This is part two on why doctors run late in the office—more specifically, why I might run late some day while you are waiting for me! The same scenarios I presented in the blog last week are explained here in more detail. I am trying to make you understand why things aren’t always simple when it comes to keeping to a schedule.
Please understand, I am not trying to excuse myself for running late. Hardly anything causes me as much stress as getting behind on my schedule and forcing others to wait for me. I always strive to keep to my schedule by having appointments scheduled in a way that allows enough time for the problem and number of patients to be seen in a time slot. I try to be efficient during the appointment. I even ask people to reschedule—especially if they are so late for a check-up (or similar non-urgent appointment) that almost all of the allotted time has gone by before they arrive.
I have had people give me analogies such as getting their muffler fixed, oil changed, or brakes replaced on their car—for these procedures they are given an appointed time, and apparently their mechanic sticks to the schedule. My first response to this is that people aren’t cars! People talk back to me, and have opinions and feelings about what is happening to them. Secondly, it is unlikely there would be an emergency repair a mechanic would have to make immediately (when they thought they would just be simply replacing the muffler). And finally, in my experience, mechanics haven’t been very good at sticking to the schedule when it comes to fixing any of my cars. Or what about any other appointment you have had scheduled, such as getting your hair cut? Your stylist can keep to her schedule, right? Again, a doctor’s appointment isn’t the same as getting your hair cut. Much is known ahead of time about what will happen in the salon (making scheduling more accurate), but the flow of an appointment with your doctor is often unpredictable.
So here are my scenarios—with more detail to give you an idea of why I often must just deal with the problem as it comes up, instead of cutting people off or making them reschedule an appointment. And I’m not even including the little things—such as the newly potty trained three year old who has to go to the bathroom in the middle of the appointment, or the child who vomits everywhere as soon as I walk in the room, or the adolescent who faints after her immunization, or the poopy diaper that goes up the back and onto the exam table.
1. My first patient of the morning is seven minutes late. She is sick and there are no other appointments available until after hours. The child cannot drive herself to the office and I don’t feel right about penalizing her because her parent did not make it to the office on time. It turns out the reason the parent was late is because the child was vomiting all over the place before getting in the car—the best laid plans to arrive at the office on time went awry due to unpredictable circumstances. Or, there was an accident and traffic was re-routed, causing the drive to take longer than usual. Or, the roads were icy. Or, they were just late—but it really isn’t the fault of the 5 year old with the high fever.
2. An appointment was given for one child, but it turns out the sibling is also ill and needs to be seen. Mom is looking stressed and near tears, she won’t have a car that afternoon to bring the sibling back. I don’t have the chart, and have to request it. This is a really common scenario. I am asked to see siblings, or “just take a quick look in the ears,” or “just answer a quick question about brother’s potty training” many times throughout the day. How would you feel if you were in this Mom’s position? I don’t think you would be very happy if your pediatrician said “No, I’m sorry Mrs. Smith, next time you should think ahead and schedule another appointment for little Johnny. Have a nice day.” It would help me if parents could alert my nursing or front desk staff ahead of time so I could have the sibling’s chart, and so I could be aware from the onset that I must divide my time between two kids instead of using all the time for one. But it’s not very likely that I am going to refuse to see a sibling if it is for a simple illness such as a potential ear infection. Adding on another child (or even just a conversation about another child) at the end of the first child’s appointment may take an extra five to ten minutes. If I know about it ahead of time I can be more efficient.
3. A middle-school student is in the office for a sore throat. I do a brief history and physical exam, get a throat swab, and step out while the test runs. I return to inform the family the child has strep, discuss the illness, and write the prescription. I write a note to excuse the student from school, and another to explain the parent’s absence from work. As I get up to leave the parent asks their child to step out because they want to discuss something privately with the doctor. At this point I had thought we were finished with the appointment. But the conversation reveals that the patient is having some serious mental health problems and the parent needs some advice TODAY. This part of the visit turns out to be more important than the strep throat, and yes, it will put me 10 to 15 minutes behind in my schedule. Again, if I had known ahead of time I could have planned better—perhaps having this discussion while we waited for the strep test to run—but I can’t turn this person away just because the problem wasn’t scheduled into my day.
