title: 2011 Joseph W. St Geme Jr lecture: five things I'd like to see changed in American pediatrics, five lessons I've learned.
abstract: OBJECTIVE
  In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and chronically ill patients, development of empathy, and restoration of responsibility that may help ameliorate this serious problem. Toward this end, I also offer 1 approach, a 24/7 telephone consultation network, for enriching interaction of primary care providers (PCPs) and subspecialists who can potentially provide rapid access to needed advice, reduce demand for subspecialty appointments, bolster decision-making and expertise, and realign resources with need.
  
  
  METHODS
  Data were obtained from 579 requests by PCPs for telephone consultation by subspecialists in 8 areas (including child psychiatry).
  
  
  RESULTS
  Of calls, 27% took <5 minutes and 79% took 5 to 15 minutes. Of calls, 28% resulted in a clinic visit; 8% prompted hospital transfer, hospital admission, or referral to an emergency department; and the remaining 64% resulted in continued management by PCP with reinforcement of the plan. Assuming most inquiries would have resulted in referral to a subspecialist were there no telephone consultation, we estimated that 70% (8+64%) of consultations realigned resources with need, resulting in large saving of unnecessary clinic visits, travel, expense to families, lost days at work, or missed school.
  
  
  CONCLUSIONS
  Development of rapid telephone consultation networks could provide increased access to care for those children in greatest need, use limited resources more efficiently, foster collegial and productive relationships between medical providers, and increase expertise of PCPs and subspecialists.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX 75390-9063, USA. george.lister@utsouthwestern.edu
authors.forename: George
authors.initials: G
authors.lastname: Lister
mesh_terms: D002648:Child; D002908:Chronic Disease / Q000628:therapy; D002983:Clinical Competence; D003299:Cooperative Behavior; D003479:Curriculum / Q000639:trends; D003661:Decision Support Techniques; D004503:Education, Medical, Graduate / Q000639:trends*; D006297:Health Services Accessibility / Q000639:trends; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education* / Q000639:trends*; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011340:Problem Solving; D019114:Remote Consultation / Q000639:trends; D013038:Specialization / Q000639:trends; D014481:United States