Rationalization of Pediatric Medicine By: Liana Mattera

McDonaldization is a term coined by George Ritzer, describing the influence of fast-food principles on society. McDonaldization discusses the implications of rationalized and standardized practices in society. To understand rationalization it is important to discuss the four key principles of McDonaldization and how they have already taken place in pediatric medicine. The first dimension is efficiency which discusses how to complete tasks in the least amount of time possible. Tasks can range from simple to complex but the main point is how to complete them in the smallest amount of time possible. The next dimension is calculability, which focuses on quantifiable measures. Ritzer argues that when it comes to rationalization, numbers are more important than quality. Companies' success is measured by the numbers. Whether it is how much they sell or how many people served, it comes down to the number. The medical field is no different. Another dimension mentioned by Ritzer is predictability, which focuses on the uniformity present. Uniformity is consistency in similar scenarios, with little to no variation present. Predictability is essential for treatment in medicine. The last dimension of McDonaldization is control. Control consists of standardizing the processes used. In medicine, the standardizing of tasks is a common way to enforce a level of control across the medical field.

The Rise of Technology

Since the 1950s, medicine has embraced technology like AI. AI analyzes vast amounts of data to suggest treatments and diagnoses, improving accuracy and reducing human error. Machine learning models, a type of AI, analyze patient data in standardized ways, like identifying abnormalities in scans. This technology helps doctors make more predictable treatment decisions, especially for children, potentially improving overall patient outcomes. However, some limitations exist, such as AI basing recommendations on potentially outdated data.

Private Practice vs. Hospital Settings

In the 1960s, most pediatricians worked in private practices, enjoying more autonomy and flexibility. However, limited after-hours care was available. The 1970s saw a shift towards osteopathic medicine emphasizing patient well-being. Technology also began changing everyday tasks, with paper charts transitioning to electronic ones. Imaging systems also saw advancements during this decade.

Pediatric care has shifted away from private practices. A 2016 survey showed a significant decline in solo practitioners, with most pediatricians now affiliated with hospitals or larger systems. This trend is driven by factors like easier administration, consistent salaries, and access to specialist colleagues and cutting-edge technology within hospital systems. Private practices often have fewer resources available to pediatricians.

The Rise of a New Medicine

The 1970s saw a shift towards a more humanistic approach to pediatric medicine in Italy. Children were no longer confined to hospital rooms but allowed to play and continue schoolwork. This recognized the impact of factors beyond just disease on a patient's well-being. This holistic approach, also seen in osteopathic medicine, emphasizes preventing illness by considering a patient's environment and lifestyle. This marked a turning point in medical philosophy, moving towards treating the whole person, not just the disease.

Electronic Medical Records

The way medical records are kept has transformed alongside medicine itself. A push towards electronic health records (EHR) began, allowing quick access to a patient's entire medical history. This saves time for doctors and nurses, as all information is readily available. EHRs also benefit pediatric care, where swift and focused treatment is crucial. Digital records streamline communication within healthcare systems and ensure data is centralized for future reference. This increased data allows researchers to identify trends and make improvements in healthcare.

Evidence Based Medicine

Advancements in technology led to the rise of evidence-based medicine in pediatrics. This method relies on past studies and patient data to determine the most effective treatment options, reducing errors and biases. Standardized questions like the "Five A's" further streamline this process. While machines may present treatment options in the future, technology currently assists pediatricians by providing data-driven insights. This allows doctors to stay current on the latest advancements and personalize treatment plans, ultimately improving patient outcomes. The role of the pediatrician is evolving alongside technology, becoming more collaborative and reliant on data analysis.


The 1990s saw the implementation of HIPAA, a law protecting patient privacy in the medical field. HIPAA restricts how medical information is shared, building trust and encouraging patients to seek care. It creates a standardized system across the country, ensuring consistent rules for pediatricians to follow and reducing confusion that could lead to data breaches. HIPAA remains a cornerstone of data security in medicine today.

Technological Innovation

Since the introduction of X-rays, imaging technology has been crucial for medical diagnosis. MRIs and CT scans offered a new level of detail, allowing doctors to see internal structures and diagnose previously unknown conditions. This information helps tailor treatments to each child's specific needs and genetic makeup, paving the way for future advancements in efficiency and affordability.

