What Pediatricians Want You to Know

By Rachel Hoeing

I asked some local doctors for feedback and asked them the question, “If you could tell parents one thing before they entered your office, what would it be?”  These doctors did not fail to impress.  I was thrilled with the answers provided and I know they will be of huge help to many of you.  I promised to keep their comments anonymous, so I will not state any names, but I want to say “Thank You!” to all the doctors who gave me input on this blog.  You know who you are!

So without further ado … here is what your pediatrician might want you to know …

Scheduling Appointments:

• There are two main reasons doctors run behind schedule: (1) patients arrive late (even 10 or 15 minutes makes a HUGE difference in the flow for the physician); and (2) patients come with too many significant problems that can be reasonably handled in a 15, 20, or 30 minute appointment.
• Be early for your appointment.  Our intention is to see your child at the scheduled appointment time.  If you arrive 10-15 minutes earlier, you can check-in and talk with the Clinical Assistant and be ready.
• Make an appointment for each child who needs to be seen.  We take every question seriously and need the full amount of time to evaluate your problem.
• When you call the office for advice or to make an appointment, please state your child’s first, middle, and last name as well as date of birth.  We can’t find a record in our Electronic Medical Record if you call your child by a middle name or a nickname!
• If you are planning foreign travel, contact our office several months beforehand.  We schedule an office visit to review the dates of travel, and itinerary in order research what vaccinations, medications, or other precautions are needed to ensure a safe trip.  We consult the CDC for foreign travel information as it is updated frequently based on outbreaks worldwide.
• Children on chronic medications (for asthma, blood pressure, ADHD, etc) usually need office visits every 3-4 months to track their progress.
• We recommend annual physical exams for our patients of all ages.  Young children have frequent weight checks and immunizations.  As they get older we pay attention to development, school, social skills, and safety.  And of course, there are some immunizations for teens.  Paperwork for Sports or Camp usually requires a physical during the preceding year.  Plan ahead and schedule the physical before the last minute rush!
• As your children get older, plan for their check-ups to be partially with a parent and the Doctor and partially alone with the Doctor.

At Your Visit:

• TV characters and Celebrity Doctors are made up!  Fake!  Phony!  Actors! Your experience will be very different.
• When you come to an appointment, be organized: have all your medicines with you, have a typed list of medical events and doctors you have seen since your last physical — in other words, you want to spend your time with the doctor on present-day problems, not on information transfer from you to the doctor.
• Tell your doctor all the facts, all the medicines (including herbals, vitamins, supplements) you have used, and all the previous physicians who have treated you.
• Speak up if you don’t understand, can’t afford, or don’t intend to follow the prescribed treatment plan.  We can’t help if our recommendations/ prescriptions are not followed.
• Understand the nature of the treatment plan- if an infection is going to resolve by itself; if prescriptions are needed; if symptomatic care is needed; if a specialist physician or therapist is needed.
• Be your child’s best advocate.  You know more about your child than anyone.  We will ask you about them when you come for advice and care. You are the expert regarding your child.  We are the expert regarding child well being. Please take our recommendations in the way they are intended- to help your child become or remain healthy. When we need an expert opinion we consult our own expert in a specific field. We don’t search the Internet and ask a celebrity about children’s health. We don’t consult a Talk Show Host. We don’t put much stock in fringe theories. We rely on Peer-Reviewed publications not blogs by folks with an ax to grind or a book or a phony cure to sell.  There is quackery in the modern world just as there was in the 1890s Snake-oil-days or the 1960s coffee-enema days.

Medicines & Treatments:

• Pharmaceutical ads on TV and in magazines are like every other kind of advertising – biased information presented in a way which makes you want to buy something.  Whether or not you actually need anything!  Keep that in mind.
• Learn the concept of Risk/Benefit ratio.  We base everything we do upon this idea.  Our treatments might have side effects, but the desired effect is so much more valuable and more likely that it is worthwhile.  Over the years we change our treatments as we learn more.
• Vaccines are your friends. Your great grandparents lost brothers and sisters to these diseases. We are lucky we don’t have to lose children to these.  Trust your doctor who advises you in this matter.
• If your Doctor tells you an illness will take a couple of days to respond to a treatment, don’t call the next morning saying “the fever is still there”.  We will tell you the things to expect and the things to look for that need reevaluation.
• Why won’t my doctor just call in medicine for my child? Because with children especially, things aren’t always what they appear; for example, I have had a father call and demand antibiotics for his 5 year old because he was sure that his child’s fever was due to another ear infection, and why did he need to come in for that? I refused to call in antibiotics; the child came in to be seen, and it turned out his ears were fine but he had pneumonia!

Insurance:

• Note: most insurance companies will pay for a face-to-face visit between the parents and doctor without the child present. This isn’t a perfect rule for all insurance plans, but it is worth knowing because often it is better and more effective to talk about issues like ADHD, anxiety, behavioral problems, and depression outside of the presence of the child.
• When you call to make an appointment for a physical, tell them how many problems you want to discuss, and ask if these will all be covered by this visit, or should some of these be covered in a separate appointment. Or, can some be covered in the same day but you will be given more time AND pay a co-pay for that ‘additional’ portion of the visit.
• Just because something is discussed, diagnosed or treated during a physical or well child check does not necessarily mean it is ‘free’ to the patient and covered under the umbrella of a well visit. Insurance companies pay doctors a certain set amount to provide a certain set of services during that well visit. Anything done outside the scope of those set services should generate an additional charge and/or a copay.

Other Helpful Tips:

• Less TV is good
• Spend time outside and use appropriate sun protection:
  • Sunscreen or sunblock
  • Protective clothing
  • Choose the hour of the day wisely
• Read to your kids every day, as much as possible.   It’s more important than just about anything.
• Don’t smoke.
• Don’t smoke around your kids if you are a smoker.  (If you think that your kids are safer because you only smoke outside, or in your bedroom or bathroom, remember the old saying: “if you pee in the corner of the pool, it makes its way throughout all the water”.)
• Teach your kids to respect their teachers and their school.
• Don’t spend your time watching TV being passive- act out a story you’re reading.  Make music.  Draw pictures. Sing songs. Create a home full of music, art, creativity, spirituality and joy.
• A temperature of 99 or 100 degrees is not a fever.
• “Fever” is not dangerous (no matter what your Mother or Grandmother told you).  The danger is related to what is CAUSING the fever.  Mild illnesses can have a high fever; serious illnesses can have a low fever.  Our concern is all the symptoms not just fever.
• True or False: If my baby goes a day without a bowel movement, it’s constipation?  (FALSE)
• You should develop a trusting relationship with your doctor to help you sort misinformation from real information.  Information from website or magazine article or advice from a friend or relative may be inaccurate, inappropriate for your specific problems or might be outright false and misleading- quackery!