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As a pediatrician, I am the best buddy and confidante for the parents of my patients. Want to know one of the most common confessions I hear from parents? They’re scared. Sometimes terrified. From caring for a teeny-tiny newborn to coping with a child’s medical crisis, they’re afraid they’ll make a horrible mistake. Good parents like you want to do everything right for their kids.
But a little bit of fear is a good thing. It keeps you on your toes—it makes you question, focus, and think. When it comes to your kids’ health, being blissfully unaware can have devastating consequences. As a pediatrician and a mom of three, I’ve seen the good, the bad, and the very ugly on both sides of the stethoscope. I know the goofs that even ultra-intelligent parents can make and the mistakes that happen in even the best hospitals. Modern medicine can work wonders, but it can also do real harm, thanks to human errors and mechanical breakdowns.
That said, the last thing I want is to paralyze you with fear and worry. A much smarter strategy—one that I use myself and encourage you to use as well—is to use fear to your advantage. Treat being scared as a signal that you need to know more. The more you know, the smarter the decisions you’ll make about your children’s health. Yes, you’re right, there’s so much information out there that a person could drown in it. So what’s the best way to navigate this vast sea of new medical knowledge you’re blessed (and burdened) with?
1 in 15 children in hospitals is injured by medical mistakes and adverse drug reactions.
That’s why I wrote this book: to give you my insider’s recommendations on how to protect your child’s health. Because that’s your most important mission as a parent.
Don’t feel compelled to read this book straight through. You’re a parent. You don’t have much extra time on your hands, do you? Take a spin through chapter 1 whenever you need to give your child a medication, even a simple fever reducer. Read chapters 2 and 3 so you know how to find the right pediatrician and how to keep your kids healthy. And read chapter 4 so that you’re prepared for the unexpected. Otherwise, open it when you start to feel that uneasy sense of fear creeping in but before you’re in a full-blown panic.
When it is your child’s turn to go to the hospital, you shouldn’t leave anything to chance. As a doctor, I’ve seen too many things go wrong from the start. You need to be more vigilant about your child’s care in the hospital than anywhere. And you’ll likely have to be at your best when you’re nearly at your wit’s end and would rather become a dumbfounded bystander.
It happens to thousands of parents every day.
But don’t let it happen to you.
I want to give you tips on how to hold it together and make things go right, because I have truly been there and done that. This book provides the inside strategies that I use to get good results and avoid critical, common blunders where it matters most—in the emergency department, pediatrics ward, all-night pharmacy, exam room, or any other medical hot spot where your child’s health can be on the line. While there are plenty of books loaded with children’s health advice—believe me, I own them all—none approaches health care quite like this field guide does. It will help you make the right decisions, whether you’re just trying to get the best care for your child during a routine office visit or you’re in the middle of a full-blown health crisis.
If you live in the U.S., the odds that your child will be hospitalized this year are 1 in 25.
The great team behind this book will also help you. My coauthors include The Joint Commission—a not-for-profit organization that accredits and certifies more than seventeen thousand hospitals, health care organizations, and programs in the United States—and RealAge, a health company that provides some of the most useful free tests on the Internet, including its Healthy Kids Test. (I’m its chief pediatric officer.) Collaborating with these two organizations has yielded insights that you’ll find in no other book.
The experts at The Joint Commission impart wisdom that you’ll find invaluable (as I have) in choosing the best hospital for your child. (That’s a mission you should start right now, by the way; see page 166 to learn why.) The Joint Commission evaluates hospitals and other health care organizations to ensure that they meet top-quality standards in care, cleanliness, and procedures—and when hospitals fall short, it works to get them fixed. The Joint Commission strives to fulfill its vision that “all people always experience the safest, highest quality, best-value health care across all settings.”
You may know The Joint Commission by way of YOU: The Smart Patient, the bestseller that it produced with two lovable guys whom I’ll bet you’re familiar with: Michael Roizen, MD, and Mehmet Oz, MD. Known to millions as the “YOU Docs,” these physician-authors have changed countless lives through their books, TV appearances, and radio programs. They also wrote the foreword to this book. Thanks, guys!
