How Well Visits Are Billed and What Happens if a Problem is Found?

Written by David Sprayberry MD

In a previous post, I tackled the subject of what constitutes a well visit. Today I will try to explain the way well visits are billed and what happens if a problem is found and/or addressed at the same visit.

Medical billing is quite complex and is based on a process called coding. I will see if I can explain it in a way that makes sense. Let me know if I was successful.

Think of your medical bill for an office visit as being similar to the bill you receive at a restaurant. Each service, procedure, lab, and screen is billed separately just like each menu item is billed separately at a restaurant.

When you go to your doctor for a visit, he or she is required to follow certain rules, called CPT and ICD-9 rules, for describing what happened during the visit (unless he does not accept any insurance and is paid directly by the patient for the visit).

Each thing that is done during the visit has a code and each diagnosis has a code.

The physician must report these codes to the insurance company in order to get paid for the work that was done. There are codes for well visits, codes for sick or problem visits, codes for each test, codes for each vaccine, and codes for each procedure.

If these codes are not reported correctly, your doctor will not be paid for the visit.

Many times they are reported correctly and your doctor still does not get paid correctly by the insurance company (which is generally due to a “mistake” by the insurance company).

Most medical offices have one or more employees whose entire job is to report these codes and to make sure the insurance company or patient actually pays correctly for them.

At a well visit, the typical codes that are reported to the insurance company are the well visit code, codes for each vaccine, codes for the administration of each vaccine, and codes for each test or procedure (like hearing, vision, hemoglobin, lead testing, developmental screening).

These codes are all linked to the diagnosis “well child”. Depending on the insurance plan, some or all of these codes are “covered services” and are paid by the insurance company.

Sometimes the insurance company requires the patient/parent to pay for all or part of a visit (either in the form of a co-pay, deductible, or because the insurance company doesn’t cover a particular service).

This depends completely on the contract between the patient/parent and the insurance company. The physician’s office is required to collect from the patient/parent whatever the insurance company didn’t pay.

What often causes confusion is when there is an illness or other problem that is addressed or treated at the same visit.

For example, if I were to find an ear infection and treat it, I would be required to submit a code that told the insurance company I had taken care of a problem and done more than just the well visit. This is where the confusion for parents may start and here’s why:

Many, if not most, insurance plans require the patient to pay for a portion of any services that are not part of the well visit. Depending on the plan, the patient may need to pay a co-pay or may pay the entire amount of the extra service if they have not met their deductible.

Whether they need to pay this is determined by their insurance company, not their physician. The insurance companies have intentionally designed this system to create tension between the patient and physician, when, in reality, the insurance company has caused the need for the parent to pay the extra amount.

The physician merely did her job and described the visit accurately to the insurance company.

To summarize, the physician reports the codes that describe what occurred at the visit to the insurance company. The insurance company reviews the codes and determines if the patient owes any additional fee to the physician.

Whether the patient owes anything depends entirely on the patient’s contract with the insurance company, not by the physician.

I hope this helps clarify the issue. Please feel free to share your comments or questions.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

Photo Credit – Dr. Nan


A Little Info On Wellness Visits

Written by David Sprayberry MD

As a pediatrician, I often have expecting parents who come in to interview me or my partner to decide if they want to use us as their pediatricians.

At the visit, we talk about how our practice works and we present them with the recommended schedule of well visits (established by the American Academy of Pediatrics). This schedule can be found here.

Parents are often surprised at the number of visits that are recommended.

If they want more information, we explain a bit about what goes on at a well visit and why they are important.

We mention that we review the growth and development of their child, perform a head to toe physical exam, provide guidance on things like feeding and safety, give immunizations, and perform a variety of screens, labs and other assessments depending on the age of the child.

If you look at the Bright Futures schedule linked above, you can see how involved some of these visits are. As a result of all that is required, the visits (including paperwork, tests, and vaccines) can take anywhere from 20-60 minutes, so parents should probably plan that it will take approximately an hour to complete the visit.

Some of the visits that are less involved (like the 9 month visit) may be faster and a few may take longer (like the 4 year and 11-12 year visit).

Another thing that sometimes surprises parents is how these well visits are billed and what charges are incurred during a well visit. Medical billing is complex and is based on a process called coding.

I will address that in an upcoming post. For the time being, think of your medical bill for an office visit as being similar to the bill you receive at a restaurant.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

Photo credit – AppleTree Learning Centers


Gifts of a Father’s Presence. Part 3 of 3

Written by David R. Sprayberry, MD

My last few posts have revolved around the negative effects that absent fathers have on their children.  So far, we have talked about how the absence of a father contributes to poverty, substance use and abuse, psychological and behavioral problems, poorer educational performance, and increased participation in criminal activities.  Today we turn to the positive things that a present father brings to the lives of his children.

