doctor

One day at an Idaho hospital, half the newborns Dr. Tom Patterson saw didn’t get the vitamin K shots that have been given to babies for decades to prevent potentially deadly bleeding. On another recent day, more than a quarter didn’t get the shot. Their parents wouldn’t allow it.

“When you look at a child who’s innocent and vulnerable — and a simple intervention that’s been done since 1961 is refused — knowing that baby’s going out into the world is super worrisome to me,” said Patterson, who’s been a pediatrician for nearly three decades.

Doctors across the nation are alarmed that skepticism fueled by rising anti-science sentiment and medical mistrust is increasingly reaching beyond vaccines to other proven, routine preventive care for babies.

A recent study in the Journal of the American Medical Assn., which analyzed more than 5 million births nationwide, found that refusals of vitamin K shots nearly doubled between 2017 and 2024, from 2.9% to 5.2%. Other research suggests that parents who decline vitamin K shots are much more likely to refuse getting their newborns the hepatitis B vaccine and an eye ointment to prevent potentially blinding infections. Rates for that vaccination at birth dropped in recent years, and doctors confirm that more parents are refusing the eye medication.

“I do think these families care deeply about their infants,” said Dr. Kelly Wade, a Philadelphia neonatologist. “But I hear from families that it’s hard to make decisions right now because they’re hearing conflicting information.”

Innumerable social media posts question doctors’ advice on safe and effective measures like vitamin K and eye ointment. And the Trump administration has repeatedly undermined established science. A federal advisory committee whose members were appointed by Health Secretary Robert F. Kennedy Jr. — a leading anti-vaccine activist before joining the administration — voted to end the long-standing recommendation to immunize all babies against hepatitis B right after birth. On Monday a federal judge temporarily blocked all decisions made by the reconfigured committee.

One common thread that ties together anti-vaccine views and growing sentiments against other protective measures for newborns is the fallacy that natural is always better than artificial, said Dr. David Hill, a Seattle pediatrician and researcher.

“Nature will allow 1 in 5 human infants to die in the first year of life,” Hill said, “which is why generations of scientists and doctors have worked to bring that number way, way down.”

Vitamin K’s importance

Babies are born with low levels of vitamin K, leaving them vulnerable because their intestines can’t produce enough until they start eating solid foods at around 6 months old.

“Vitamin K is important for helping the blood clot and preventing dangerous bleeding in babies, like bleeding into the brain,” said Dr. Kristan Scott of the Children’s Hospital of Philadelphia, lead author of the JAMA study.

Before injections became routine, up to about 1 in 60 babies suffered vitamin K deficiency bleeding, which can also affect the gastrointestinal tract. Today the condition is rare, but research shows that newborns who don’t get a vitamin K shot are 81 times more likely to develop severe bleeding than those who do.

Hill has seen what can happen.

“I cared for a toddler whose parents had chosen that risk,” the Seattle doctor said. The child essentially had a stroke as a newborn and wound up with severe developmental delays and ongoing seizures.

At a February meeting of the Idaho chapter of the American Academy of Pediatrics, doctors said they knew of eight deaths from vitamin K deficiency bleeding in the state over the preceding 13 months, said Patterson, who is president of the chapter.

Infections prevented by other newborn measures can also have grave consequences. Erythromycin eye ointment protects against gonorrhea that can be contracted during birth and potentially cause blindness if untreated. The hepatitis B vaccine prevents a disease that can lead to liver failure, liver cancer or cirrhosis.

Even if a pregnant woman is tested for gonorrhea and hepatitis B, no test is perfect, and she may get infected after testing, said Dr. Susan Sirota, a pediatrician in Highland Park, Ill. Either way, she risks passing the infection to her child.

Why are parents refusing routine care?

Parents give many reasons for turning down preventive measures, including fear that they might cause problems and not wanting newborns to feel pain.

“Some will just say they want more of a natural birth philosophy,” said Dr. Steven Abelowitz, founder of Ocean Pediatrics, which has three clinics in Orange County. “Then there’s a ton of misinformation. … There are outside influences, friends, celebrities, nonprofessionals and political agendas.”

Abelowitz practices in an area of the county with about an equal mix of Republicans and Democrats.

“There’s more mistrust from the conservative side, but there’s plenty on the more liberal side as well,” he said, “It’s across-the-board mistrust.”