As a parent, you work hard to teach your kids not to do certain risky things, from running with scissors to sending their e-mail address to a stranger. Moms and dads need expert guidelines too, especially when it comes to their kids’ health. This book will give you my rules for dealing with the medical system—the kinds of tips that could save your child’s life one day. Even tomorrow.
And remember, it’s okay to be a little scared. It’s the sure sign of a smart parent.
© 2010 Joint Commission Resources,
Have you made a love connection with a pediatrician? or are you unhappy with your child’s doc? Or are you just starting to look for one? Take this quiz to find out if your search for a pediatrician is on the right track. If you can correctly answer the following questions (there may be more than one correct answer), feel free to skip to the next chapter. But if you miss a question or two, read on. (Answers can be found at the end of the chapter.)
1. When shopping for a pediatrician, what should you always ask the pediatrician’s office manager?
2. A parent who’s tempted to call an ambulance every time her child skins a knee would probably be best served by a pediatrician whose treatment style …
3. How long is too long to regularly wait in a pediatrician’s waiting room?
4. Even in a pinch, you should not use a retail health clinic (often found in pharmacies) to treat your child for …
5. Never tell your child that a shot …
6. Which of these is something many pediatricians consider a time-wasting pet peeve?
7. What is not a legitimate reason to give your pediatrician the boot?
Two weeks ago, I saw a seven-year-old girl with a severe ear infection. Her mother had found me on the Mount Sinai Physician Referral Hotline that morning.
“We love our regular pediatrician, but she doesn’t work on Wednesdays,” she explained.
Happy to be able to help but also curious, I asked, “Not a big fan of anyone on her backup team?”
“She doesn’t have a backup team,” the parent replied.
Now, this woman seemed like a typical mom. I doubt she let her daughter play on an interstate highway or with matches. But when it came to picking her baby’s doctor, she wasn’t at her brightest. If her daughter had a serious medical problem on a Wednesday, or whenever this pediatrician was unavailable, the girl would have to be treated by a doctor who knew nothing about her. A similar situation for you and your child could make a difference in how your child is cared for in critical moments, which is why choosing the right pediatrician is one of the most important decisions you’ll ever make as a parent.
I was pretty lucky when I went through this particular rite of passage. When my husband David and I had our first child thirteen years ago, I knew just the right pediatrician for us. No, it wasn’t me. Although I’m fortunate enough to be the right pediatrician for many patients, I knew I couldn’t be objective as Dr. Mom. But I had watched the right doctor for my kids for several years. I knew her reputation in our professional circles—where flaws aren’t sugarcoated. And I had the advantage of being able to compare her skills and decisions with those of many pediatricians, including myself. I knew how this physician thought, how she reacted in emergencies, and how well she recognized her limits. Most parents don’t have all of these advantages, but they do have far more than they think.
Nevertheless, many parents select their doctor based on two things: If the practice accepts their insurance, and if the office is within a twenty-minute drive. Sure, many people ask their friends, their family members, and their own docs for recommendations, and others do a few Internet searches to see if likely pediatricians have won any awards or perhaps have a police record. Some also ask good basic questions: “Are you affiliated with a teaching hospital? Are you board certified in pediatrics?” (See page 56 for more on board certification.)
All are good steps to take, but they could lead to dozens of pediatricians who are good doctors but not necessarily the right doctors.
So how can you find the right doctor?
Let’s say I’m in the market for a new hairstylist—someone I can trust with my appearance and see happily every few weeks for years. Being around the corner isn’t going to seal the deal.
I will shop around and ask my friends, family, even someone in the grocery line who’s got a great haircut for recommendations. I might try out a few by getting a basic trim, or—less of a commitment—by getting an updo or blow-dry (no scissors!). If I’m not happy with the results and the person, I’ll move on until I find exactly the right fit for me.
