Needlman R.Department of Pediatrics, Case Western Reserve University, MetroHealth MedicalCenter, Cleveland, Ohio, USA. robert.needlman@case.edu
Primary care clinicians confront a long list of topics that are supposed to becovered during well-child visits, but evidence for the effectiveness ofpreventive counseling for most issues is limited, and it is doubtful thatcovering more topics confers correspondingly enhanced clinical benefits. Amidgrowing professional interest in rethinking primary care, 3 ideas that wouldfacilitate constructive change are proposed. First, face-to-face time betweendoctors and parents should be allocated as a scarce resource, with prioritygiven to topics that are both important and uniquely responsive to in-officeintervention. Second, to maximize the educational value of anticipatoryguidance, visits could focus on experiential, as opposed to merely didactic,learning. Finally, recommendations for primary care should be based on evidence,rather than expert opinion. Competing protocols for preventive care ought to besubjected to large-scale, coordinated research. The unit of analysis should bethe visit or series of visits, rather than a single intervention. A crucialfirst step would be the definition of universal outcome measures.