Technology is revolutionizing pediatrics by assisting with tasks from note-taking to complex data analysis. This improves treatment accuracy, efficiency, and accessibility by reducing errors and personalizing care. While concerns exist about ethics and data security, technology's benefits seem to outweigh them for now. As technology's role grows, questions about its responsible use become increasingly important.

The Increase in Specialization

Pediatricians are increasingly collaborating due to a rise in subspecialties. This allows for diverse perspectives on each case, improving the effectiveness of care. Chronic and mental health conditions, more common today, necessitate this specialization. Subspecialization also allows doctors to focus on specific areas and offer patients case-specific treatment. Interestingly, this trend fosters collaboration across specialties, a rarity in the 1950s.

The Rise of Mental Health and Chronic Conditions

The rise in mental health disorders among children, affecting one in six in the US, has led to increased specialization in pediatrics. A lack of access to treatment, especially in the South, underscores the need for more affordable and accessible care. Similarly, the growing prevalence of chronic conditions (affecting 38% of US children) necessitates specialists who can provide holistic treatment plans. These plans manage all aspects of a child's condition, improving their quality of life and ability to cope with symptoms. With 20% of US children having special healthcare needs, pediatric specialization ensures they have access to doctors who specialize in their specific conditions. Overall, specialization in pediatrics offers patients and families more resources and a greater chance of effective treatment.

Technology after COVID-19

The COVID-19 pandemic spurred a surge in telemedicine for pediatrics. Platforms like Teladoc connect patients with doctors virtually, providing convenient consultations for chronic conditions and increasing access to care in remote areas. This technology streamlines doctor visits for both pediatricians and patients.

While telemedicine offers convenient access to mental health services, concerns exist about data privacy and accessibility. Not everyone has the internet or technology needed, and language barriers can arise. The increased use of telemedicine in pediatrics for checkups may reduce clinic visits, potentially leading to job losses for nurses and other staff.

Genetic Testing

Advanced technology in pediatrics has led to more accurate and timely diagnoses. Imaging, molecular tests, and evolving lab tests provide deeper insights into underlying conditions. Genetic testing adds another layer of information about a patient's makeup. These advancements have driven specialization in healthcare, allowing for precise point-of-care tests, specific medications, and more efficient lab procedures.


Rationalization in pediatrics offers benefits but also raises concerns. The main worry is a lack of flexibility. Unlike McDonald's where a mistake might mean a bad burger, a mistake in medicine can cost a life.

One negative outcome of rationalization, called "irrationality" by Ritzer, is the rigid implementation of standardized procedures. This can remove the human element and essential medical judgment from decision-making. Medical care requires tailoring treatments to individual patients, not a one-size-fits-all approach. This inflexibility can delay recovery or even be fatal.

Resistance to Change

In pediatrics, clinging to established methods can hinder the adoption of new treatments and slow patient care. Change is especially difficult due to the need for caution with children's health. Doctors are naturally risk-averse with new technologies, and the desire to protect children further slows the acceptance of potentially beneficial advancements. Ultimately, progress in pediatrics hinges on the medical field's openness to new practices.

The Need for Connection

Strong relationships between pediatricians, patients, and families are crucial for effective treatment. This trust allows for open communication and timely interventions. Pediatricians rely on experience, knowledge, and intuition to create personalized treatment plans that weigh risks and benefits. However, an overemphasis on efficiency in rationalized medicine can threaten this human connection. Ritzer argues that prioritizing efficiency can lead to overlooking emotions and essential information, potentially compromising patient outcomes.

Pediatricians into the Future

Technology has significantly impacted pediatrics, influencing how doctors diagnose and treat patients. While the job market seems stable, the practice of medicine itself is becoming more rationalized and standardized, similar to the principles of McDonaldization. This means efficiency, predictability, and data-driven approaches are emphasized.

This trend has both benefits and drawbacks. Technology allows for faster diagnoses, more effective treatments, and increased access to care. However, concerns remain about privacy, human connection, and the potential rigidity of standardized practices.

Overall, rationalization, fueled by technology and evidence-based medicine, has improved knowledge, patient care, and treatment outcomes. While there are valid concerns, this approach seems likely to continue shaping pediatrics and leading to future advancements.