Now, you’ve probably invested that kind of time in some sort of search. If it wasn’t choosing a stylist, perhaps it was picking out a stroller or a paint color or a preschool—or even a pair of jeans or a flat-panel TV. Finding a pediatrician shouldn’t be much different. The same or greater diligence you’d put into any of those searches should go into finding the right doctor for your child.
So let’s lay out a plan.
Your pediatrician does many jobs, but in general you can expect the doctor to:
Basically, you should view me (I’m standing in for your pediatrician here) as a partner whose main goal is to keep your child physically and mentally healthy.
Like any important project, searching for a great pediatrician is less daunting when you break it into small tasks and spread them out over time. If you are pregnant, start looking at least three months before you’re due. This allows plenty of time to find the child doctor of your dreams. If you already have a new baby but don’t have a regular pediatrician yet, start now so that you, your baby, and your future pediatrician have the advantage of starting a relationship as early as possible.
If you already have a pediatrician, that’s fantastic. But if you have any niggling concerns, this chapter will help you decide if that doctor is indeed right for your children and for you. You’ll either feel more confident about your choice or realize you need to press the “eject” button and find someone else.
First, get recommendations for pediatricians from the most obvious sources: your obstetrician or nurse midwife, and your own primary care doctor. If you’re adopting, which brings special concerns (see page 59), you can also ask the adoption agency for recommendations. Then ask friends, family, coworkers, and neighbors. Getting word-of-mouth referrals from people you trust is incredibly important (it’s how I get most of my patients). It’s like getting the name of a good caterer from a neighbor or an aunt—except, of course, a caterer won’t be meeting your child in an emergency department at four A.M.
When you’re asking someone for a doctor recommendation, include some or all of these questions in your friendly grilling:
If the same one or two names keep coming up, great. Put those doctors at the top of your list. But don’t discard the others yet. There’s always the teeny chance that some of the people who give you enthusiastic recommendations 1) are satisfied with mediocre health care; or 2) have been lucky recipients of sporadic good treatment from a doctor who disappoints many other patients. You’re just gathering information now, so throw all possible candidates into the pool.
When you have at least a few names, it’s time to narrow down your list.
Let’s start with one of the biggest issues: money. Check your insurance plan to find out which pediatricians, if any, are in your insurer’s provider network. If your health insurer only covers in-network doctors, these contenders just got some stars by their names. If your insurer covers a percentage of the expenses for out-of-network docs, see “Can Going ‘Out-of-Network’ Work for You?” on page 42.
Next, check out these doctors online. Start with an ordinary Google search. You may find a hospital bio page for the doctor … or, oops, a page on a social-networking site with wild photos of the doc in CancÚn on spring break. Some general searches can also quickly give you an idea if the doctor has authored any clinical studies (good sign) or worked with local organizations (also good). Next, check the site of the American Board of Medical Specialties (www.abms.org) to be certain that candidates are board certified in specialties that focus on the care of children, such as pediatrics or family medicine. See “What Kind of Primary Care Provider Do You Need?” (pages 56–57) for more good choices. The ABMS site can also provide you with additional candidates if your list is thin.
Having health insurance that only covers “in-network” doctors can really limit your options. You’ll either have to choose a pediatrician from their in-network list or foot every bill yourself—and for most people, that’s not an option. However, many insurance plans will cover a percentage of the cost of a doctor who’s not in their network. If your dream doc isn’t, and you can afford the extra fees for an out-of-network doctor, it may be the right choice for you and your child.
Other than the one used for demonstration purposes, that is. Find out if your candidates have any nasty incidents lurking in their past. While a cursory search won’t reveal everything, check the Federation of State Medical Boards (FSMB) to see if there have been any serious disciplinary actions or professional peer reviews (trouble brewing) against the pediatrician. This is rare, but I’d sure want to know about it. In most states, the information is public and free. Find your state’s link at www.fsmb.org/directory_smb.html or call (817) 868-4000 to get the number for your state board.
