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Two Who Remember That First Issue

2019; American Academy of Pediatrics; Volume: 40; Issue: Supplement_1 Linguagem: Inglês

10.1542/pir.2019-40s03

1529-7233

Lawrence F. Nazarian,

Medical Research and Practices

When I was a resident, a common practice was to create a reprint collection. If a particular article was clear and interesting, and if it focused on situations I was likely to encounter in the years to come, I would obtain a reprint and file it in a collection of folders grouped and identified as addressing a particular organ or disease.A common way to obtain a specific article was to send a postcard to the author requesting that a reprint be mailed to me. Later, when I became an author, I realized that authors traditionally assumed the responsibility of mailing the reprints (which often could be bought from the journal at the time of publication) and paying any costs involved. This system has disappeared with the arrival of duplicating machines and computers.As the physician moved from one place to another, the reprint file came along, at some point requiring a filing cabinet to accommodate the folders stuffed into the cabinet. But there were problems in this system, including the fact that most papers addressed a specific aspect of a particular disorder, requiring the physician to amalgamate the information from many papers into a logical whole; the acquisition was done in a somewhat random way; over time, all of the articles became outdated; and a particular paper would be consulted rarely, if at all, by the busy clinician, leading to the creation of a “history of medicine” file over the years. Textbooks gave a much more coordinated and complete picture but were costly and became outdated in a relatively short time.Simultaneously, the explosion of electronic tools brought to the clinician a much more effective and efficient system of continuing medical education. Especially if one has privileges at an affiliated medical library, articles could be found and brought up on the home computer and selected in the wide context of a specific topic. There is a limitless reprint file out there in the ether that does not require an explanation to the spouse about why we have to lug that bulky filing cabinet from home to home.To make the task of education much more valuable and efficient, along came Pediatrics in Review 40 years ago. Dr Robert Haggerty had been chief of pediatrics at the University of Rochester during my residency, and I should have been able to predict that he would bring fresh ideas on how pediatricians could stay up to date with the latest thinking and research in the field. After all, he was the one who predicted that the “new morbidity,” in which psychosocial disorders would be taking more of our attention, would evolve. He also made it clear that involvement in the community was a necessary and fulfilling pursuit for pediatricians. His concept of an ongoing journal of review articles aimed at the practitioner would add a significant element to the clinician’s ongoing learning process. Not only would the generalist welcome such a tool, but the specialist who wanted to stay current with the whole of pediatrics would use it as well.So, when the first issue of this new journal was published, I wrote a letter to Dr Haggerty telling him what a gift he had given, especially to practitioners, and that it would receive widespread use and improve the quality of practice immensely. That prediction, although not as prescient as defining the new morbidity, has turned out to be true. I did not, however, predict that I would someday have the privilege of being the editor-in-chief of the journal.To replace the randomness that sometimes accomplishes our acquisition of knowledge, the choice of topics for the journal occurs on a cyclical basis so that everything is covered in a specified period of time. Cooperation with the American Board of Pediatrics has enabled the editors to find out the information considered important in every area of pediatrics, as determined by task forces of specialists. The material in the journal has been augmented and supplemented by the PREP® (Pediatrics Review and Education Program; American Academy of Pediatrics, Itasca, IL) questions, a most valuable companion to the journal that together with the journal forms PREP® the Curriculum.When I was editor-in-chief of the journal, I would daydream about how many pediatricians and especially how many children would benefit from what we were doing. Today, with a large readership and an international perspective, I have to think that the number of children around the world who have enjoyed better health in the past 40 years because of Pediatrics in Review numbers in the millions. Gratitude is owed to the authors, editors, production staff, and publishers; to the American Academy of Pediatrics; and especially to Dr Haggerty, the progenitor of PREP® and my role model, mentor, and friend.David Tayloe, Jr, MD††Community pediatrician, founder of Goldsboro Pediatrics PA, Goldsboro, NC; former president of the NC chapter of the AAP and the national AAP; AAP delegate to the AMA; and chair of the AMA Council on LegislationI can truthfully say that I have read every Pediatrics in Review and completed every CME quiz since 1979 and have likewise completed every PREP® Self-Assessment, including reading all the commentaries. I tell all my pediatrician, nurse practitioner, and physician assistant colleagues that PREP® is the best thing I do, year in and year out, for continuing education.I met Dr Haggerty in 1973 when I was interviewing for pediatric residency positions. I visited 13 children’s hospitals in the northeast, having decided to leave my comfortable southern setting for a “big city” academic pediatric experience. Strong Memorial Hospital in Rochester, New York, proved to be the only pediatric residency program where the chairman of the department of pediatrics gave the applicants a personal tour of the local health-care system. Dr Haggerty drove me all over Rochester in his personal car. He made it very clear to me that his residency program was integrated with the larger community and that the health of his patients depended on a collaboration involving multiple health and human services professionals and organizations. He presented the medical home concept to me, although I was, at that formative time in my medical career, clueless as to what he was really saying to me! My wife pretty much refused to live in a cold place like Rochester, so I did not follow through with what might have been my best opportunity to become a really complete pediatrician!As I reflect on what has happened in my career and think back on Dr Haggerty’s extremely visionary approach to pediatrics, I realize that I have tried to re-create Dr Haggerty’s Rochester in my medium-sized semirural community in eastern North Carolina. Our practice grew from my solo rental office behind the local health department in 1977 to a 4-office, 6-school–based health center, 30-provider system of care that provides comprehensive health services for thousands of children living in a 7-county region of rural eastern North Carolina. We provide hospital pediatric and neonatology services for our 200-bed community hospital, where more than 1,500 babies are born each year. Our practice provides leadership for a countywide early literacy initiative as well as for a school-based/linked mental health network supporting at-risk children and adolescents. The practice is carefully integrated with a variety of health and human services professionals and organizations.I expect that Dr Haggerty knew, before he died, that many of us have tried to emulate his model medical home during our careers. Thanks for the opportunity to pay tribute to such an incredible pediatrician!