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 Doctor patient relationship. Show all posts
Showing posts with label Doctor patient relationship. Show all posts
Monday, May 23, 2011
Saturday, May 21, 2011
Why Do Doctors Run Late?
You know how it is, right? You’re sitting in the waiting room with your child, bored out of your mind, while snotty nosed toddlers cough, sneeze, and wipe their boogers on every imaginable surface, including you and your previously healthy baby. You wonder if you have been forgotten, it has been 20 minutes, then 30. Finally you are escorted to an exam room, told the doctor will be with you shortly, and the door is closed. Claustrophobia sets in. It’s warm and stuffy, and there is no window. Your children turn into unrecognizable beings that must belong to someone else. They open drawers, pull out tongue depressors, rip off exam table paper, and spill crackers on the floor. Someone has to go potty. You’re not sure if you have time to make it to the bathroom and back—what if the doctor comes in right then? Finally you open the door to make sure they still remember you are here, take a step into the hallway to find the potty, and there I am—it’s your turn!
I have looked at my own schedule many times. While I can’t answer the question of why other doctors run behind on their schedules I have thought a lot about why I might get behind. I do understand it better, and have made improvements, but as many of you know, I have not solved this problem after fourteen years in private practice!
Why do I sometimes run behind in my schedule? From day-to-day this is the one thing that causes me a great deal of stomach churning, acid refluxing, and gut flip-flopping, head-aching stress! Often I will think back on my day, and if I have stayed close to my schedule and not finished too late it has been a good day. If I’ve run behind I’ll end the day feeling frazzled and out of breath, apologizing to everyone, and will go home to tell my family what an awful day I had.
One message I would like you to take home from this blog post is that I really do care about your schedule. I hate making people wait for me, and I am thinking about it constantly throughout the day.
I have done audits on myself. I’ll take several days and write down my starting and ending time for each appointment, and then compare it to my schedule. While it is fresh in my mind I’ll jot down any special circumstances that might have made an appointment start or end at a different time than it was scheduled. The first time I did this I was trying to find the one problem I was having that would explain getting off schedule. There must be something simple that could be adjusted, right? Perhaps it is just an improper scheduling issue?
What I have found when I audit myself is that there are MANY reasons I can get behind in a day. Most of them are UNPREDICTABLE. Most of them are UNAVOIDABLE if I am to provide good quality patient care. You must understand that it is my goal to provide the best possible care to each child in my office. I cannot sacrifice good care in favor of staying on schedule. I do set priorities each day, and at times cannot satisfy every need a patient has in one office visit.
Let me give you some examples of where things can go wrong, and why you might end up waiting for me. I, of course, have changed these scenarios to protect the privacy of my patients, but you will understand the general principles. I will use my NEXT blog to go into more detail about why each of these can affect my schedule so much, why I don’t think there are simple answers to each schedule-wrecking situation, what I do to try to keep myself on track, and what parents can do to help me stay on schedule.
1. My first patient of the morning is seven minutes late.
2. An appointment was given for one child, but it turns out the sibling is also ill and needs to be seen.
3. A middle-school student is in the office for a sore throat. After the office visit is completed, and I get up to leave, the parent asks their child to step out because they want to discuss something privately with the doctor
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.
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.
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, potty training, ADHD, a child’s grief, parents’ divorce, bed-wetting/constipation/soiling the underpants, sleep, etc.
7. I was given a ten minute time slot for a patient with apparently just two days of headache, but actually it turns out this problem has been going on for more than a year, and also there has been ongoing problems with abdominal pain.
8. During one office day I received several phone calls from the hospital to tell me urgent things about patients in the hospital. I am interrupted from office visits with patients to take these calls.
9. My eight year old patient won’t cooperate for a strep test.
10. Someone walked in with an injury needing urgent treatment and didn’t have an appointment.
I will probably think of more. On any one day my schedule can probably handle one or two of these without disastrous effects. But some days, especially if there is an admission to the hospital, I just end up terribly behind. I can tell you that when auditing myself I see many different reasons throughout the day to explain how my schedule went awry. Sometimes there is a single thing, such as the hospital admission, that explains everything. But more often it is many different situations throughout the day which add up to put me behind. And I am certainly not just standing around drinking coffee or chatting on the phone with my mother while you are waiting for me.