Okay, time to call the candidates and schedule a “meet-and-greet”—a prenatal or preadoption consultation, or a consultation to switch from Dr. So-So to Dr. Right. Most insurance companies don’t cover this kind of visit, even though it’s necessary, but—good news—many physicians welcome these interviews and don’t charge for them. Still, some do. Ask when you call for an appointment.
If at all possible, bring your child along so you can see how the doc and the staff interact with her. Arrive early so you can do some stealth detective work. Look around.
Chat up the other parents and ask if they’re happy with the pediatrician; if it’s a group practice, ask which docs they do and don’t like. Are the waits long? (Half an hour should be the longest.) Is getting a return call from the pediatrician difficult? Is the staff helpful when there’s an insurance snafu?
TIP: Bring your own toys! When I take my kids to the pediatrician, I always bring a couple of favorite toys from home for them to play with, especially during cold and flu season, when the office toys are likely to be germ riddled. At my office, we wash the toys regularly and disinfect them with Lysol, and we also give parents disinfectant wipes to clean toys before their kids dive in. But there’s no getting around it: Lots of sick kids touch those toys, and we can’t clean them every fifteen seconds. Quite often, at the very second a parent is ripping open a disinfectant wipe, his three-year-old is across the room clutching the truck that a two-year-old licked a minute ago. Smart parents bring their own toys. Bringing your own toys also means that they can be brought into the exam room to keep your child entertained.
Even if you’re disappointed before you even see the pediatrician, don’t leave yet. Just like a job interview, it’s worth doing, even if only for the experience.
During your visit, always—always—seek out that treasure trove of information who resides near the waiting room. Yes, the office manager. The person who knows many things. Good things and bad things. Charm some key intelligence out of this oracle. Start with small talk, throw in a genuine compliment (“Nice earrings!”), then ask the insider questions that follow. (Make a copy of them to use as a cheat sheet.)
After your incredibly fruitful time in the waiting room—which hopefully was not excessively long—you’ll be ushered back to interview the candidate. Here’s a checklist of questions I would recommend asking; add any others you like.
Start with getting basic credentials and some personal info.
The Joint Commission
The Joint Commission, a private, not-for-profit organization, has been the nation’s leader in continuously improving patient safety and health care quality for almost sixty years. The Joint Commission is the principal standards setter and evaluator for a variety of health care organizations, including hospitals, ambulatory care, behavioral health care, home care, laboratories, and long-term care. Joint Commission accreditation—the coveted Gold Seal of ApprovalTM—means that a health care organization complies with the most rigorous standards of performance. More information about The Joint Commission can be found in later chapters or by visiting its website at www.jointcommission.org.
Next, determine how well the pediatrician handles emergencies.
Next, ask about the pediatrician’s treatment experience, philosophies, and patients.
Next, find out how easy it will be to deal with this doctor for routine stuff.
Finally, it’s time to talk money. You can also get this info from the office staff, but if you have special concerns, speak directly to the doctor.
For your eyes only.
I hope so. But if you visited only one pediatrician, be skeptical about love at first sight; interview at least two more to be sure you’re going with the right person. The chemistry you felt with the doctor is just as important as the answers you got to your questions. Did you like the doc’s style? Did anything put you off? If you felt at all intimidated or talked down to, this may not be a match. If you felt rushed or just didn’t click with the pediatrician’s personality, you may not want to go forward either. A lot of people have a gut feeling when they find the right pediatrician, so listen to your inner voice.
Finally, make sure you are comfortable with the doctor’s age and gender. With a little luck, you and your children will be relying on this person’s medical care and advice for twenty years or more. Do you want to fall in love with a pediatrician who’s hitting retirement in five years? If your kids are in their teens, maybe. But if you’ve got an infant, you might want to think twice.
