Childhood disease survivors need comprehensive care

A look at how internists can manage a rising population of patients who, while currently well, might need lifelong follow-up.

Survivors of pediatric diseases are a growing group in the U.S., and will soon make up a larger segment of internists' practices. More than 90% of children with a chronic or disabling health condition are expected to live more than 20 years, and every year more than 500,000 children with special health care needs turn 18. A good history in these patients is particularly important since some treatments, such as chemotherapy early in life, have a profound effect on appropriate care as patients get older. Internists caring for adult survivors of pediatric diseases need to work closely with previous specialists to help build a medical home. Our story offers expert advice on developing a comprehensive care plan for this group of patients.

Online rating sites have proliferated in recent years, allowing people to offer their unvarnished opinions on everything from restaurants to plumbers to, yes, even doctors. Critics of online ratings for physicians argue that the anonymity offered by most sites calls credibility into question, and that doctors often aren't able to challenge negative reviews. But others take a more positive view, saying that rating sites give physicians a chance to get valuable feedback they might not obtain any other way. Regardless, online ratings aren't going away, so physicians will need to learn how to handle them, both the good and the bad.

Elsewhere in this issue, we feature two stories about improving primary care at different ends of the spectrum. The Scholars in Rural Health program at the University of Kansas offers college freshmen and sophomores guaranteed acceptance to medical school and loan forgiveness in exchange for future practice in an underserved area. And read about how one medical practice put in the time and effort to become Rhode Island's first National Committee for Quality Assurance Level 3 patient-centered medical home, emphasizing preventive care and patient-clinician collaboration in the process.

Are you taking steps toward becoming a medical home? We'd love to hear about it. Please send your comments and questions.


Jennifer Kearney-Strouse