Effects on Infants

Let’s starts with infants.  Even in the first few days of life, the effect of a father’s presence can be discerned.  Newborns will preferentially turn their heads to the voice of their fathers over the voices of other men.  Premature infants whose fathers visit the NICU more often tend to have better weight gain during the hospitalization and perform better on behavioral and social-developmental tests during the first 18 months of life.  Infants who demonstrate the most emotional security and attachment have fathers who are affectionate, who spend time with their children, and who have a positive attitude.  Keep in mind that these effects are happening long before the child can even walk and talk.

Effects on Mothers

What about mothers?  When fathers are involved, their children’s mothers are more likely to start and continue breastfeeding.  Mothers with positive relationships with their children’s fathers also demonstrate better parenting skill and fewer emotional difficulties.  Mothers who are feeling supported are more likely to encourage the fathers to be involved with the children.

Early Childhood

Fathers can help reduce the likelihood of stranger anxiety in their children.  Toddlers with present fathers are also less likely to worry and less likely to disrupt the play of other kids.  Preschool children of involved fathers have been found to have higher cognitive development.  They also exhibit more empathy and have a greater sense of mastery over their environment than their peers with less involved dads.

Long-term Benefits

Children who live with both parents are more likely to finish high school, be economically self-sufficient, and be physically healthy.  Fathers have a unique and strong influence on their children’s gender role development and serve as important role models for both boys and girls.


Fathers who set appropriate limits for their children and who provide sufficient autonomy have children with higher academic achievement.  Fathers who discipline harshly and/or inconsistently have a negative impact on emotional and academic development.

Educational Benefits

When dads are involved, kids tend to have improved educational outcomes.  Children of fathers who are involved in their children’s education are more likely to achieve better grades, more likely to enjoy school, more likely to participate in extracurricular activities, and are less likely to have repeated a grade.

Additional Benefits

There are numerous other benefits that result from fathers who are involved.  Fathers who spend time alone with their kids and perform routine childcare at least twice a week raise the most compassionate adults.  Physical play with fathers promotes intellectual development and social competence.
Fathers are capable of doing incredible good to their kids by staying involved in their lives.  Dads, you only have a few years with your kids at home.  Make the most of them and be their dad!  Perfection is not necessary.  Presence and participation are.
Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


O Father, Where Art Thou? Part 2 of 3

Written by David R. Sprayberry, MD

In my last post, I introduced the problem of absent fathers in the U.S. and described the magnitude of the issue. What I hope to do today is to present a strong case for why fathers need to be very intentional about staying involved in the lives of their children.

This topic is important to me for several reasons. First, I am a father of three children (hopefully four sometime in the next year or so) and I want to be the kind of father they need. Second, I am tired of seeing friends separate and/or divorce. If these posts do anything to help just one father decide not to leave, it will have been a worthwhile endeavor. Third, I see kids who are suffering the consequences of father absence in my office very frequently and I am often called upon to help the kids deal with them. I see these kids spiral downward in the wake of their parents’ divorces and would love to see less of it.

So, what are the consequences to children when their fathers are absent from the home?

Let’s start with poverty.

Young children living with unmarried mothers are five times more likely to be poor than other children and ten times more likely to be extremely poor. Nearly 75% of children living in single-parent homes will experience poverty before the age of 11. Only 20% of children from two-parent homes will do the same. Homelessness is more common among children from broken homes. Finally, children of teen mothers are more likely to be unemployed when they become adults.

Tobacco, Alcohol and Drugs.

Children who live apart from their fathers are 4.3 times more likely to smoke than those who grow up with their fathers in the home. Adolescents living with both biological parents less frequently engage in heavy alcohol use. Latchkey children, children who have daily unsupervised periods at home after school, are more common when the father is absent from the home. These children are more than twice as likely to abuse drugs as children who are not left alone after school and begin abusing substances at younger ages. Latchkey children are also at greater risk for teen pregnancy and are more likely to be victims of sexual abuse.

Emotional and Behavioral Consequences

Children from single-mother homes have a greater risk for psychosocial problems, an effect which is over and above the impact of coming from a low-income home. Young girls experience the emotional loss of a father as a rejection of them. Continued lack of involvement by the father is experienced as ongoing rejection.

Post-traumatic stress disorder is significantly more common in youths with an absent parent. Children with eating disorders and children who self-mutilate (e.g., “cutting”) often come from homes where fathers are absent. Antisocial symptoms are also more common in kids with absent fathers, a risk that is not mitigated by the presence of a stepfather. Even more frightening is this: three out of four teen suicides occur in households where a parent has been absent.