4. A teenager was given a ten minute appointment for the primary complaint of a sore throat. When I get to the room she tells me that she was too embarrassed to say anything to the receptionist, but actually she is having problems with her periods. By the way, she has also recently become sexually active, and is worried about STDs and pregnancy prevention. Obviously we could have allotted more time if we had known all of these issues, but isn’t it understandable why she had trouble telling this to the receptionist? Maybe her dad made the appointment for her, and he is sitting in the waiting room right now wondering if she has strep throat or mono. Meanwhile I am having a completely different conversation with his daughter. And then I will have to reach an agreement with the teenager about how we are going to talk about this with her dad, then dad has to come in and we have another conversation. This will add 15 to 20 minutes to the scheduled 10 minute appointment.
5. A two year old is in the office at 2pm because of two to three days of fever and fatigue. The usual ten minute time slot was allotted for this basic, acute illness. During the exam it quickly becomes apparent she will need to be hospitalized. She is so pale and lethargic that it is clear something is seriously wrong. Now it is 2:12pm (her appt. technically ended at 2:10). I must arrange for her hospital admission. This will involve conferring with my office staff (five minutes), possibly collaborating with another doctor at my office to inform them of the admission and get their opinion (five to ten minutes), talking with other doctors and nurses at the hospital (minimum of ten minutes, may involve more than one phone call), and discussing the possible diagnosis with the child’s family and explaining the diagnostic and treatment plan to them (ten-twenty minutes). Now I am ending this child’s appointment at least 30 minutes (up to 50 minutes) after it had been scheduled to end. To those who are waiting, and feeling frustrated and annoyed, all I can say here is that I would give your child the same time and attention if they were seriously ill.
6. Another scenario is the “by the way, doctor” that is added on as I am walking out the door. This could be a list of questions from the patient who hardly ever comes into the office, is here today, and needs some answers. Or, it could be a behavioral question about a preschooler, or a potty training question for a two year old. It could be questions regarding when to think about ADHD, school problems, how to handle a child’s grief over their grandparent’s death, how to help a child through their parents’ divorce, what to do about bed-wetting/constipation/soiling the underpants, how to get a child to sleep better, etc. Many parents wouldn’t think of making a separate appointment for these questions, but they are important topics that will take at least a few minutes of my time. It is always helpful if a parent can help me plan the time in the office visit by saying at the beginning of the appointment something like: “We are here because we suspect an ear infection, but I also wanted to ask you a question about potty training.” Or, “we made the appointment for back pain, but we have seven other things on our list to ask you about.” For those with a long list I will probably then ask them to prioritize in order of importance, and tell them at the beginning that they have a ten minute appointment and we may have to reschedule to discuss some of the other problems. If I don’t know about the list until I am finished evaluating the primary complaint it affects my schedule more.
I think there were at least four more scenarios in my original blog on this topic. There is enough here, however, to give you a general idea of how and why I can get off schedule. There are also some things you can do to help me stay on schedule. These would include providing accurate information to the scheduler about the main reason, and any other secondary reasons, for the appointment (including how long the symptoms have been present), letting me know at the beginning of the appointment about everything you want to discuss, and informing my office staff that you are planning to have me check a sibling in addition to the child who originally was scheduled for an appointment.
To those of you who simply cannot tolerate waiting, or who have such a tight schedule that it isn’t possible to run late, you might consider booking your appointments as early as possible in the morning or first thing in the afternoon. In general it is more likely I will be running behind as it gets to be later in the day. And my pledge to you is that I will continue to work on staying on schedule and being efficient during my office day—while still striving to treat each patient as an individual who may have important and unexpected needs. Ultimately I will try to treat each family as I would want someone to handle my own.
Showing posts with label Check-ups. Show all posts
Showing posts with label Check-ups. Show all posts
Monday, May 23, 2011
Wednesday, May 18, 2011
HPV Vaccination: Prevent Cancer!
Yes, it’s time to talk about another vaccine. I guess I really love this topic, or perhaps it’s just that I think it’s really important. The one I’m referring to this time is the Human Papilloma Virus (HPV) Vaccine. The purpose of this vaccine is to prevent genital (including cervical) and anal cancers, and genital warts. I recommend this vaccine for all middle school students. My oldest child started the series at age 12 and was fully vaccinated at 13.
One commonly recognized brand of this vaccine is Gardisil, which prevents four types of HPV: HPV 6 and 11, which cause genital warts, and HPV 16 and 18, which cause anal and genital cancer and precancer. A more newly released vaccine is Cervarix. It covers HPV 16 and 18. Neither vaccine covers all forms of cancer-causing HPV, but HPV 16 and 18 cause approximately 2/3 of cervical cancers.