Social media provides ample fuel, spreading myths and pushing unregulated vitamin K drops that doctors warn babies can’t absorb well.

Doctors in numerous states say parents refusing vitamin K shots often also decline other measures. Sirota, in Illinois, encountered a family that refused a heel stick to monitor glucose for a baby at high risk for having potentially life-threatening low blood sugar.

Care refusals aren’t a new phenomenon. Wade, in Philadelphia, said she’s seen them for 20 years. But until recently, they were rare.

Twelve years ago, Dana Morrison, now a Minnesota doula, declined the vitamin K shot for her newborn son, giving him oral drops instead.

“It came from a space of really wanting to protect the bonding time with my baby,” she said. “I was trying to eliminate more pokes.”

Her daughter’s birth a couple of years later was less straightforward, leaving the infant with a bruised leg. Morrison got the vitamin K shot for her.

Knowing what she does now, Morrison said, she would have gotten it for her son, too.

Efforts to persuade

Doctors hope to change minds, one parent at a time. And that begins with respect.

“If I walk into the room with judgment, we are going to have a really useless conversation,” Hill said. “Every parent I serve wants the best for their children.”

When parents question the need for the vitamin K shot, Dr. Heather Felton tries to address their specific concerns. She explains why it’s given and the risks of not getting it. Most families decide to get it, said Felton, who has seen no uptick in refusals.

“It really helps that you can take that time and really listen and be able to provide some education,” said Felton, a pediatrician at Norton Children’s in Louisville, Ky.

In Idaho, Patterson sometimes finds himself clearing up misconceptions. Some parents will agree to a vitamin K shot when they find out it’s not a vaccine, for example.

These conversations can take time, especially since the parents doctors see in hospitals usually aren’t people they know through their practices.

But doctors are happy to invest that time if it might save babies.

“I end every discussion with parents with this: ‘Please understand at the end of the day, I’m passionate about this because I have the best interest of children in my mind and heart,’” Patterson said. “I understand this is a hot topic, and I don’t want to disrespect anybody. But at the same time, I’m desperately saddened that we’re losing babies for no reason.”

Ungar writes for the Associated Press.

Appearing on BBC Morning Live, Dr Punam Krishan gave exact time people should have cough for before getting it checked

A BBC doctor has said that this week, two patients came to her with a cough, and it turned out to be a disease with no cure. Appearing on BBC Morning Live, Dr Punam Krishan was speaking out about a chronic condition which 1.7 million suffer from – but hundreds of thousands more have without knowing.

And she explained exactly how long people should have a cough for before they get it checked out properly. Host Nick Knowles raised how a viewer had asked about COPD and cures he’d seen online, which claim it can be sorted out in 7-14 days. Because the weather has changed, people are also experiencing hayfever, and symptoms like a lingering cough or wheezing can be easy to dismiss.

Dr Punam said: “Over the last few years, I’ve been seeing more and more patients coming through to me and saying, ‘Look, I’ve seen this on social media or I’ve tried this’ and it has the potential to cause harm as well and there is a lot of misinformation and it can be really hard and you can see why adverts like this can be so appealing if you are somebody who’s living with COPD.

“So, for anyone who doesn’t know what that stands for, it stands for chronic obstructive pulmonary disease. It’s a term that we use to describe lung conditions that really make your breathing difficult. Now, the thing is if you do come across anything online, you’re not sure about it, always go to a trusted medical source.

“So, the NHS website’s a great place to start. Medical experts, speak to your doctor or your pharmacist before trying anything. Unfortunately, when it comes to COPD, it is a progressive lung condition, which means it can worsen over time. So, sadly, there isn’t a cure. Certainly, nothing over 7 to 14 days that’s going to make a difference.”

Dr Punam said the illness is often missed or just put down to ageing. She said: “Around 1.7 million people in the UK are currently living with COPD, but we believe that number is actually a lot higher. And that’s because the symptoms can develop over a long period of time and they tend to develop slowly . So, people tend to dismiss them or put it off to maybe it’s because I’m getting older. Maybe it’s because I’m unfit. COPD tends to be diagnosed when you’re like middle-aged or older adults, but it can affect anybody earlier as well.”