As a parent there are things you can do to get your questions and needs addressed while still helping me to stay on track. There are times in the day when I am less likely to be behind in my schedule. And if, to you, the above scenarios seem easy to solve—then wait for my next blog and I’ll explain why they might be more complicated than they appear at first glance.
I have looked at my own schedule many times. While I can’t answer the question of why other doctors run behind on their schedules I have thought a lot about why I might get behind. I do understand it better, and have made improvements, but as many of you know, I have not solved this problem after fourteen years in private practice!
Why do I sometimes run behind in my schedule? From day-to-day this is the one thing that causes me a great deal of stomach churning, acid refluxing, and gut flip-flopping, head-aching stress! Often I will think back on my day, and if I have stayed close to my schedule and not finished too late it has been a good day. If I’ve run behind I’ll end the day feeling frazzled and out of breath, apologizing to everyone, and will go home to tell my family what an awful day I had.
One message I would like you to take home from this blog post is that I really do care about your schedule. I hate making people wait for me, and I am thinking about it constantly throughout the day.
I have done audits on myself. I’ll take several days and write down my starting and ending time for each appointment, and then compare it to my schedule. While it is fresh in my mind I’ll jot down any special circumstances that might have made an appointment start or end at a different time than it was scheduled. The first time I did this I was trying to find the one problem I was having that would explain getting off schedule. There must be something simple that could be adjusted, right? Perhaps it is just an improper scheduling issue?
What I have found when I audit myself is that there are MANY reasons I can get behind in a day. Most of them are UNPREDICTABLE. Most of them are UNAVOIDABLE if I am to provide good quality patient care. You must understand that it is my goal to provide the best possible care to each child in my office. I cannot sacrifice good care in favor of staying on schedule. I do set priorities each day, and at times cannot satisfy every need a patient has in one office visit.
Let me give you some examples of where things can go wrong, and why you might end up waiting for me. I, of course, have changed these scenarios to protect the privacy of my patients, but you will understand the general principles. I will use my NEXT blog to go into more detail about why each of these can affect my schedule so much, why I don’t think there are simple answers to each schedule-wrecking situation, what I do to try to keep myself on track, and what parents can do to help me stay on schedule.
1. My first patient of the morning is seven minutes late.
2. An appointment was given for one child, but it turns out the sibling is also ill and needs to be seen.
3. A middle-school student is in the office for a sore throat. After the office visit is completed, and I get up to leave, the parent asks their child to step out because they want to discuss something privately with the doctor
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.
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.
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, potty training, ADHD, a child’s grief, parents’ divorce, bed-wetting/constipation/soiling the underpants, sleep, etc.
7. I was given a ten minute time slot for a patient with apparently just two days of headache, but actually it turns out this problem has been going on for more than a year, and also there has been ongoing problems with abdominal pain.
8. During one office day I received several phone calls from the hospital to tell me urgent things about patients in the hospital. I am interrupted from office visits with patients to take these calls.
9. My eight year old patient won’t cooperate for a strep test.
10. Someone walked in with an injury needing urgent treatment and didn’t have an appointment.
I will probably think of more. On any one day my schedule can probably handle one or two of these without disastrous effects. But some days, especially if there is an admission to the hospital, I just end up terribly behind. I can tell you that when auditing myself I see many different reasons throughout the day to explain how my schedule went awry. Sometimes there is a single thing, such as the hospital admission, that explains everything. But more often it is many different situations throughout the day which add up to put me behind. And I am certainly not just standing around drinking coffee or chatting on the phone with my mother while you are waiting for me.
As a parent there are things you can do to get your questions and needs addressed while still helping me to stay on track. There are times in the day when I am less likely to be behind in my schedule. And if, to you, the above scenarios seem easy to solve—then wait for my next blog and I’ll explain why they might be more complicated than they appear at first glance.