Have you heard of Human Papilloma Virus? Did you know that the lifetime risk of becoming infected with this virus is 80%? Are you aware that approximately 20 million people in the USA are infected with the virus? And 18% of 14 to 19 year-old girls are infected? Did you know the virus causes cervical cancer, anorectal cancer, and genital warts? Yuck, right? It’s a sexually transmitted disease (STD) that causes cancer and is PREVENTABLE.
The vaccine was introduced to the general public in 2006. By 2009 44.3% of adolescent girls in the United States had received at least one dose of HPV vaccine, and 26.7% had received all three recommended doses. In Australia, during the first year of a national HPV vaccination program, 75 to 80% of targeted girls had received all three doses! The vaccine is now recommended for girls AND boys, ages 9 to 26.
The vaccine has a good track record when it comes to side effects. Adverse effects shown to be caused by the vaccine are headaches, low-grade fevers, and a sore arm. Adolescents have been known to faint after receiving the vaccine. This reaction can be seen after any vaccine given to an adolescent, and is not limited to the HPV vaccine. Claims of more serious adverse effects have not been substantiated or shown scientifically to be more common in vaccine recipients than in the general public. You can find complaints about the vaccine on the internet, of course, but much of this is hearsay or linked to attempts at legal action.
Why is the vaccination rate so low? The vaccine prevents CANCER! What I hear from my patients’ parents are comments such as these: “We’re not going to give THAT vaccine.” “It’s too new.” “My daughter doesn’t need it because she isn’t going to have sex before marriage.” “If we give the vaccine then my child will think it’s ok to have sex.” “It hasn’t been around long enough for me to feel comfortable.” “I don’t know how long the immunity will last, so I want to wait until my child is older.”
I would like to respond to these comments.
1. First of all, scientific studies have shown that a fairly high percentage of kids ages 14 to 19 are already infected with the HPV virus (18% of girls in one study), so it is quite possible your child could be exposed to the virus during his or her teen years. Waiting until they are older could mean they become infected with the virus before they receive the vaccine. And you don’t have to have sexual intercourse to become infected. HPV can be transmitted via oral sex (among other ways) too! Also, there is evidence that there is more long-lasting immunity when the vaccine is given at a younger age.
2. Studies that have examined the rate of sexual activity among teenagers have shown that providing information about STD and pregnancy prevention, and even handing out condoms, has not led to an increased number of teenagers having sex. To me, therefore, it seems unlikely that giving the HPV vaccine will cause teenagers to become promiscuous.
3. Millions of doses of HPV vaccine have been administered to date, with proven safety. The vaccine is not new; it has been given to the general public since 2006.
4. Perhaps your child will wait to become sexually active until they are married. After all, you waited, right? But you don’t get to control the sexual activity of your child’s potential spouse. HPV infection (except in the case of genital warts) is not visible to the naked eye, and there is no test that can tell you if someone is infected with it.
5. I don’t want to offend anyone, here. But you should know that it is fairly common for me to see teenagers in my office who are having sex, and I don’t think most of their parents know they are sexually active. Don’t be naive. A 2002 study showed that by ages 15, 16, and 17 30-50% of teenagers were already having sexual intercourse! Talk about relationships, values and expectations with your child. But protect their health. I, too, don’t want my daughters (and I would say sons, if I had a son!) to become sexually active at such a tender age—but I will take a practical approach when it comes to preventing such a serious disease as cancer.
One commonly recognized brand of this vaccine is Gardisil, which prevents four types of HPV: HPV 6 and 11, which cause genital warts, and HPV 16 and 18, which cause anal and genital cancer and precancer. A more newly released vaccine is Cervarix. It covers HPV 16 and 18. Neither vaccine covers all forms of cancer-causing HPV, but HPV 16 and 18 cause approximately 2/3 of cervical cancers.
Have you heard of Human Papilloma Virus? Did you know that the lifetime risk of becoming infected with this virus is 80%? Are you aware that approximately 20 million people in the USA are infected with the virus? And 18% of 14 to 19 year-old girls are infected? Did you know the virus causes cervical cancer, anorectal cancer, and genital warts? Yuck, right? It’s a sexually transmitted disease (STD) that causes cancer and is PREVENTABLE.
The vaccine was introduced to the general public in 2006. By 2009 44.3% of adolescent girls in the United States had received at least one dose of HPV vaccine, and 26.7% had received all three recommended doses. In Australia, during the first year of a national HPV vaccination program, 75 to 80% of targeted girls had received all three doses! The vaccine is now recommended for girls AND boys, ages 9 to 26.