During the first year of your baby’s life, you will visit the pediatrician a dozen times—and that’s just for vaccinations and wellness checks. That doesn’t include ear infections, coughs, colds, or mishaps. You’d better be able to work well with this person and be thinking about the future. If you have a boy, you might prefer a male pediatrician so your son feels comfortable as he grows, especially through puberty. (Yes, your little angel will go through puberty someday.) If you have a girl, you might prefer a female pediatrician for the same reasons. (At least there are options now!)
When I chose a pediatrician for my children, I wanted a female who’d had kids herself. I know that I tend to relate to this type of physician best … perhaps because we share the same experiences. But those are my preferences. Bottom line: Pick someone who suits your preferences. It’s okay to be persnickety.
Even if the doc seems smart, kind, and trustworthy, try to get a handle on whether his or her medical style complements yours. For instance, if you are a chronic over-the-top worrier—someone who inwardly considers calling 911 every time your child skins a knee—you may want a doctor who exudes calm and takes a “watch-and-wait” approach (as well as one who’s skilled at talking worried parents off the ledge). However, if you tend to be the watch-and-wait type yourself, you may want a doctor with a more gung-ho, proactive treatment style who will give more intense scrutiny to symptoms you might minimize. Make sure you see eye to eye when it comes to how the doctor views your role. Does the doctor look at parents as partners or prefer to be the Lone Ranger? Make sure you both have the same expectations. Also, you need to determine if you’re more comfortable with a patient-centered or paternalistic relationship with your doctor.
I’ll explain. There was a time not so long ago when the patient was in the backseat and the doctor drove the proverbial bus—that is, made all the decisions. Most patients went along with this and tended to view MDs as all-knowing.
Today, however, far fewer doctor-patient relationships fit this paternalistic paradigm. People now have access to almost unlimited medical information via the Internet, TV, books, and magazines. While most people still want and need the knowledge and experience doctors bring to the equation, many also want to be part of the health care process. In fact, one study found 86 percent of parents are likely to participate in decision-making with their doctor. But it also found that those who wanted a paternalistic relationship with their physicians were quite happy with doctors who had the same mind-set.
I strongly prefer parents who view our relationship as a partnership. We are in it together. I provide medical expertise and know-how. You offer information that helps me diagnose and treat. And, of course, you make your final decisions with my guidance.
You also help me help your child—for example, by making sure medications are taken or symptoms are treated or a blood test is scheduled. We really do need each other, and that includes deciding on treatments together. It’s best if we’re both fully invested in the final outcome: good care and good health for your child.
These roles need not be absolute, by the way. You may want to have a patient-centered relationship, but during emergencies you expect your pediatrician to assume a paternalistic role and take charge. Whatever you envision, talk to the doctor about how you see your role. Personally, I feel like if you’re involved in the decision-making, you will be happier with the outcomes.
As a doctor and a mom, I know how important it is for my style to complement the styles of my patients’ parents. I always give my office number to parents and tell them to call me if they have further questions or forgot to ask something. I want them to know from the get-go that it’s okay to call me. There are no silly questions, just questions that parents may not know the answers to. I’m not bothered by questions, and the right pediatrician for your child shouldn’t be either.
The right doctor for your child doesn’t have to be a pediatrician. It may be one of the experts listed below. You need to figure out who will be the best choice for you and your family. Your decision may also depend on the age of your kids and the health care choices where you live. Here’s who does what:
Pediatricians focus on kids’ physical, emotional, and social health from birth through young adulthood. They work hard to treat health problems, but they work even harder to prevent trouble by making sure kids have immunizations and regular checkups and eat and sleep properly. Pediatricians must complete four years of medical school and three years of pediatric residency. To be board certified, they must pass a written exam given by the American Board of Pediatrics and then be recertified every seven years. To be eligible for license renewal and to care for patients, a pediatrician must also obtain continuing medical education credits. These are designed to keep doctors up-to-date on the latest medical practices and procedures.
