A look back at the future of pediatric care

Working with pediatric residents and medical students to care for patients provides many opportunities to recognize, and be grateful for, progress. Some patient discussions I recently had highlight improvements in medical care that, in the absence of historical perspective (in other words, if you haven't been around for a long time) would be easy to take for granted:

There's another sign of progress revealed in the care of this infant: Pneumococcal empyema in a fully immunized 10-month-old is unusual enough that we are typing the causative bacteria. If the typed strain is included in the conjugated pneumococcal vaccine, we'll want to test her immune system.

Appreciation of progress requires a longitudinal perspective that residents and medical students lack. For them, these patients are examples of challenges ahead, rather than successes of the past. They wonder why we can't prevent, or develop better methods of treating, E coli meningitis, HIV infection, and pneumococcal pneumonia, and they are frustrated by waiting 24 hours for a blood culture to turn positive. While I'm marveling at the progress that's been made, they're chafing at the limitations of the present. The perspective of experience might be interesting, but we should be grateful that they want more.