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Arch Pediatr Adolesc Med. 2003;157:1033.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The article by Forrest et al,¹ and the commentary by Ferris,² do not mention the main reason for the disparity in subspecialty consultations. The reason is a shift in the training philosophy of the pediatric resident. Years ago, pediatric house officers were taught: "You will be a specialist in the care of children." Today's pediatric resident, however, receives a different, double message: "You will be a specialist in the care of children but you will not be good enough to care for complex problems in infectious disease, neurology, cardiology, gastroenterology, developmental medicine, and so on. Complicated (interesting) patients must be referred for diagnosis and care to the pertinent subspecialist."

This mantra does little for the self-image of the general pediatric resident. Ask today's house officer for a treatment plan for a child with any complicated problem, and the response is: "We need a (subspecialty) consult." This philosophy carries over into . . . [Full Text of this Article]

Horst D. Weinberg, MD
7 Debra Ct
Scotch Plains, NJ 07076

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Pediatric Referral Patterns—Reply
Christopher B. Forrest, Azeem Majeed, Jonathan Weiner, and Andrew Bindman
Arch Pediatr Adolesc Med. 2003;157(10):1033-1034.
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