Education and Development

Children living with a single parent have lower GPAs, lower college aspirations, worse attendance, and higher drop-out rates. Fatherless children are 1.7-2 times as likely to drop out of school. Father absence has also been associated with delayed motor skill development in preschool children. I would suggest that this is due to the fact that the way fathers interact with their kids is different than mothers. Play with dads is often characterized by physicality – wrestling, tickling, tossing, spinning, etc. This physical play certainly contributes positively to the motor development of children.


Given what we have already discussed, it is likely no surprise that criminality is more common among children with absent fathers. Delinquent behavior is more likely in father-absent homes, especially when combined with socioeconomic disadvantage. Children born to teen mothers are 3 times more likely to be incarcerated during their adolescence and early twenties than children of older mothers (as you will recall, children of teen mothers frequently have absent fathers). Boys born to unmarried teen mothers are 8-10 times more likely to become chronic juvenile offenders.


Children with an absent parent have been shown to be more likely to be perpetrators and victims of sexual abuse. Teens from two-parent households have been found to be less likely to be sexually active. Studies have shown that about 70% of teen pregnancies are to children of single parents.

Girls from father-absent homes tend to begin puberty earlier, have sex earlier, and have their first children earlier than girls from father-present homes. According to a study conducted in the U.S. and New Zealand, the risk of increased sexual activity is greater the earlier in a girl’s life that the father becomes absent. Higher socioeconomic status does not protect the girl from these effects.

Medical Consequences

Unmarried mothers are less likely to obtain prenatal care and are more likely to have a low birthweight baby. Infant mortality rates are higher for unmarried mothers and teen mothers (roughly 50% higher for teens). Sudden Infant Death Syndrome has also been shown to be more common in children of unmarried and teen mothers. Asthma and obesity are both more likely in children of single mothers, and blood sugars are more poorly controlled in diabetic children of single mothers.

For married men and women, hopefully this post will help strengthen your conviction to stay married and help maximize the positive impact you can have on your children. For divorced men and unmarried fathers, I hope this will convince you to stay as involved as possible in the lives of your children in order maximize your positive influence. For mothers who are not married to the father of their children, my desire is that you will encourage the fathers to remain involved, so long as they do not pose a threat to the children.

My final post on fatherhood will summarize the positive things that occur when a father is present and some practical ways that pediatricians can encourage fathers to remain involved.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


Who’s Your Daddy?: Part 1 of 3

Written by David R. Sprayberry, MD

You have undoubtedly heard this question used as a taunt of another, but let’s take the question seriously.

What do you know about your dad? Do you know him or do you know of him? I grew up in a two-parent home with my birth parents.

Things were not always perfect. I can tell you the positive things about my dad and some negatives.

The reason, though, that I can tell you the negatives is that I know my father and I know him well because he was there.

He was there at the dinner table. He was there at my baseball practices. He was there at my basketball games. He was at all the school functions and awards nights.

He was there.

During my pediatric residency, one of my classmates was posed this question by one of the kids he was seeing in the clinic: Are you my daddy? Sadly, this was not a joke.

The child had no idea who his father was. More and more American kids are growing up not knowing their fathers at all or having minimal relationships with them. Their dads are just not there, either partially or fully.

The absence of a father from a child’s life can do immense harm and the presence of a father can do immense good.

Scope of the problem

In discussing this issue, it is important to define what an absent father is. In general, when we use the term absent father, we are speaking of fathers who are physically absent from the child’s primary home. This includes fathers who have only joint custody of their children.

The degree of this issue is immense. Over one-third of all U.S. children live absent from their biological fathers. Nearly half of all children from disrupted families have not seen their fathers in the past year.

Nearly 20% of kids in female headed households have not seen their fathers in 5 years.

From 1960 to 2000, the proportion of children living with just one parent increased from 9% to 28% over that 40 year span. When the statistics are broken down by race, results become even more alarming.

As of the year 2000, 20.9% of all white children lived in single-parent homes. At the same time, 31.8% of all Hispanic children and 57.7% of all black children were living in single-parent homes.

The reasons for the racial differences are debatable, but what is clear is that this is a problem that is not limited to a single race.

Reasons for father absence

Why do we have so many absent fathers? There are many factors that contribute to this problem, but a large proportion of absent fathers are absent for one of the following reasons.

One of the largest reasons that fathers are absent from the homes of their children is divorce. The number of currently divorced adults has nearly sextupled from 4.3 million in 1970 to 23.7 million in 2010.

The number of divorces per year has increased from 390,000 in 1960 to 1.2 million in 2009.

