Paed-Iconoclasm: Breaking the Myths without Breaking Your Patient - Tim Horeczko

Myths persist because they are essential to the human experience and our development as a society. They fill the gap between what we know and what we think we know. Where does this gap hurt us the most? In our vulnerable populations, for example, in our care of children. The “myth incarnate” in medicine: defective dogma. Not all dogma is bad – after all, dogma means “that which is believed universally to be true”. The problem with medical dogma is that our critical thought processes are curtailed by wholesale acceptance. Medical dogma is a special kind of myth, because it’s difficult to define. We repeat defective dogma for three reasons: “It is known”. Sometimes the dogma is all that is known on the subject, or it is simply the majority consensus. Be careful with this one – because there may be a reason for this specific teaching – not all dogma is bad. Dogma is sentimental. We learned from our teachers who learned from their teachers. We want to honor those who taught us, and we get attached to some ideas. Sometimes – even subconsciously – we allow our attachment to an idea to give it more credence than it deserves. The third driver of dogma is insecurity. “I know what I know”. In other words, “don’t make me reveal my limitations.” Myth: “They’re all fine” Remedy: Remember to look for the subtleties in children. Early warning signs are there, in the history or in the physical exam. If it doesn’t add up, investigate. Myth: “Only pediatricians are experts” Remedy: Don’t delegate decisions. You can do this. You sometimes are the only one that can. Myth: “I will break them” Remedy: Children are not another species. Use all of your skills for all of your patients” Powered by #FOAMed – Tim Horeczko, MD, MSCR, FACEP, FAAP