Sunday, November 28, 2010
My Advice on Immunizations
Here is the blog I've been dreading, avoiding, and wishing I didn't have to write. It SHOULD be an easy one for me because it is a topic I know well, discuss daily, and am quite clear on where I stand--which is YES, you should fully vaccinate your child, on time, using the schedule recommended by the ACIP (Advisory Committee on Immunization Practices), AAP (American Academy of Pediatrics), and CDC (Centers for Disease Control), and endorsed by me and my colleagues in my pediatric practice. In fact, I believe that immunizing children is one of the most important contributions I can make to maintaining, or even improving an individual child's health as well as a vital contribution to the health of my community.
To me, this is a "no doubt about it" kind of recommendation. It's not an easy subject to write about, however, because it has become controversial. I don't like to have conflicts with families in my practice, or even with parents trying to decide if they should choose me as their pediatrician. It's hard for me to have to disagree. I don't think I'm very good at presenting my opposing point of view in a tactful way. I don't want to offend anyone, or make them feel bad. Still, I am going to write this blog, and I am going to be very clear about my recommendations for vaccinating your child.
I am asked daily to comment on the following questions or statements:
To vaccinate, or not to vaccinate...? Which vaccines are "the most important?" Do vaccines cause autism? What about thimerosol? What about mercury? Tell me about aluminum in vaccines? We were told at our new baby class to ask prospective pediatricians about vaccinations... Don't babies get too many vaccines these days? I don't what to overwhelm their immune system... We aren't taking the baby to day care, so they won't get exposed to any of these diseases. Can you look at this "alternative" vaccine schedule and make recommendations? We are going to vaccinate, we just want to "delay" the vaccines. The diseases we vaccinate for are pretty rare, right? I don't want to do anything that might hurt my child.
These are only some of the questions that come up every day. And it's understandable. After all, you should be an informed health care consumer, right? You just want to do the right thing. And vaccines are a hot topic right now for new parents. Many parents would feel they are not doing their job if they don't ask about or question their pediatrician about vaccines. However, in having these discussions, and responding to all of these details, I think we can lose sight of our goal (which, in my opinion, is a healthy and safe child).
I often get the impression that parents believe I am blindly following vaccine schedule recommendations, just spouting the "party line." When this happens, I don't think I am being given enough credit for doing my job. It is my responsibility to know about each disease and each immunization given to prevent the disease. I take this responsibility seriously.
My colleagues and I have built a schedule of vaccines for our patients that will effectively immunize them at the time when they are at most risk for the diseases. We regularly review this schedule, the type of vaccines we provide, and the benefits versus risk of every vaccine. Our decisions are made based upon scientific evidence, meaning they are supported by deliberate testing and study of the effects of each vaccine. We then recommend a routine vaccination schedule that we have created or actively given our endorsement. This schedule takes into account which vaccines can be given at the same time (to ensure a good immune response while minimizing potential side effects), proper intervals between vaccines, appropriate ages to give vaccines, and the number of actual injections given each time a patient is vaccinated. It becomes a routine part of our well child visits. Having a routine schedule helps minimize the possibility of errors such as a vaccine given at the wrong interval, or age.
Benefit versus risk is an important concept to think about. There are very few things we do that are without risk. We get used to certain risks and simply live with them. Common activities that involve some degree of risk include transporting our child in a car (what if there were an accident?), living in our homes (potential exposure to lead, radon, or carbon monoxide, burns from the stove, hot coffee, or curling irons, cuts needing stitches from falls against coffee tables, falls down the stairs...), taking any kind of medication (acetaminophen carries the rare risk of liver damage, ibuprofen can cause anaphylaxis in those who are allergic, or rarely can damage the kidneys, amoxicillin or any other antibiotic can cause an allergic reaction in some people), and allowing our children to play outdoors or participate in sports (the monkey bars are one of the most common sources of fractures in children, trampolines can lead to neck and spine injuries as well as fractures in the legs, head injuries occur all the time in sports and from falls (especially when unhelmeted) off of bikes/skateboards/scooters). There must be some kind of benefit that outweighs the risks involved in these activities, or we wouldn't be able to allow our children to live a "normal" life!