Family physicians also have to complete four years of medical school and three years of residency, which often includes training in pediatrics and/or other areas such as internal medicine, orthopedics, and gynecology. Family physicians are qualified to provide basic care for patients of all ages. To be board certified, they must pass a written exam given by the American Board of Family Medicine and then be recertified every seven years. To be eligible for license renewal and to care for patients, a family physician must also obtain continuing medical education credits. These are designed to keep doctors up-to-date on the latest medical practices and procedures. A family physician can see your child from birth through adulthood, but make sure you ask about age policies since some family physicians don’t see children younger than a certain age.
Pediatric nurse practitioners (PNPs) have a master’s degree in nursing and get special training in performing physical exams, taking medical histories, and making basic diagnoses in children. If PNPs encounter a complicated medical problem, they’re trained to consult with the doctor. PNPs are increasingly popular in group practices because they have the knowledge and time to, say, go over a treatment again when the doctor’s already seeing the next patient.
“I’m sorry, I’m not able to take your child as a patient due to my current workload, but I can recommend some other pediatricians who might have more open schedules.”
A pediatrician who delivers this line may be telling the whole truth. Perhaps they really couldn’t wedge another patient into their schedule with a crowbar. Or they might be telling a half-truth … they wouldn’t wedge you into their schedule with a crowbar. Why? Evaluations go both ways, and docs decide whether they can work with you, too. We may realize our treatment style doesn’t sync with yours or just sense that the chemistry between us is off. Or you may ring our alarm bell because you …
… have changed doctors a dozen times in the last five years. That’s a red flag that you’re not going to be satisfied with any medical professional.
… were a problem parent for a pediatrician five towns away. What, you think we don’t talk to each other? If you had a blowup with Dr. Jones, let Dr. Smith know—briefly, accurately, and without casting aspersions on Dr. Jones.
… have been mysteriously cryptic about your child’s medical past or refused to provide medical records (especially records of consultations with specialists). This often means that a parent already has a fixed viewpoint about a particular issue, such as the source of their child’s symptoms, and is shopping for an agreeable doctor who will give them the opinion they want to hear and prescribe the treatment they want rather than actually provide independent medical expertise.
Once you’ve picked your pediatrician, don’t throw away that voluminous pile of information you’ve collected. What if your wonderful doctor moves out of town? Or decides to quit medicine and hike across America? Or what if a few years from now your daughter doesn’t want to see a “boy doctor” anymore? Or your insurance changes and excludes your current pediatrician? Hanging on to that info means you won’t have to start over from scratch.
… seem like a “headline parent.” See page 260 in chapter 8 for more on this merry phenomenon.
If you haven’t started keeping meticulous records of health history and medical care for yourself and your child, please consider yourself nudged in that direction. Good family medical records are so vital that they’re a recurring theme in this book. If you haven’t started keeping them, it’s never too late.
The first step I’d recommend is going to the American Academy of Pediatrics (AAP) website and using the Care Notebook you’ll find there (www.medicalhomeinfo.org/tools/care_notebook.html). The notebook is an organizing tool that will help you become an expert on your child’s and family’s health care. You can pick and choose from dozens of handy forms that will help you track immunizations, allergy records, doctor appointments, hospital stays, growth patterns, family and medical history, nutrition, insurance providers, and therapists. There’s an online tour to walk you through the steps of putting the Care Notebook together. And you’ll find the AAP site is super-useful in general.
Adoption is more popular among Americans than ever before. Each year, about 125,000 native-born children are adopted, and another 23,000 or so children are adopted from countries outside the U.S.
If you adopt a child through a U.S. agency, you should receive a complete medical record for your child to share with your pediatrician. Unfortunately, medical records for children adopted from other countries are not always complete or reliable, and usually the only source of information is the agency or orphanage from which you adopted. Nevertheless, try to obtain as much information as possible for your child’s medical records.
