Pediatrics by the Book: Pediatricians and Literacy Promotion

Change can come slowly in medical practice—unless of course it comes in a sudden and absolute flurry of discovery, evidence-based recommendations, and new standards of care. But the kind of change that is based on consensus, on slowly dawning realization, or just on revamping ingrained habits can be slow indeed—it has not proved easy, for example, or even doable, to get physicians to expand our role by screening regularly and consistently for maternal depression, home firearm safety, or domestic violence.^1–7 It can sometimes seem that as regularly as we read articles about the need to incorporate undeniably important issues into pediatric primary care, we then read complimentary studies about how problematic it is for us to do so consistently. Most of the issues around which pediatricians are asked to consider expanding their roles are psychosocial or developmental, though all have clear and demonstrable impacts on the health and well-being of children—in other words, most are slightly outside the traditional boundaries of medical responsibility and a physician’s role.^8–10 It is a testament to the flexibility and resilience of the profession that individual pediatricians, research groups, and formally constituted committees of the American Academy of Pediatrics (AAP) are ready to take on the challenges of convincing their colleagues to alter everyday behavior. On the other hand, some of the studies testify to the difficulty of achieving widespread change, even with convincing evidence in an evidence-based climate. Change may come slowly because of inertia and the strength of our established patterns, along with the persistence of the original constraints and imperatives that helped establish those patterns. Sometimes physicians may find it difficult to expand the vision of our role and responsibilities, a vision that already seems so broad and complex and one that already struggles against time …