In thinking about vaccines you should think about benefit versus risk. Like any medication there are some small risks, and for most vaccines these risks are fever and the possibility of an allergic reaction. However, the benefits of the vaccines far outweigh any risk they present to a child. In looking at risks and benefits I think it is important to look at scientific evidence, not anecdotal reports. Anecdotal reports are the reports of a few individuals who tell their own story, these people may or may not have any background qualifications to lend credibility to their claims. Scientific evidence, on the other hand, is the result of deliberate study of the effects of an intervention or treatment (such as a vaccine). Scientific evidence is subject to peer review (scientific experts evaluating the evidence and methods of study), and to statistical evaluation to determine if the results could just be due to chance.
I think your child deserves to be treated according to recommendations made using scientific evidence. As an experienced, board-certified, pediatrician it is my job to do the best I can to provide this kind of care. I also think that you should expect your pediatrician to provide, at a minimum, the same level and quality of care that she would want for her own children. And my children were fully vaccinated, on time, in accordance with our recommended schedule of vaccines.
In writing this blog I also have to say something about trust, and the doctor-patient relationship. Do you trust your pediatrician? Do you value her advice on growth, developmental milestones, sleep habits and position, feeding issues, how to start solid food, pacifiers, thumbsucking, stooling, urinating, behavioral concerns, potty training, car seat recommendations, among other issues often discussed at well exams? Do you call your pediatrician for advice on what to do when your child has a fever, is vomiting, or is otherwise ill? Do you take your ill child to be evaluated by your pediatrician, and place your trust in her to determine what is wrong and how best to treat it? Do you value all of your pediatrician's education, training, ongoing efforts to keep up with current science, and her expertise in helping you raise a healthy child? If you do, then why would you so easily dismiss your pediatrician's advice on immunizing your child? And if you don't trust your pediatrician, then why do you keep bringing your child to her office? Isn't preventing meningitis, polio, measles, and pertussis (among others!) more important that the correct order in which to introduce solid food?
If you are inundated with anti-vaccine messages, considering Dr. Sears' advice on delaying or altering the vaccine schedule, feeling overwhelmed and worried about vaccinating your child, and spending a lot of time researching the issue, then you should also look at the case FOR immunizations, and at sources that use scientific evidence to back up their claims. The following websites can be very helpful:
http://www.chop.edu/service/vaccine-education-center/home.html
http://www.cdc.gov/vaccines/
http://www.aap.org/immunization/
And, for an interesting article in the lay press (not a scientific journal):
http://www.wired.com/magazine/2009/10/ff_waronscience
To me, this is a "no doubt about it" kind of recommendation. It's not an easy subject to write about, however, because it has become controversial. I don't like to have conflicts with families in my practice, or even with parents trying to decide if they should choose me as their pediatrician. It's hard for me to have to disagree. I don't think I'm very good at presenting my opposing point of view in a tactful way. I don't want to offend anyone, or make them feel bad. Still, I am going to write this blog, and I am going to be very clear about my recommendations for vaccinating your child.
I am asked daily to comment on the following questions or statements:
To vaccinate, or not to vaccinate...? Which vaccines are "the most important?" Do vaccines cause autism? What about thimerosol? What about mercury? Tell me about aluminum in vaccines? We were told at our new baby class to ask prospective pediatricians about vaccinations... Don't babies get too many vaccines these days? I don't what to overwhelm their immune system... We aren't taking the baby to day care, so they won't get exposed to any of these diseases. Can you look at this "alternative" vaccine schedule and make recommendations? We are going to vaccinate, we just want to "delay" the vaccines. The diseases we vaccinate for are pretty rare, right? I don't want to do anything that might hurt my child.
These are only some of the questions that come up every day. And it's understandable. After all, you should be an informed health care consumer, right? You just want to do the right thing. And vaccines are a hot topic right now for new parents. Many parents would feel they are not doing their job if they don't ask about or question their pediatrician about vaccines. However, in having these discussions, and responding to all of these details, I think we can lose sight of our goal (which, in my opinion, is a healthy and safe child).
I often get the impression that parents believe I am blindly following vaccine schedule recommendations, just spouting the "party line." When this happens, I don't think I am being given enough credit for doing my job. It is my responsibility to know about each disease and each immunization given to prevent the disease. I take this responsibility seriously.