The vaccine has a good track record when it comes to side effects. Adverse effects shown to be caused by the vaccine are headaches, low-grade fevers, and a sore arm. Adolescents have been known to faint after receiving the vaccine. This reaction can be seen after any vaccine given to an adolescent, and is not limited to the HPV vaccine. Claims of more serious adverse effects have not been substantiated or shown scientifically to be more common in vaccine recipients than in the general public. You can find complaints about the vaccine on the internet, of course, but much of this is hearsay or linked to attempts at legal action.
Why is the vaccination rate so low? The vaccine prevents CANCER! What I hear from my patients’ parents are comments such as these: “We’re not going to give THAT vaccine.” “It’s too new.” “My daughter doesn’t need it because she isn’t going to have sex before marriage.” “If we give the vaccine then my child will think it’s ok to have sex.” “It hasn’t been around long enough for me to feel comfortable.” “I don’t know how long the immunity will last, so I want to wait until my child is older.”
I would like to respond to these comments.
1. First of all, scientific studies have shown that a fairly high percentage of kids ages 14 to 19 are already infected with the HPV virus (18% of girls in one study), so it is quite possible your child could be exposed to the virus during his or her teen years. Waiting until they are older could mean they become infected with the virus before they receive the vaccine. And you don’t have to have sexual intercourse to become infected. HPV can be transmitted via oral sex (among other ways) too! Also, there is evidence that there is more long-lasting immunity when the vaccine is given at a younger age.
2. Studies that have examined the rate of sexual activity among teenagers have shown that providing information about STD and pregnancy prevention, and even handing out condoms, has not led to an increased number of teenagers having sex. To me, therefore, it seems unlikely that giving the HPV vaccine will cause teenagers to become promiscuous.
3. Millions of doses of HPV vaccine have been administered to date, with proven safety. The vaccine is not new; it has been given to the general public since 2006.
4. Perhaps your child will wait to become sexually active until they are married. After all, you waited, right? But you don’t get to control the sexual activity of your child’s potential spouse. HPV infection (except in the case of genital warts) is not visible to the naked eye, and there is no test that can tell you if someone is infected with it.
5. I don’t want to offend anyone, here. But you should know that it is fairly common for me to see teenagers in my office who are having sex, and I don’t think most of their parents know they are sexually active. Don’t be naive. A 2002 study showed that by ages 15, 16, and 17 30-50% of teenagers were already having sexual intercourse! Talk about relationships, values and expectations with your child. But protect their health. I, too, don’t want my daughters (and I would say sons, if I had a son!) to become sexually active at such a tender age—but I will take a practical approach when it comes to preventing such a serious disease as cancer.
Friday, July 23, 2010
Why Bother with a Regular Check-up?
It's summer! In my office there is less coughing, and more bug bites. Poison ivy, sunburn, heat rash, cuts, scrapes, swimmer's ear, allergies, and swimmer's itch all make themselves known again. While in the winter months I have to move fast in order to tend to a larger group of younger sick children, in the summer I have more time scheduled to devote to physical exams for school-age children and teenagers.
Regular check-ups are important. They establish a good doctor-patient relationship, empower children by helping them understand their bodies, screen for important health problems, monitor ongoing illnesses, and address new concerns.
I love having the opportunity to spend more time with my patients and listen to their concerns. I think that seeing usually healthy children and teens regularly (at least every two years after age five) gives me the chance to establish a solid, health-enhancing relationship with my patients. A relationship like this is based on familiarity, good communication, accurate expectations of what will happen in the office visit, and trust.
For a perfectly healthy child a physical exam can be a boost to her self-esteem by showing how well she grew and gained weight over the last year or two. It can be interesting to find out what the blood pressure means, and that a normal blood pressure is a good sign that her heart is healthy. These very personal bits of data can make a child feel strong and healthy, proud of himself and his ability to take care of his body. I believe that regular, positive interactions with his own doctor can be empowering for a child, laying the footing for him taking responsibility for his own health for a lifetime.
At a regular check-up I can reinforce what many parents are already telling their children. I emphasize the importance of eating fruits and vegetables, and of limiting time in front of a TV or other "screens". I talk about safety, such as wearing a bike helmet or seat belt. For older children and teens I might discuss how the choices they make and the influence of their peer group can affect their health. I also talk about hygiene! Including deodorant, showers, washing hair and faces, and shaving.