There are recent reports of decreasing divorce rates, but these decreases are generally looking at divorces as a proportion of the general population, not as a proportion of marriages. Additionally, the marriage rate has declined considerably, likely leading to an increase in the second factor contributing to absent fathers.

A second significant reason that fathers are absent is births out-of-wedlock. Forty-one percent of all newborns in the U.S. were born out-of-wedlock in 2009, up from 33% in 2000.

About 75% of all teen births are out-of wedlock. In many of these cases, the father never lives in the child’s home, even at the beginning.

A smaller, but still significant, reason for father absence is incarceration. As of 1991, there were an estimated 423,000 fathers in prison with children under the age of 18. That number has increased to 744,200 as of 2007.

To be fair, many men may not be able to control the amount of time they are with their children. They may want to be involved, but are prevented by factors beyond their control.

As a pediatrician, I understand how difficult it is to balance a demanding work schedule and family life, and I don’t always do a great job at maintaining that balance.

I point these issues out not for the sake of being critical, but in order to spur men on to take a larger role in the lives of their children and to become more physically and emotionally present for them. We have a relatively short time to raise our children. Let’s make the most of it.

My next post (the second in a three-part series) will discuss the consequences of father absence and the benefits of father presence.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


Photo credit:  Chin.Musik


A Day in the Life of a Pediatrician

Written by David Spraberry MD

Ever wonder what your pediatrician does all day? Ever wonder why you sometimes have to wait to be seen (or, in my case, many times)? Doesn’t he or she just spend 8 hours a day at the office and then go home? Why does he sometimes seem a little tired? How can she be tired if she only works 4 days a week in the office?

If you have ever wondered about those things, I am going to give you a peek into what my typical work day looks like.

6:00 a.m. – Get up and get ready for the day. (If I am really disciplined, I will get up at 5:00 or 5:30 so I can exercise.)

6:45 – Leave for the hospital

7:05 – Arrive at first hospital, make rounds in newborn nursery, then move on to the pediatric ward to round on inpatients.

8:00 – Leave first hospital and go to second hospital. Repeat the above.

8:45 – Leave second hospital and drive to office.

Note: I do not always have patients at both nurseries and both pediatric wards. I do often have to go to both hospitals, though. If I don’t have patients at both hospitals, I go get some coffee and spend some quiet time before the office.

9:00 – Arrive at the office to start the office day. I am usually met with multiple questions that relate to patients who might need to come in immediately but don’t want to, or who must have this form now or they won’t be able to go to football practice (but they didn’t bring it in until this morning), or I find out that a staff member won’t be at work today because they are sick or something urgent happened. Or, if it is winter, “The schedule is full already, where do you want to add sick patients?”.

9:05 – Start seeing morning patients. I will generally see an average of 4 patients per hour. In winter I may see 6 per hour. In summer, I may see 3 per hour, depending on the type of visits. Between patients, I am usually greeted with more questions about where to fit someone in, presented with more forms to sign, forced to be cordial to the drug rep who is bringing in the samples that we need and has her boss with her, have to call back to the hospital about a patient, or have to argue with an insurance company about approving the MRI that our patient desperately needs to prove she does not have a brain tumor or spinal injury.

Along the way, I do have the great privilege of conversing and playing with lots of fun little kids while making the best medical decisions for them that I am able. The relationship with the kids and their parents is what makes all the other hassles worthwhile.

1:30 – I finish my “morning” after 6 1/2 hours of work. I then move on to my lunch “hour”, which is usually less than 30 minutes and is spent reviewing labs, returning phone calls, and signing forms while shoveling in whatever I happen to have available for lunch that day.

2:00 – I start the afternoon and do more of what I did from 9:00-1:30. The after school phone calls begin and we work to try to fit in those kids who got picked up from school sick. If our schedule for the afternoon is already full, we usually add those kids on anyway and stay late to see them, unless I have a firm evening commitment that requires me to leave by a certain time. Right before closing is when the asthmatic in severe respiratory distress walks in and must be urgently treated in the office while arranging for admission to the pediatric ward.

5:00-7:00 – I will finish seeing patients somewhere between 5:00 and 7:00, depending on the time of year and day of the week. Once all patients have left the office, I will usually still be at the office for another hour or two finishing documentation and making phone calls. If I admitted someone, I will also dictate the admission note and follow up on any admission orders that I have done.

6:00-8:30 – I finally make it home somewhere between these hours, depending on time of year. My family has usually eaten dinner already, so I will either eat quickly and start hanging out with the kids, or I will hang out with the kids and then eat dinner once they have gone to bed.