My colleagues and I have built a schedule of vaccines for our patients that will effectively immunize them at the time when they are at most risk for the diseases. We regularly review this schedule, the type of vaccines we provide, and the benefits versus risk of every vaccine. Our decisions are made based upon scientific evidence, meaning they are supported by deliberate testing and study of the effects of each vaccine. We then recommend a routine vaccination schedule that we have created or actively given our endorsement. This schedule takes into account which vaccines can be given at the same time (to ensure a good immune response while minimizing potential side effects), proper intervals between vaccines, appropriate ages to give vaccines, and the number of actual injections given each time a patient is vaccinated. It becomes a routine part of our well child visits. Having a routine schedule helps minimize the possibility of errors such as a vaccine given at the wrong interval, or age.
Benefit versus risk is an important concept to think about. There are very few things we do that are without risk. We get used to certain risks and simply live with them. Common activities that involve some degree of risk include transporting our child in a car (what if there were an accident?), living in our homes (potential exposure to lead, radon, or carbon monoxide, burns from the stove, hot coffee, or curling irons, cuts needing stitches from falls against coffee tables, falls down the stairs...), taking any kind of medication (acetaminophen carries the rare risk of liver damage, ibuprofen can cause anaphylaxis in those who are allergic, or rarely can damage the kidneys, amoxicillin or any other antibiotic can cause an allergic reaction in some people), and allowing our children to play outdoors or participate in sports (the monkey bars are one of the most common sources of fractures in children, trampolines can lead to neck and spine injuries as well as fractures in the legs, head injuries occur all the time in sports and from falls (especially when unhelmeted) off of bikes/skateboards/scooters). There must be some kind of benefit that outweighs the risks involved in these activities, or we wouldn't be able to allow our children to live a "normal" life!
In thinking about vaccines you should think about benefit versus risk. Like any medication there are some small risks, and for most vaccines these risks are fever and the possibility of an allergic reaction. However, the benefits of the vaccines far outweigh any risk they present to a child. In looking at risks and benefits I think it is important to look at scientific evidence, not anecdotal reports. Anecdotal reports are the reports of a few individuals who tell their own story, these people may or may not have any background qualifications to lend credibility to their claims. Scientific evidence, on the other hand, is the result of deliberate study of the effects of an intervention or treatment (such as a vaccine). Scientific evidence is subject to peer review (scientific experts evaluating the evidence and methods of study), and to statistical evaluation to determine if the results could just be due to chance.
I think your child deserves to be treated according to recommendations made using scientific evidence. As an experienced, board-certified, pediatrician it is my job to do the best I can to provide this kind of care. I also think that you should expect your pediatrician to provide, at a minimum, the same level and quality of care that she would want for her own children. And my children were fully vaccinated, on time, in accordance with our recommended schedule of vaccines.
In writing this blog I also have to say something about trust, and the doctor-patient relationship. Do you trust your pediatrician? Do you value her advice on growth, developmental milestones, sleep habits and position, feeding issues, how to start solid food, pacifiers, thumbsucking, stooling, urinating, behavioral concerns, potty training, car seat recommendations, among other issues often discussed at well exams? Do you call your pediatrician for advice on what to do when your child has a fever, is vomiting, or is otherwise ill? Do you take your ill child to be evaluated by your pediatrician, and place your trust in her to determine what is wrong and how best to treat it? Do you value all of your pediatrician's education, training, ongoing efforts to keep up with current science, and her expertise in helping you raise a healthy child? If you do, then why would you so easily dismiss your pediatrician's advice on immunizing your child? And if you don't trust your pediatrician, then why do you keep bringing your child to her office? Isn't preventing meningitis, polio, measles, and pertussis (among others!) more important that the correct order in which to introduce solid food?
If you are inundated with anti-vaccine messages, considering Dr. Sears' advice on delaying or altering the vaccine schedule, feeling overwhelmed and worried about vaccinating your child, and spending a lot of time researching the issue, then you should also look at the case FOR immunizations, and at sources that use scientific evidence to back up their claims. The following websites can be very helpful:
http://www.chop.edu/service/vaccine-education-center/home.html
http://www.cdc.gov/vaccines/
http://www.aap.org/immunization/
And, for an interesting article in the lay press (not a scientific journal):
http://www.wired.com/magazine/2009/10/ff_waronscience
Sunday, September 5, 2010
Calling the Doctor After Hours
Every time I am on call I answer after hours calls from worried parents. I have been on call, on average, 7 days a month for the last thirteen years. That would be 1092 call nights/days since I joined Trestlewood. If I average 10 calls a night (weekends more, weeknights less, winter more, summer less, but averaging it all out) that means I have answered over 10,000 calls from worried parents so far in my career! I have a lot of experience answering after-hours questions from parents via my cell phone. I know what are the most common reasons people call and what advice to give them. I know what really scares parents in the middle of the night, and how to tell parents what to look for if the illness is getting worse.