I talk about puberty at check-ups. Most pre-teens and teens want to know if their body is developing normally, how it compares to other kids their age, whether things are too big or too small, if it's starting too early or too late, or when certain events are likely to happen. Normally, for girls, I talk with parents at their daughter's age of seven about the eventuality of breast development--something that can start to happen close to age nine. At nine I start talking to girls directly about this topic, at whatever level they might need (maybe their friends are wearing bras, maybe they need a bra, maybe they don't know where to get a bra, why they might want to wear one, etc.). And my discussion becomes more advanced as the patient gets older.
A check-up involves checking all parts of the body. If a child has been having regular check-ups with me from the beginning, this is not a surprise to them. After all, I've been checking their private parts since they were born, why would I stop checking once they are five, or seven, or nine, or eleven, or thirteen..? They know I will make sure they have privacy, are covered up, and have only agreed-upon family members in the room. They know how I will check them, how long it will take (usually seconds), and they probably know exactly what I will say. If puberty has started I can also give them an idea of how far into it they are and what will come next.
At my office a check-up includes an external genitalia exam only. Girls would be referred to a gynecologist for a pelvic exam and pap smear if there are problems identified, within two years of becoming sexually active, or by age twenty-one.
One important screening that takes place at a regular check-up is the examination of the spine for scoliosis. Ideally we should identify scoliosis before a child's rapid growth spurt occurs. If I see a child at age five, and then not again until they need a sports physical for high school, it might be too late to treat scoliosis. Screening for normal blood pressure, vision, and growth can identify problems early, as well. Starting at age three we calculate a body mass index (BMI) for every patient during their well visit. This can identify children at risk for obesity. The child's immunization record is reviewed, and anything needed will be given at the end of the check-up.
For a child who has a chronic illness, or takes regular medication for a condition, a check-up will include a review of that condition. I will look at the impact of that condition on the child's health over the last year, evaluate the severity of the condition and the need for any further evaluation or adjustment in treatment. I will refill necessary medications.
Sometimes a patient has a new problem being brought up during a regular well exam. The detail involved in the well exam helps establish a better context for the problem. Sometimes the regular questions and information provided in an otherwise healthy child well exam must be abbreviated to properly address the new problem. There is no specific formula for this, we will do what we must do to address the most important concerns. The complete physical exam would still be performed.
Sports physicals are done along with a regular physical exam. I do not have a separate appointment for a sports physical available. If a teen is there for a sports physical we will do the whole physical exam. Parents and patients will notice that the checklist on the sports physical form is quite comprehensive, and includes all body parts, anyway! If needed, I will complete the forms at the time of the check-up, or up to twenty-four months after the check-up if there have been no changes in health or injury status during that time, and there are no chronic illnesses we have been monitoring.
I have one more thought for you as a parent helping your child on his or her journey to a lifetime of personal responsibility for good health. When do you think you should encourage your child to have a few minutes to talk to the doctor on her own? Usually I have initiated this at age 13, encouraging parents to wait in the waiting room (not just the hallway) while I do the physical examination part of the visit.
By high school I really think it is a good idea for the teenager to have a little time with the doctor without a parent present. Teenagers, who are now thinking for themselves, need to learn how to talk to, and listen to a doctor. Parents, this means you might have to trust me to talk to your teen alone. Why would you bring your child to me if you don't trust me? When I talk to your teen the discussion will be focused on establishing rapport, on physical and mental health, on making good choices, and on bringing family and parent-teen relationships together. By having you (the parent) out of the room it is very likely that I will be reinforcing things you have already discussed with your teen. You will look much smarter and more reliable to your teen if he realizes the same information is coming from the doctor!
So, call and schedule your child's well exam soon. Get on at least an every other year schedule (every year for monitoring chronic conditions). Let's think long term about promoting a healthy life for your child. And yes, I will read those little notes you pass to me secretly before the check-up and along with my usual advice I will emphasize whatever health rule you think needs a little extra reinforcement at home.
Regular check-ups are important. They establish a good doctor-patient relationship, empower children by helping them understand their bodies, screen for important health problems, monitor ongoing illnesses, and address new concerns.
I love having the opportunity to spend more time with my patients and listen to their concerns. I think that seeing usually healthy children and teens regularly (at least every two years after age five) gives me the chance to establish a solid, health-enhancing relationship with my patients. A relationship like this is based on familiarity, good communication, accurate expectations of what will happen in the office visit, and trust.
For a perfectly healthy child a physical exam can be a boost to her self-esteem by showing how well she grew and gained weight over the last year or two. It can be interesting to find out what the blood pressure means, and that a normal blood pressure is a good sign that her heart is healthy. These very personal bits of data can make a child feel strong and healthy, proud of himself and his ability to take care of his body. I believe that regular, positive interactions with his own doctor can be empowering for a child, laying the footing for him taking responsibility for his own health for a lifetime.