For more information on medical records for adopted children, check out these resources.
www.aap.org/sections/adoption Web page on adoption and foster care at the American Academy of Pediatrics (AAP) website
www.adoptioncouncil.org The National Council for Adoption
www.adoption.org/adopt/national-adoption-information-clearinghouse.php Website of the National Adoption Information Clearinghouse
adoption.state.gov Website of the State Department with info on international adoptions
www.adoptivefamilies.com Link to national magazine for families who are planning to adopt or already have adopted children
www.childwelfare.gov The Child Welfare Information Gateway, which contains info on both adoption and foster children
www.davethomasfoundation.org Foundation created by Wendy’s founder Dave Thomas, who was an adopted child
www.openadoption.org Website of the American Association of Open Adoption Agencies
Electronic health records (EHRs) are here to stay, in part because the federal government wants everyone to have an EHR within ten years as a way to reduce medical errors, improve efficiency, and cut health care costs. So if your pediatrician already uses them—roughly 20 percent do at the moment—you might want to get started. Why? As more and more doctors and hospitals move to EHRs, you’ll soon be able to say, “Doctor, can you e-mail me my son’s lab results?” Not only will you have them quickly and precisely but you can then copy those results into your own electronic records.
Yes, there are privacy concerns, but frankly, that’s true of paper records, too. According to a study done by the Los Angeles Times, roughly 150 people (doctors, nurses, technicians, billing clerks) have some access to a patient’s medical record during a hospitalization. And that doesn’t include insurers and other billing companies. That’s why there are strict privacy rules designed to make sure health care information is secure—surely you remember those gazillions of HIPAA (Health Insurance Portability and Accountability Act) forms we had to sign back in the late nineties!
The first year or two of your child’s life will include regular wellness visits to the pediatrician to check on growth and development, get vaccinations, and just generally make sure everything is going along fine. But little ones have steel-trap memories, so if your toddler equates going to the doctor only with getting shots, you may find yourself with some “splaining” to do. (“So that’s why the nurse often gives the shots,” you’re thinking. “Now I get it.”) Kids need to understand that docs do a lot more than give shots—tell them that we help kids stay healthy and get well. Whether they are going in for a routine exam or because they are injured or sick, you can help quell their fears.
As kids reach adolescence, they may stop talking to you about certain issues. Boys may prefer to go to the doctor with their dads, and girls with their moms. If you’re the one being shunned, your child still loves you. This is normal, and you can rest assured that the shunning will cease when they’re old enough to need a big bump in their allowance or to borrow the car keys. When my patients turn twelve, I create a contract with them. I see them first with a parent and then without. This gives tweens and teens a chance to ask and answer my questions free of embarrassment or fear regarding important issues such as sex, alcohol, smoking, and drugs. My patients also know that if they’re doing something to physically hurt themselves, or someone else, I have an obligation to tell their parents.
“You need to bring her in.” I know you probably don’t want to hear those words, but in many cases, I simply can’t answer questions without seeing a child. I’ll do what I can to save parents a trip to my office, and many cases can be handled over the phone. But not all. Every child is different, and there are nuances and symptoms that I must physically see in order to diagnose and treat the child. During a sick visit—or any visit for any reason, for that matter—use these ten tips to be a smart communicator and to help your child get quicker treatment.
Doctors call them “doorknob moments.” It’s when the visit is wrapping up, we have our hand on the exam room doorknob to leave, and a parent says, “Wait … do you think Matthew could be vomiting because he fell down the stairs?”
Maybe you’re anxious about telling the doctor something so you save it for last. (“I gave him two tablets instead of one … could that be a problem?”) It’s understandable. But here’s the thing. We need you to be open about everything during the initial discussion so that we don’t miss important clues that could change the diagnosis or treatment. Still, if you do remember something at the last minute, don’t be afraid to bring it up. We’d rather have the full picture, doorknob moment or not. And here’s a tip that might help: Write down your questions and your child’s symptoms before you come.
It’s a sad fact; not all of my patients love seeing me all of the time. I don’t take it personally. Sometimes, kids will open up about why they’re afraid of going to the doctor, but more often they remain silent and stew privately. Here’s what you need to know, even if they don’t tell you.