Still, after all these years, I greatly prefer that face-to-face contact in the office. It is still sometimes hard for me to figure out how sick a child is when I am talking to a parent over the phone. A description of a rash, swelling, injury or bug bite by the parent, using their frame of reference and experience, may conjure up a completely inaccurate mental picture in my mind when I try to match it to my frame of reference. Thermometers are broken, degrees are added or subtracted from temperatures, weights are not known, allergies are not remembered. Sometimes the person calling me isn't even with the child, so they are themselves telling me information they received from a third party.
And I often think my goals for the phone call and the parent's goals for the call differ wildly. My primary interest is to quickly and accurately provide an assessment of the nature and severity of the illness and whether it is possible to use home/natural methods to provide comfort until the child can be seen in the office. I think many people want more out of the phone call than that--it would be nice to be able to go back a month, or year, or years in the history to be able to arrive at an exact diagnosis, prognosis, and prescription, and possibly a note for school or daycare, and sometimes even a refill on another medication that has run out.
So with that preface I will provide you with my perspective, as an experienced after-hours phone call answerer, of what a parent should expect from the doctor answering the phone after hours.
What to Expect From After-Hours Phone Calls
If your child is an established patient at Trestlewood Pediatrics we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is available on our office answering machine, and is on our business/appointment cards. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.
Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.
The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.
Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?
After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.
It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.
Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.
Because we can’t see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this the child would need an appointment in the office.
Still, after all these years, I greatly prefer that face-to-face contact in the office. It is still sometimes hard for me to figure out how sick a child is when I am talking to a parent over the phone. A description of a rash, swelling, injury or bug bite by the parent, using their frame of reference and experience, may conjure up a completely inaccurate mental picture in my mind when I try to match it to my frame of reference. Thermometers are broken, degrees are added or subtracted from temperatures, weights are not known, allergies are not remembered. Sometimes the person calling me isn't even with the child, so they are themselves telling me information they received from a third party.
And I often think my goals for the phone call and the parent's goals for the call differ wildly. My primary interest is to quickly and accurately provide an assessment of the nature and severity of the illness and whether it is possible to use home/natural methods to provide comfort until the child can be seen in the office. I think many people want more out of the phone call than that--it would be nice to be able to go back a month, or year, or years in the history to be able to arrive at an exact diagnosis, prognosis, and prescription, and possibly a note for school or daycare, and sometimes even a refill on another medication that has run out.
So with that preface I will provide you with my perspective, as an experienced after-hours phone call answerer, of what a parent should expect from the doctor answering the phone after hours.
What to Expect From After-Hours Phone Calls
If your child is an established patient at Trestlewood Pediatrics we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is available on our office answering machine, and is on our business/appointment cards. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.
Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.
The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.
Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?
After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.
It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.
Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.
Because we can’t see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this the child would need an appointment in the office.
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.
Saturday, July 10, 2010
"Blood owies" or What do I want for my patients?
What are "blood owies"? you ask. Keep reading, I'll get to that later. What do I want for my patients and my own children? I want many things for them, so this could be a difficult question to answer. However, there is one thing I come back to, over and over. I want my patients to grow up feeling confident and in control over their bodies and minds. I want them to know that their bodies are strong and capable of fighting disease, and that they have control over the choices that help keep them healthy.
Of course parents help children BE healthy. We love them, feed them, and keep them safe. We give them a sense of right and wrong. We try to influence their choices. Most of all we love them. I believe that parents play a crucial role in helping children FEEL healthy, too.
