“How Much Is a Child Worth?”

Patients face dilemmas of how much to pay for these technologies—how much a child is worth. Countries range widely in their laws and regulations concerning insurance coverage but generally have restraints. Prospective parents commonly draw on present or future savings or income they might otherwise dedicate to graduate school or other long-term goals. Yet uncertainties can persist about how long treatment will take. Medical, financial, and legal stresses mount regarding both the total costs and the eventual extent of insurance coverage. Physicians cannot wholly foresee the kind or amount of necessary treatment, frustrating patients. Critics have also argued that many clinics are too “entrepreneurial” and profit-oriented, raising additional ethical and policy questions.

Struggling with the last breath: breathlessness at the end of life on the AMU

Breathlessness is one of the most common symptoms experienced at the end of life, affecting all areas of a patient’s life. It is frightening and leads to high rates of emergency hospital attendances. Often, there is no easily reversible cause and patients are admitted to the acute medical unit (AMU) in order to manage their symptoms with little overall benefit – frustrating patients and clinicians alike. This review reminds the generalist of the significance of breathlessness as a symptom. It highlights the management strategies available to effect improvement and gives practical tips on how this can be achieved within the busy and time-pressured environment of the AMU.

Eating Disorders in Adolescence

Eating disorders challenge the pediatrician in several ways. The treatment course can be long, and the patient's response may be frustrating. Patients find it hard to trust professionals (as they find it hard to trust themselves) and present their situation in provocative terms (eg, "I know what I need to eat; the only problem is that my parents are giving me a hard time.") that ignore the cultural, familial, developmental, and physiological roots of the disorders and minimize the patient's own confusion. The impression projected by the patient that she is "in control" can make it hard to view her sympathetically. Being "in control" of an emaciated body or of chaotic eating is part of the problem. Unpleasant feelings, such as shame, blame, frustration, inadequacy, rage, and guilt, are felt routinely by patients, parents, and professionals. The risk of serious injury or death is great. The differential diagnosis includes many other serious disorders first presenting in adolescence. For all these reasons, the eating disorders are an important part of pediatric practice, and the pediatrician monitoring the patient's physical well-being and overall development is an indispensable part of the team. The eating disorders are "model" disorders, whose management requires understanding the physical, physiological, psychological, familial, and cultural dimensions of a teenager's life.