November 13, 2013
George Dover, M.D. Director,
Johns Hopkins Children’s Center
Given Professor of Pediatrics
A recent TED talk by physician writer Abraham Verghese reminds us in this era of modern medicine that much of the art of medicine is still in the hands. He makes the case that when we shortcut the physical exam and lean toward ordering tests, we not only overlook simple diagnoses that can be made at an early, treatable stage but also risk losing a ritual at the heart of the patient-physician relationship— in his words “the power of the human hands, to touch, to comfort, to diagnose.”
Our cover interview with long-time community pediatrician Will Standiford also reminds me of the power of palpation and percussion in diagnosis—and how so much of what pediatricians used to do regularly has been succeeded by developments in imaging, among other advances. We’re grateful for innovations, some of which come to us daily and serendipitously—like pediatric dermatologists Bernard Cohen and Kate Puttgen’s research of the hypertension drug propranolol as a swift remedy for severe infantile hemangiomas. Another surprise is pediatric gastroenterologists Maria Oliva-Hemker and Suchitra Hourigan’s fecal transplant clinic for patients infected with the drug-resistant bacterium C. difficile. Who would have thought?
We do have to wonder what else will come our way. Interestingly, we are moving from a field focused on detection of existing disease to one focused on diagnosis of disease before it becomes apparent. In the process we may prevent the onset of complex and common adult disorders. The genetic code is only part of the puzzle— how the genome reacts to the environment is another. What about proteomics? Will we be increasingly identifying biomarkers as sources for early detection of disease? We can’t help but wonder at such possibilities— we also can’t help but feel grounded by the Will Standifords who personify the simple transcendent truth of pediatric practice. As he concluded, “I enjoyed working with kids—I still do.” Now, that’s a nice touch.