So what does that mean, anyway? A little anecdote might help you understand what I am talking about. At my daughters' daycare the kids used to have a saying for their little cuts and scrapes that happened throughout the day. A skinned knee that didn't bleed was just an "owie", really no big deal. But a skinned knee that BLED was a "blood owie", which was very impressive to all.
I would receive tales of "blood owies" when the kids arrived home each summer day. It was a major event, as if the life force of the affected child was draining onto the ground. This kind of owie seemed to have a mystical power in my daughters' lives. Rose, our daycare provider, and my dear friend, normalized these "blood owies" for my children. She always had a hug and a band-aid ready, and she seemed to always convey to them that this was no problem, and would get better fast with that band-aid. I would look at the ravaged knee with the princess band-aid perched on top, hide a shudder and smile big at how great the owie looked now. My injured daughter would walk away feeling strong and proud of herself.
Of course most illnesses are more serious than a skinned knee! But how great would it be if we, as parents, could help our children be confident in knowing that most aches, pains, colds, flu, viruses, rashes, bug bites, etc. are common and happen to lots of people who get over them with no problem.
Preschoolers and adolescents, especially, seem to notice lots of bumps and aches all over their bodies. Don't you, too? Our children need us to explain these things to them. They don't know if these things are important, or not. "Too bad your tummy hurts, maybe you have to go potty?", or "I'm sorry to hear you have a stomachache, do you think you had too much milk? Or that you are worried about your exam?" "That happens to me sometimes, it usually just goes away after a while." "Let's try some pain reliever, and go to bed early tonight, maybe you're just tired."
But what if you miss something this way? Aren't some stomachaches and other symptoms important? Yes they are sometimes important, I'm not advocating ignoring symptoms. What I am saying is that I think the parent should be the one guiding the attitude about the illness.
The ultimate message that I want kids to receive is that their bodies and minds are amazing, strong, resilient, normal, and capable of healing. And that their parents will help them stay that way. As a pediatrician I definitely have a role in shaping this attitude, but I think parental influence is greater. Think about this. Let me know what you think.
Of course parents help children BE healthy. We love them, feed them, and keep them safe. We give them a sense of right and wrong. We try to influence their choices. Most of all we love them. I believe that parents play a crucial role in helping children FEEL healthy, too.
So what does that mean, anyway? A little anecdote might help you understand what I am talking about. At my daughters' daycare the kids used to have a saying for their little cuts and scrapes that happened throughout the day. A skinned knee that didn't bleed was just an "owie", really no big deal. But a skinned knee that BLED was a "blood owie", which was very impressive to all.
I would receive tales of "blood owies" when the kids arrived home each summer day. It was a major event, as if the life force of the affected child was draining onto the ground. This kind of owie seemed to have a mystical power in my daughters' lives. Rose, our daycare provider, and my dear friend, normalized these "blood owies" for my children. She always had a hug and a band-aid ready, and she seemed to always convey to them that this was no problem, and would get better fast with that band-aid. I would look at the ravaged knee with the princess band-aid perched on top, hide a shudder and smile big at how great the owie looked now. My injured daughter would walk away feeling strong and proud of herself.
Of course most illnesses are more serious than a skinned knee! But how great would it be if we, as parents, could help our children be confident in knowing that most aches, pains, colds, flu, viruses, rashes, bug bites, etc. are common and happen to lots of people who get over them with no problem.
Preschoolers and adolescents, especially, seem to notice lots of bumps and aches all over their bodies. Don't you, too? Our children need us to explain these things to them. They don't know if these things are important, or not. "Too bad your tummy hurts, maybe you have to go potty?", or "I'm sorry to hear you have a stomachache, do you think you had too much milk? Or that you are worried about your exam?" "That happens to me sometimes, it usually just goes away after a while." "Let's try some pain reliever, and go to bed early tonight, maybe you're just tired."
But what if you miss something this way? Aren't some stomachaches and other symptoms important? Yes they are sometimes important, I'm not advocating ignoring symptoms. What I am saying is that I think the parent should be the one guiding the attitude about the illness.
The ultimate message that I want kids to receive is that their bodies and minds are amazing, strong, resilient, normal, and capable of healing. And that their parents will help them stay that way. As a pediatrician I definitely have a role in shaping this attitude, but I think parental influence is greater. Think about this. Let me know what you think.
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