November 11, 2015

Screens in a Pediatric Office

Paul Smolen MD FAAP
Carolinas Medical Center, Charlotte NC
 Author of Can Doesn't Mean Should-Essential Knowledge for 21st Century Parents

Every practicing pediatrician struggles daily with a growing tension in American medicine. This tension is between the emerging prominence of consumer driven data (such as patient satisfaction surveys, insurance company ratings, and online ratings of patient loyalty) and national expert panel guideline measures of quality and positive health outcomes. Unfortunately, what often makes parents happy with their visit to their pediatrician is not always what makes their children healthier. For example, patient satisfaction begins in the waiting room, and pediatric waiting rooms are usually outfitted with screens, media, and marketing messages.

 In today’s world, scoring well on patient satisfaction surveys and practicing good pediatric medicine are occasionally at odds with one another.  My practice began making patient satisfaction surveys public and searchable to parents in October 2015, presumably to enable prospective patients to compare one pediatrician in my community with another. The assumption is that parents who are happy with their child’s pediatrician have good pediatricians.

The converse assumption is that pediatricians are only good when they make their patients’ families happy.  By this logic, I should prescribe antibiotics for a child who may not need them if her family wishes, or hesitate to describe a child as overweight rather than just a little plump for fear of offending his parent, or provide a flat screen TV with commercial programming in my waiting room if that is what my patients want. In the future, my ability to stay economically viable may be contingent on whether most parents who visit my office have a “pleasant experience” or “get a good vibe” as many parenting magazines suggest is a way of judging an unfamiliar pediatric practice. (1)

Pediatric waiting room screen exposure creates tension between patient satisfaction and expert panel guidelines because time spent in a waiting area is part of the pediatric visit.  Parents have come to expect a media experience that likely makes their child’s pediatric visit easier but is contrary to expert guidelines that direct pediatricians to discourage screen time for children under two years of age (2), to limit entertainment screen time in older children, and to strongly promote reading to children. (3) Many pediatric waiting rooms ignore these guidelines and provide what patients want - screens.  Recently, I surveyed many pediatric practices in my community and found that all but one continuously showed child programming with commercials in their waiting areas, regardless of the ages of the patients or reasons for the visits.

    Arguably, television with child-centered programming improves patient satisfaction and may even reduce stress and anxiety for children during a visit.  A recent study demonstrated that an iPad is more effective at reducing anxiety in a child than a dose of Versed! (4). Will the pediatric practices that thrive in the future be the ones with the biggest flat screens showing the most recent Disney blockbuster in their waiting rooms? If the trend toward patient satisfaction is any indicator, the Disney Corporation has nothing to fear.

Maybe in the era of portable screens and streaming of any content, anywhere, anytime, the best solution for waiting room satisfaction is to encourage parents to bring with them whatever will calm and entertain their child - a screen, a toy, a book - and get pediatricians out of the business of entertaining children.  Pediatricians shouldn’t be in the entertainment business anyway.


1. Q: When should I start searching for a pediatrician, and what are the main things I should look for? PARENTS, 2009

2. AAP Policy Statement: Children, Adolescents, and the Media. PEDIATRICS, Volume 132, Number 5, Nov 2013, pp 958-961

3. AAP Policy Statement: Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. PEDIATRICS, Volume 134, Number 2, August 2014, pp 404-409

4. Tablet-based Interactive Distraction (TBID) vs oral midazolam to minimize perioperative anxiety in pediatric patients: a noninferiority randomized trial. PEDIATRIC ANESTHESIA, Volume 24, Issue 12, December 2014, pp 1217-1223

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