At a regular check-up I can reinforce what many parents are already telling their children. I emphasize the importance of eating fruits and vegetables, and of limiting time in front of a TV or other "screens". I talk about safety, such as wearing a bike helmet or seat belt. For older children and teens I might discuss how the choices they make and the influence of their peer group can affect their health. I also talk about hygiene! Including deodorant, showers, washing hair and faces, and shaving.
I talk about puberty at check-ups. Most pre-teens and teens want to know if their body is developing normally, how it compares to other kids their age, whether things are too big or too small, if it's starting too early or too late, or when certain events are likely to happen. Normally, for girls, I talk with parents at their daughter's age of seven about the eventuality of breast development--something that can start to happen close to age nine. At nine I start talking to girls directly about this topic, at whatever level they might need (maybe their friends are wearing bras, maybe they need a bra, maybe they don't know where to get a bra, why they might want to wear one, etc.). And my discussion becomes more advanced as the patient gets older.
A check-up involves checking all parts of the body. If a child has been having regular check-ups with me from the beginning, this is not a surprise to them. After all, I've been checking their private parts since they were born, why would I stop checking once they are five, or seven, or nine, or eleven, or thirteen..? They know I will make sure they have privacy, are covered up, and have only agreed-upon family members in the room. They know how I will check them, how long it will take (usually seconds), and they probably know exactly what I will say. If puberty has started I can also give them an idea of how far into it they are and what will come next.
At my office a check-up includes an external genitalia exam only. Girls would be referred to a gynecologist for a pelvic exam and pap smear if there are problems identified, within two years of becoming sexually active, or by age twenty-one.
One important screening that takes place at a regular check-up is the examination of the spine for scoliosis. Ideally we should identify scoliosis before a child's rapid growth spurt occurs. If I see a child at age five, and then not again until they need a sports physical for high school, it might be too late to treat scoliosis. Screening for normal blood pressure, vision, and growth can identify problems early, as well. Starting at age three we calculate a body mass index (BMI) for every patient during their well visit. This can identify children at risk for obesity. The child's immunization record is reviewed, and anything needed will be given at the end of the check-up.
For a child who has a chronic illness, or takes regular medication for a condition, a check-up will include a review of that condition. I will look at the impact of that condition on the child's health over the last year, evaluate the severity of the condition and the need for any further evaluation or adjustment in treatment. I will refill necessary medications.
Sometimes a patient has a new problem being brought up during a regular well exam. The detail involved in the well exam helps establish a better context for the problem. Sometimes the regular questions and information provided in an otherwise healthy child well exam must be abbreviated to properly address the new problem. There is no specific formula for this, we will do what we must do to address the most important concerns. The complete physical exam would still be performed.
Sports physicals are done along with a regular physical exam. I do not have a separate appointment for a sports physical available. If a teen is there for a sports physical we will do the whole physical exam. Parents and patients will notice that the checklist on the sports physical form is quite comprehensive, and includes all body parts, anyway! If needed, I will complete the forms at the time of the check-up, or up to twenty-four months after the check-up if there have been no changes in health or injury status during that time, and there are no chronic illnesses we have been monitoring.
I have one more thought for you as a parent helping your child on his or her journey to a lifetime of personal responsibility for good health. When do you think you should encourage your child to have a few minutes to talk to the doctor on her own? Usually I have initiated this at age 13, encouraging parents to wait in the waiting room (not just the hallway) while I do the physical examination part of the visit.
By high school I really think it is a good idea for the teenager to have a little time with the doctor without a parent present. Teenagers, who are now thinking for themselves, need to learn how to talk to, and listen to a doctor. Parents, this means you might have to trust me to talk to your teen alone. Why would you bring your child to me if you don't trust me? When I talk to your teen the discussion will be focused on establishing rapport, on physical and mental health, on making good choices, and on bringing family and parent-teen relationships together. By having you (the parent) out of the room it is very likely that I will be reinforcing things you have already discussed with your teen. You will look much smarter and more reliable to your teen if he realizes the same information is coming from the doctor!
So, call and schedule your child's well exam soon. Get on at least an every other year schedule (every year for monitoring chronic conditions). Let's think long term about promoting a healthy life for your child. And yes, I will read those little notes you pass to me secretly before the check-up and along with my usual advice I will emphasize whatever health rule you think needs a little extra reinforcement at home.
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