We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Otitis Media, Shared Decision Making, and Enhancing Value in Pediatric Practice

Stephen Berman, MD
Arch Pediatr Adolesc Med. 2008;162(2):186-188. doi:10.1001/archpediatrics.2007.19.
Text Size: A A A
Published online


How can we improve performance in pediatric practice? How can we identify situations in which we can enhance quality while reducing costs to maximize the value of our services? How can we best refocus care processes to be more efficient and patient centered? The answers to these questions will be critical to the redesign of 21st-century pediatric practice. However, the answers are likely to emerge from a series of small steps that together form a larger roadmap. These small steps will have a common theme: ways of better educating and empowering parents through shared decision making. Just as the pharmaceutical companies have shifted much of their attention to direct consumer marketing from physician marketing, we must rebalance our approach and shift more of our attention from physician guidelines to parent education and shared decision making. Targeting ear pain and acute otitis media (AOM) for this shift in emphasis seems reasonable because this condition is such a frequent cause of pediatric visits during early childhood and so often results in an antibiotic prescription. We can enhance quality by reducing excessive antibiotic use that contributes to rising rates of bacterial antibiotic resistance in the community. More judicious antibiotic use may also reduce the frequency of AOM episodes as studies suggest that antibiotic treatment alters nasopharyngeal colonization that predisposes to an earlier subsequent episode.1,2 We can also reduce costs by avoiding unnecessary visits for ear pain and otitis to primary care offices during normal hours and to emergency departments and urgent care centers after hours. These visits are very common and are the largest component of well over $5 billion spent annually on otitis media.3 Children between the ages of 1 and 3 years account for more than 40% of otitis-related expenditures in children younger than 14 years.3

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Otitis Media, Child

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Otitis Media, Child