One site with extensive information is http://www.mayoclinic.com/ but many hospitals offer credible web resources. You may wish to check out a local medical center’s site first.

See sites devoted to health information. Some examples are http://kidshealth.org/ (which has information targeted to kids and teens as well as to parents) and www.uptodate.com.

Strength in numbers. If several web sites give the same medical information, there’s an increased chance that it’s credible. Also check that there are multiple physician reviewers and that the information has been verified for accuracy recently.

Consider the source. Before getting too concerned about something you read online, consider who authors the site. Some organizations and individuals can look official but may not really provide trustworthy information.

Talk to your doctor. Your doctor should be your sounding board when it comes to making sense of online medical information. If you have questions about something you’ve read, be sure to ask your pediatrician, who can put the information into the context of your own child’s health. Better yet, ask your doctor for recommendations for favorite health web sites so you can go straight to a reliable source.