She said smoking is one of the most common causes. The two main problems within COPD are emphysema and chronic bronchitis. She added: “And what’s really happening in the lungs during that is that it causes inflammation. It causes narrowing of the airways. It causes scarring. It affects the tiny air sacs in our lungs whose job it is to transfer oxygen into the bloodstream so that we can breathe properly. So of course, if those are damaged, it really does impact you long term.”

She said people should not ignore coughs – and gave an exact time people should get it checked out. Dr Punam said: “A lot of people do just sit on it and dismiss it. The earlier you get it diagnosed, the better it is because there are lots of things that we can do to support the symptoms.

“So, if you have a new cough that is persisting, I would say the rule of thumb is four to six weeks. If something is persisting beyond that time, it’s not going away. You don’t know why you’ve got it, so have a chat with your doctor because we can investigate that to look at the root cause, but don’t just dismiss it. Anything more than four weeks, a cough that you just don’t know why it’s there, get it looked at.”

Nick asked: “We’ve had hay fever as we’ve been hearing this week already this year. Is that a complication?” Dr Punam said: “Well, it is. Just this week, actually, I had two patients who have COPD who came in because they felt that their hay fever had started affecting them.

“The thing is a quarter of people that have got COPD will be sensitive to pollen. We’re loving spring – it’s around the corner. But with that, of course, pollen counts rise and if you’re sensitive to that, it can affect your breathing. So often I find people with COPD can get misdiagnosed, or maybe it’s just a flare-up of the condition or a chest infection, but actually, if you’re coughing a lot more, if you’re producing a lot more phlegm, you’re congested, now is the time.”

This article contains spoilers for Season 2, Episode 9 of “The Pitt.”

Midway through Season 2, “The Pitt” has taken on the perils of the digital age and given me a reason to love the show as much as everyone else does.

Don’t get me wrong — I understand perfectly why so many people, including recent Emmy and Golden Globe voters, have lost their minds over the HBO Max medical drama: The propulsive day-in-the-life of a Pittsburgh ER conceit, the dazzling ensemble cast, the writers’ heroic attempts to showcase our perilously broken healthcare system, the healing power of empathy and, of course, the Noah Wyle-ness of it all. His brilliant and gentle-voiced Dr. Michael “Robby” Robinavitch is as aspirational a character on television as we’ve ever seen.

But having recently spent almost six hours passing out and vomiting from pain in the waiting room of my local ER (which was empty except for one other man), while being told there was nothing anyone could do until the next shift arrived, I confess I have watched “The Pitt” with a jaundiced eye. The regular crowd shots of the waiting room too often reduce the afflicted into a zombie-like horde bent on making life more difficult for our beloved medical staff.

Sure it’s tough to work in an ER when you are worried about your mother’s expectations, grieving your dead mentor, struggling with addiction or worrying about your sister, but no doubt many of those in the waiting room are experiencing similar issues while also in terrifying and hideous pain.

I’m just saying.

In this second season, however, “The Pitt” gave me reason to cheer. It chronicles the day before Robby is set to leave on a three-month sabbatical, and in the early hours, we meet his temporary replacement, Dr. Baran Al-Hashimi (Sepideh Moafi). Having already attempted to force those suffering in waiting rooms to create their own “patient portals,” Dr. Al-Hashimi goes on to advocate for an AI-supported system to aid the doctors with pesky paper work.

Robby, of course, does not think any of this is a good idea and since he is always right (and no television writer is going to openly promote AI), her plan backfires almost immediately. First, with a medical notes transcription that gets Very Important words wrong and then after a complete digital blackout.

After a nearby hospital is hacked and ransomed, the higher-ups decide to defend its system by shutting it down, which means business must be conducted in the old-fashioned, paper-and-clipboards way.

The result is chaos, and a few too many jokes about young people not knowing how to work a fax machine or manage paper. Some of the more seasoned staff, including and especially the indefatigable charge nurse Dana Evans (Katherine LaNasa), remember the days before everyone carried an iPad well enough to keep things moving. Even so, Dana wisely calls upon the services of “retired” clerk Monica Peters (Rusty Schwimmer).

When the computer system at the Pitt is shut down, Dana (Katherine LaNasa), center, calls in Monica (Rusty Schwimmer), far right, who arrives to help.

