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Celebrating the wonderful growth of Society of Ambulatory and General Pediatrics of Japan (SAGPJ)


ambulatory and general pediatrics, Noboru Kobayashi, Society of Ambulatory and General Pediatrics of Japan, pediatricians in private practice

The 22nd Annual Meeting of the Society of Ambulatory and General Pediatrics of Japan (SAGPJ) was held at Pacifico Yokohama from August 24-26, starting Friday late afternoon and lasting over the weekend. Dr. Shun'ichiro Yokota, a pediatrician practicing in Odawara city, presided as chair, and I attended as a member of the organization.

This Society started in 1991 when Dr. Minoru Tokumaru, a pediatrician practicing in Matsuyama, Shikoku held the first meeting of the Group for Research on Ambulatory and General Pediatrics of Japan. On the tenth meeting, the name was changed to the current one and the Society meet annually thereafter. The recent 22nd Annual Meeting was attended by nearly 3,000 people, not only doctors, but also pediatric nurses, child care hospital staff, office staff and even pharmacists. Each of them reported on what they had learned through their work and their efforts to improve ambulatory pediatric care. With 2,700 attending on first day, August 24, it was a great success. The enthusiasm of all the participants who had come from all over Japan made it a truly wonderful occasion, and I hope the Society will continue to flourish.

Ambulatory and general pediatrics is based on an approach that emerged in the United States in the late 1970s. In the United States, on whose mainland no fighting occurred during World War II, the field of pediatrics became increasingly specialized as children's hospitals also grew in number in the postwar period, and the fields dealing with specific diseases such as pediatric neurology, pediatric cardiology, pediatric nephrology, and pediatric allergology became specialized and systemized. While the treatment of pediatric diseases made great strides, this resulted in a much less holistic approach to the child as a human being and to the relationship between the child's body and mind. In some cases, pediatricians providing ambulatory care would fail to diagnose diseases outside their specialty. Ambulatory and general pediatrics, referring to pediatrics that treats both the mind and body of the child patient primarily on outpatient basis, emerged to rectify this situation.

As you may know, "ambulant" and "ambulate" mean "walking" or "to walk" or "to move from one place to another." This refers to the patient walking to receive medical treatment or to the doctor or nurse walking to the patient to provide treatment. The outpatient clinic where the patient walked to receive treatment came to be called an "ambulatorium" and the vehicle that carried the patient became an "ambulance." On the other hand, "general" in "general pediatrics" emphasizes that the approach is not specialized.

Dr. Tokumaru, whose idea was responsible for founding the Society, was working at university and prefectural hospitals and treating children in private practice, when he became familiar with trends in ambulatory pediatrics and general pediatrics in the United States. Thinking that he wanted to establish such medicine in Japan, he asked Dr. Yamashita, then professor of pediatrics at the Kurume University School of Medicine, and me for advice. This was because while we recognized the importance of specialties in pediatrics, we had also stressed for some time the importance of treating children in a more comprehensive manner or holistically.

That is one reason why this Society has always been very special to me, and I have looked forward to attending these annual meetings when possible. I have been able to directly feel the enthusiasm of the pediatricians and others who, in close cooperation with the local community, work hard for the mental and physical health of children. As someone who has spent his life in organizations such as the university and pediatric hospital, this has been the greatest gift to me.

When I was studying at a children's hospital in London, Professor Munenori Enjoji of the Department of Pediatrics, School of Medicine, Kyushu University who was then University President, visited to attend the Conference of Japan-UK University Presidents sponsored by the UK government. He contacted me and asked if I could arrange a meeting with Dr. John Fry, a general practitioner near London and the author of the book, Common Diseases, which recorded information on the numerous common diseases of children that are often encountered in community medicine. Having read the book, Dr. Enjoji was interested in meeting him, so I bought and read the book right away and looked him up in the phone book. We then visited Dr. Fry who was a typical English gentleman and I listened to their conversation as we had tea. I remember well the large brown dog that sat by Dr. Fry's side.

They talked about the importance of research even for general practitioners and how certain kinds of research could only be conducted by a general practitioner. Based on these ideas, Dr. Fry carefully treated common diseases and recorded his observations in a book titled "Common Diseases" as research on the "national history of childhood diseases." I think it was in 1963. I still vividly remember the two of them in conversation. Dr. Fry later became a consultant for the World Health Organization and his ideas were very influential through the world. I once had the Japan Medical Association invite him to Japan. This is just one example of why I always look forward to the new research presented by SAGPJ.

The 22nd Annual Meeting consisted of a total of nearly 120 presentations: 4 pre-conference seminars, a speech by the president, speeches on education, 13 MTE (Meet the Experts) presentations, 9 symposia and discussions on various topics, 18 luncheon seminars, 4 afternoon seminars, 67 poster presentations (including 63 oral presentations). It was a lively meeting where we were able to learn about the way pediatricians in private practice live and work and how much everyone involved is studying on a daily basis.

Particularly prominent themes were vaccinations and allergies related to asthma and atopic dermatitis, followed by child-raising counseling, educational problems, developmental disorders, and contagious diseases. From these themes we are able to learn what kind of work regional private practice pediatricians are doing, the sorts of problems they face, and what they want to study.

Of course, an academic conference is not just a place for study. It is also a place where people from all over Japan get together. This time, the pre-conference event consisted of a two-hour cruise in Yokohama Bay and a dinner party at Yokohama Marine Tower. I couldn't go on the cruise, but I attended the dinner party and enjoyed seeing many friends there. On the evening of Day 1, we separated into groups to have dinner at several large Chinese restaurants in Chinatown, and this became another occasion for talking and exchanging ideas.

SAGPJ fulfills an extremely important role as a study group for pediatricians in private practice. Parents will sometimes take their child to the doctor only to find that the clinic is closed or they have to consult a different doctor because their doctor is not available. At these times, the doctor is often attending an academic conference. Please understand that like doctors at university hospitals and children's hospitals, doctors in private practice also take advantage of special opportunities to study and learn how to improve ambulatory care for each child.

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