You’ve probably seen the drop-in medical centers in big-box stores like Target or Wal-Mart and in drugstore chains like CVS or Walgreens. There are about a thousand of these “convenient care clinics,” “mini clinics,” or “minute clinics.” As a rule, they handle only common ailments and are staffed by physician assistants and nurse practitioners (NPs), who can order tests and write prescriptions. The cost is relatively low, at about $50 to $75 a visit (or an insurance copay), and the wait is not long. No wonder the clinics are popular with the young and uninsured. Less than half of those who use the clinics have a primary care doctor, which means they serve a good purpose.
So is it okay to take your child there on Sunday night if you think he has strep throat? I would advise you to call your doctor first, but if you do go to a clinic, follow up with your pediatrician as soon as possible. If I couldn’t get to my pediatrician’s office, I’d feel relatively comfortable using one of these clinics for the following common problems:
The American Academy of Pediatrics opposes the use of retail clinics for children and adolescents, though, because it feels pediatricians use even minor visits to address family issues and to check on immunizations, among other things. The AAP is also worried about continuity of care, which is a concern I share, too. In sum, use them if you’re in a pinch, but let your doctor know so that he has a record of the illness and what was done about it.
Sometimes, a relationship with a doctor can hit a speed bump—a conflict of opinions, a failure to communicate, a misunderstanding that gets tense. Now what? Here are some ways to ease through a potential rough patch with your pediatrician.
If you have a pediatrician who would fail the vigorous “exam” outlined in this chapter or who just frustrates you (do you tend to leave the office more confused than when you entered?), you and your child deserve better. There are many things that could spur you to tell your pediatrician sayonara, but here are some of my deal breakers:
American Academy of Family Physicians (AAFP) (www.familydoctor.org)
Explore a wealth of practical information on diseases, conditions, medications, symptoms, healthy living, and more.
American Academy of Pediatrics (AAP) (www.aap.org)
Go straight to the Parenting Corner for advice on choosing a physician, immunizations, child development, safety and injury prevention, and more.
Centers for Disease Control and Prevention (www.cdc.gov)
This is the place for official government health data and recommendations for kids from birth to age twenty. You will find interactive tools, charts, growth tables, recommended vaccinations, and information on infectious and chronic diseases, injuries, disabilities, and environmental health threats.
Here you’ll find practical, easy-to-read articles on a range of diseases and chronic conditions. There are also doctor-approved resources and information. The site is divided into unique areas for parents, children, and teens.
U.S. Department of Health and Human Services (www.healthfinder.gov/kids/)
Check out this site with your kids! Includes games, contests, pointers on how to surf the Net safely and create personal sites, plus information on substance abuse, safety, and more.
Yuckiest Site on the Internet (www.yucky.com)
Explore a range of fascinatingly yucky science topics with your kids. The site includes a section on understanding the gross and cool human body.
1. When shopping for a pediatrician, what should you always ask the pediatrician’s office manager? The answer is D, all of the above. (Page 45.)
2. A parent who’s tempted to call an ambulance every time her child skins a knee would probably be best served by a pediatrician whose treatment style … The answer is B. This parent should seek out a pediatrician who usually takes a more relaxed “watch and wait” approach. (Page 54.)
3. How long is too long to regularly wait in a pediatrician’s waiting room? The answer is B, twenty to thirty minutes. On occasion you may get a longer wait, but with children in the equation, you need an office that keeps things moving. (Page 70.)
4. Even in a pinch, you should not use a retail health clinic (often found in pharmacies) to treat your child for … The answer is C, breathing difficulty. (Page 68.)
5. Never tell your child that a shot … The answer is B. Can you believe that a lot of parents actually use this threat? (Page 62.)
6. Which of these is something many pediatricians consider a time-wasting pet peeve? The answer is A. (Page 66.) You know, that doorknob thing!
7. What is not a legitimate reason to give your pediatrician the boot? The answer is B. On the contrary, refusing to give you an antibiotic even when you lay on the pressure is probably a sign that your doctor is quite prudent. (Page 69.)
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