Introduction

This website has a big purpose.

It is to「reduce the number of pediatric emergency patient visits」.

There may be some who question this purpose. There is a perspective from parents that, "When my child gets sick, I want to be able to receive appropriate diagnosis and treatment at any hospital at anytime".

However, pediatric emergency care is currently in a difficult situation, and it would be greatly appreciated if we can gain the understanding and cooperation of parents as soon as possible.

First of all, please let us share with you the current situation. Then, we would like to ask you to think about how you can contribute to improving the situation.

Current Status of Pediatric Emergency Care

(1) Increasing number of visitors at night and holidays

The number of children has been decreasing year after year due to declines in birthrate. As a result, we would expect to see a similar decline in the number of hospital visits by children, but that is not the case. Although the total number of hospital visits of young children has remained stable (Figure 1), we see a steady climb in the number of visits taking place during off hours including nights and holidays (Figure 2).

This is thought to be influenced by the nuclear family structure and the declining birthrate. In the past, through sharing information with others nearby who have child-rearing experience and the experience of having a second or third child, it was common to judge how to handle slight changes in physical condition at home. In fact, in reality more than 90% of pediatric emergency patients are only mildly ill, with many being okay even without a medical visit. In the past, it may have been more common to consult someone and monitor the child at home. In addition, the changing social structure has led to increases in the number of parents in the workforce. Work obligations during the day have created challenges for parents to utilize regular outpatient mechanisms making after hour visits unavoidable, and in effect contributing to the increases in the number of hospital visits at night and on holidays.

(2) Decreasing number of pediatrics departments

Careful management is necessary in order to continue hospital operations.
Under such circumstances, pediatrics is not profitable in the current medical fee system, putting pressure on management and leading to an increasing number of hospitals to remove the pediatrics department.

(3) Reduction in willing candidates in pediatrics

There is no change in the total number of doctors, but the number of pediatricians is decreasing. This is because relatively few, graduating from medical school who took the national examination and joined the pool of young doctors, choose to pursue pediatrics. In addition, since the current hard-working pediatricians will continue to age and will eventually leave the workforce, securing enough doctors in pediatrics will surely become a problem in the future.

(4) Pediatricians in harsh situations

Although related to (3) above, if there are few pediatricians, the burden on each individual will inevitably be large. Looking specifically at working hours (Figure 3), the median hours of overtime in one month for those in their 20’s is about 110 hours (!), about 80 hours for those in their 30s, and about 70 hours for those in their 40s. The reason for these long hours is that additional night work (on duty) may be necessary, and then it is common to continue into normal work hours from the next morning.

How do pediatricians feel about their harsh situation where they are not able take a relaxing break and are required to work while tired? According to a survey conducted by the Osaka Pediatric Emergency Medical Institutions Collaborative Meeting, responses included various problems and feelings of anxiety such as, “anxiety about physical fitness and health”, “regular work is impacted by night duty”, “decrease in leisure time and holidays”, and “anxiety about medical accidents”. Furthermore, 70% of pediatricians felt that they have reached their “limit” and “very tired”. Some pediatricians have actually died of overwork.

What the medical side can do…and…What the patient side can do

As mentioned above, pediatric emergency medicine is facing difficult circumstances. However, as one measure to address the declines in birthrate, the government is actively pursuing important policy initiatives focused around improving pediatric medical care. As a way to assist in this reform process, the Japan Pediatric Society has established the “Japan Pediatric Society Pediatric Medical Reform・Emergency Project Team”. For example, to address the several issues raised above, a proposal for a “Regional Pediatric Center” was submitted for (2), an education / training system for nurturing young pediatricians was established for (3), efforts to improve working environment has been initiated for (4), etc. But unfortunately, these types of changes to social structures take time and cannot be adjusted overnight.

That is why we would like to ask parents to do what they can as soon as possible. In order to help resolve (1), we would like to make this request to parents.

Play and interact with your kids as much as possible.

Family members who spend a lot of time together should understand their children better than doctors. Based on the information you have accumulated up to now related to your child's growth, please make an appropriate decision by taking note of small changes and also comparing it with past situations. Please care for your child by making decisions such as, “My kid has a fever, but seems fine, so I can go to the clinic tomorrow” or “My kid’s situation seems different from other times, so let ’s go to the hospital.”

If you are unsure of your decision, please use this website. Based on your child's various symptoms, this website can help you decide whether to visit a hospital during off hours or to continue to monitor your child at home. Resolving (1) also leads to eliminating (4). This is because the burden on pediatricians is reduced if the frequency of unnecessary pediatric emergency visits is reduced. Also, it will help to reduce the chances of medical accidents. Of course, do not hesitate to visit the hospital when you need help from a doctor. Each doctor will do their best to address your child's illness and to relieve family concerns.