Procedures in pediatric primary care: first do no harm

Gary L. Freed

Two important considerations arise from this IJHPR article from Zimmerman and colleagues. First, is the question regarding what can be considered a "common" procedure in primary care and whether the designation can or should change over time. The second issue is whether it is enough for a doctor to feel comfortable doing a procedure for it to be within their scope of practice, or whether the practice specific outcome for the procedure in terms of safety and efficacy is a more relevant determination of whether the procedure should be performed in a given setting. In other words, just because a doctor "can" or "wants" to do a procedure, may not mean they "should" do a procedure. The role of procedures in a practice of primary care also differs markedly in the care of children vs. the care of adults. This phenomenon is partially the result of the more challenging aspects of the care of infants and small children with regard to the ability to maintain a sterile field for procedures, and the relative infrequency with which procedures are performed on children relative to adults. The scope of practice for pediatricians in the community has changed over time and is likely to continue to change. This paper helps to define the current state of practice for paediatricians with regard to the conduct of 10 specific procedures. It challenges us to think about the appropriateness of the venue of care and its implications for both the status quo and the future of community based primary care.