What Can Your Pediatrician do for You—and What Can S/he NOT Do?

By Jesse Hackell, MD

When I made the decision to become a doctor, there was no question in my mind from the start that I would be a pediatrician. Why? Well, I liked children, even back then, just barely out of my own childhood. I also liked the pediatrician who had cared for me as I grew up—he wore sandals and love beads, which made him seem relevant to me, coming of age in the 60’s. (Thanks, Dr. Johnny!)

We all have our reasons for entering this challenging and ultimately rewarding and fulfilling field. But I think it is safe to say that at least one reason which we all share is that we truly want to provide care to children as they grow from infancy through childhood, and through adolescence into adulthood. We like children, and we want to see them grow up healthy and happy. So the broad answer to the question in the title about what can your pediatrician do for you is: We can do our best to help keep your children healthy as they grow, and help you to respond to the myriad challenges along the way.

But I really want to address the more mundane issues about what we can and cannot do for you.

We CAN provide you, as parents, with information and education about the choices you have when it comes to making decisions about your children. These decisions come even before your baby is born — from hospital care, circumcision for a boy, feeding choices — and continue every day (or so it seems) until your child is truly capable of making mature decisions on his or her own. This chance to teach is yet another reason many of us became pediatricians, and we relish and enjoy it.

We CANNOT make those decisions for you, however. They are often very personal, and each family will look at the choices through its own eyes. What is right for one family is not necessarily right for another. But we CAN support you in the decisions which you do make, as long as they do not pose a threat to your child’s well-being.

We CAN be available by telephone, and after hours, especially because we realize that children do not get sick only during business hours on weekdays.

But in most cases we CANNOT treat your children over the phone, without having a chance to see and examine them. We trust your reporting as a parent, but we need to make our own diagnosis.

We CAN respond to your concerns about your children, and answer your questions.

But we CANNOT make you ask those questions in the first place. If something concerns you, please ask. There are no stupid questions.

Apart from direct medical issues, we CAN help you deal with your health insurance company. Sometimes health insurance seems like a mystery wrapped in an enigma—but only the company knows the rules and answers. This is frustrating for your pediatrician, for sure, and many times more frustrating for you who have obtained the insurance. We can follow the insurance company’s rules, as best we understand them. Remember, however, that the insurance is a contract between the insurance company and you, not your pediatrician.

We CANNOT do things or provide care which is not covered under the terms of the policy that you have chosen, unless you understand that payment for these services will be your responsibility and not that of the insurance company. And we cannot get the insurance company to pay for things which are not covered in your contract with them.

We CANNOT write “letters of medical necessity” for specialized infant formulas, for example, when your insurance policy specifically states that it does not cover nutritional products. We CANNOT change the date on an office visit or report a diagnosis which does not exist in our medical records, simply because that would allow the insurance to pay. We CANNOT put someone else’s name on a prescription, simply because that person has better prescription coverage. These actions constitute insurance fraud, and put a physician’s license at risk.

We CAN treat many common and not-so-common pediatric problems in the office which is most familiar to you and your child. If the problem is beyond our expertise, we CAN work with you to get needed specialty care, and provide referral forms as required by your insurance. We CAN refer you to the best specialist who is in your insurance company’s network.

We CANNOT back-date referrals if you have seen a specialist without getting the required referral. And we CANNOT fight the insurance company for out-of-network referrals when there are in-network specialists who can serve your children.

Most of all, we CAN be a resource and a support for you as you navigate the course of what is undoubtedly both the toughest and most rewarding task that any of us will likely encounter. By treating each other with mutual respect, and having reasonable expectations of each other, parents and pediatricians can build a warm, long-term relationship. After all, we all share the same goals—watching the growth and development of happy, healthy children (and even, dare I say, grandchildren.)

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.