(Warrick Page / HBO Max)

“Laid off by the digital revolution, not retired,” Monica corrects her. “And how’s all this digital s— working out for you now?”

This is where I cheered. I love the digital world as much as the next person currently typing on a computer to file a story that I have discussed with my editors on Slack and that I will not see in hard copy until it appears in the physical paper. But like pretty much everyone, I have suffered all manner of digital breakdowns and mix-ups, not to mention the inevitably increased workload that comes with the perception that I can do the work of previous multitudes with a few additional strokes of a keypad.

Except, of course, that’s a lie — a keypad is capable of nothing on its own. Neither are fingers, for that matter. They must be manipulated by someone whose brain has to figure out and execute whatever needs to be done. This requires an ability to navigate the ever-changing tech systems that store and distribute information (often in ways that are not at all intuitive) while also understanding the essentials of the actual work being done.

In “The Pitt,” that is the emergency medical treatment of human beings, which requires all manner of physical tasks. As this storyline makes clear, many of the medical staff do not quite understand how to order or handle these tasks without a screen to guide them.

Hence the need for Monica, representative of a large number of support workers who do understand because it was once their job to keep everything moving, to answer all manner of questions, prioritize what needs to be fast-tracked and make sure nothing falls through the cracks while also engaging with all and sundry on a human level.

The shutdown is obviously an attempt to underline the limits of AI but it also serves as a fine and necessary reminder of how readily we have surrendered people like Monica, with their knowledge and experience, to keyboards and touch pads (which, of course, don’t require salaries, benefits or lunch breaks).

But — and this is important — computers are tools not workers. Alas, that has not kept companies in virtually every industry from drastically cutting back on trained and experienced employees and handing large portions of their work (mental if not physical) to people, in this case doctors and nurses, who already have demanding jobs of their own.

But hey, you get a company iPad!

Nurse Dana (Katherine LaNasa), left, and Dr. Baran Al-Hashimi (Sepideh Moafi) have to resort to paper, clipboards and white boards to keep track of patients after the hospital’s systems are shut down.

(Warrick Page / HBO Max)

Often, including with those patient portals, what was once paid labor lands in the lap of the consumers, who in “The Pitt” are people sitting in an emergency room and likely not at the top of their game when it comes to filling out forms about their medical history or coming up with a unique password.

ER dramas, like the “The Pitt,” are inevitably fueled by the tension between the demands for speed and the need for humane care, something that is increasingly true, if not as intrinsically necessary, in all facets of our culture.

With computers in our pockets, we now expect everything to be available instantly. But when something in our online experience goes wrong, we need an actual human to help us fix it. Unfortunately, as the overwhelmed staff of the Pitt discover, those people are increasingly difficult to find because they have been laid off — even nurse Dana can’t do everything!

Dr. Al-Hashimi, like many, believes that patient portals and AI-assisted medical notes will save time, allowing the doctors and nurses to spend more of that precious commodity with their patients. But, as Dr. Robby and Dana repeatedly argue, what they really need is more staff.

There’s no point in saving a few minutes at the admittance window, or on an app, if you are then going to have to spend hours waiting for or trying to find someone who can actually help you when you need it.

That is certainly true in the medical sector, where digital technology has done little to eradicate long wait times for medical appointments or in emergency rooms. Being treated in a hospital hallway by people who can barely stop to talk to you is not an uncommon occurrence for many Americans. The U.S. is facing a critical shortage in hospital staff, with the ranks of registered nurses and other medical personnel having plummeted post-pandemic, often due to burn out.

The amount of time the staff of “The Pitt” spend with each patient, while dramatically satisfying, is almost as aspirational as the wisdom and goodness of Dr. Robby.

None of these problems is going to be solved by AI or any other “time-saving” device. We have not, as far as I know, figured out a way to extend an hour beyond 60 minutes or modified the human body so that it does not require seven to nine hours of sleep each night.

Medical institutions aside, I can’t think of any place I have visited lately that wouldn’t have benefited from more paid and experienced workers, especially those who know how to do things when computers glitch or fail.

The minute Monica sits down and starts barking orders in the ER, everyone feels much better. Here is someone who understands what needs to be done, why, and how to make it happen. Moreover, she has eyes, ears, hands and human experience enough to know that, in the end, people are less interested in saving time than getting the care they need.

In the ER and everywhere else.