Discussing Illness at Well-Child Care Visits

The recent article by Van Cleave et al¹ and the subsequent commentary by Schor² describe the collision of competing agendas of busy pediatricians and worried parents everywhere. With the growing list of recommended screening tools, developmental assessments, and preventive care guidelines and the documentation requirements imposed by pay-for-performance measures, it is understandable that pediatricians might balk at adding chronic-disease management to the annual checkup task list. The evidence for enhanced screening with validated tools in a systematic fashion is strong³ and Bright Futures is a multifaceted approach to this that is advocated by the American Academy of Pediatrics (http://brightfutures.aap.org/web/). Unfortunately, Schor's literature review indicates that pediatricians do a poor job of addressing parental concerns and struggle with covering the recommended preventive care topics at the well-child care visit. The study by Van Cleave et al reminds us that, in the eyes of the parents, concerns over an existing or possible illness may be more important than screening for disability and health promotion.