9:00-11:00 or 12:00 – The kids have made it to bed and I can then start handling the personal responsibilities that I have that are not directly related to seeing patients, like paying bills, catching up on medical reading, working on “maintenance” of my board certification, and, oh yeah, actually having a conversation with my wife.

11:00 or 12:00 – Finally I go to bed so I can repeat the above tomorrow. I will probably get about 6 hours of sleep, though I need about 8.

Not every day is this way, but many are. Once the kids are in bed, I may do some kind of leisure activity instead of the work-related things mentioned above, but this is a fairly decent representation of my average day.

Since my partner joined the practice last year, I do have more time for leisure activities since she splits the hospital duties and phone calls with me. My days and weekends off are usually spent hanging out with the kids and taking care of office planning activities that I can usually not accomplish if I am scheduled to see patients.

So there you have it. A typical pediatric work day for me. Some pediatricians will work longer hours than I work. Some will work fewer days and fewer hours than I do. Most will have a similar set of responsibilities that they must somehow manage while seeing patients in the office, making the right medical decisions, and not getting too far behind schedule.

Despite how hectic things can sometimes be, I am glad to be a pediatrician and I don’t know what else I would do with my life. The whole professional athlete plan just didn’t pan out, although some of those NFL kickers manage to keep kicking until they are 50…

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


Anticipatory Silence: Florida Law Prohibits Freedom of Speech in the Physician’s Office

By David Sprayberry, MD

Wow. I am flabbergasted and disappointed by what has happened in Florida and what is being advocated now in other parts of the country.

For those who may have missed it, Florida has passed a law that says that a pediatrician is not allowed to ask a parent if there are guns in the home. This bill was a joint effort by the National Rifle Association and the Florida Medical Association. Proponents of the bill apparently fear that the questions that physicians ask in the setting of a confidential medical visit will be used against them by the U.S. government at some point in the future.

Let me preface the rest of this discussion by saying that I support the second amendment and the right of Americans to bear arms. My objection to the Florida law is its interference in the patient-doctor relationship.

Former Georgia congressman Bob Barr has written a blog post criticizing pediatricians for asking the question and proposes that pediatricians should concern themselves only with recognizing and treating illness, rather than preventing illness.

As a practicing pediatrician who politically falls on the spectrum between libertarian and conservative, I believe that the government should interfere with citizens’ personal lives as little as possible. I believe that law and order, the common defense, and the provision of public necessities, such as the highway system, should be the primary focus of our government.

I believe the Constitution, with its amendments, is one of the greatest achievements in human history.

I believe the Constitution should be respected by our congress and by our courts and that alterations to our constitution should only be made by the prescribed constitutional process and not through activist judges.

Bob Barr claims to be a libertarian, yet his support for this misguided Florida law reveals him to be a libertarian in name only. A true libertarian would not advocate for the protection of one constitutional right (the Second Amendment) by unconstitutionally limiting another (the First Amendment).

A true libertarian would not support governmental interference in the doctor-patient relationship, but would recognize the importance of confidentiality in that relationship. A true libertarian would say that what a physician discusses with his or her patients is none of the government’s business.

Bob Barr makes a number of ridiculous statements in his blog on this issue, such as the assertion that you will see your pediatrician for an illness and be asked if you have a gun.

He also suggests that pediatricians ask children to snitch on their parents with regard to the presence of guns in the home.

If he had been to a pediatrician’s office in the last 20 years, he would be aware that pediatricians are so busy making sure they cover all the things they are supposed to cover that they really aren’t going to waste their time interrogating parents and their children about guns.

Pediatricians may counsel about gun safety verbally or, more likely, in written format, because prevention of injury is part of what we do. We will also warn about the dangers of certain sleep positions, we will advise the use of helmets when biking or skating, and we will counsel about water safety.

Apparently though, Barr also objects to any discussion of safety since he doesn’t want pediatricians talking about pools either. For his blog on the topic, go here.

Barr further asserts that all pediatricians believe that no one should own a gun. He states “Apparently, the Hippocratic Oath taken by these pediatricians includes a footnote to ignore the Second Amendment guaranteeing Americans the right to own a firearm.”

Mr. Barr neglects to acknowledge that this legislation is an infringement to the First Amendment’s guarantee of freedom of speech and also fails to recognize that pediatricians are not agents of the federal government (although I would love to be able to take advantage of the federal holiday schedule).

Leaving the fact that Barr’s position on this issue reveals him to be just another politician who will say whatever he thinks will bring him popular support, let’s move on to the question of whether a pediatrician should only be concerned with treating disease and not preventing it, as Barr asserts in his blog.

This logic, if applied to medicine in general, would be catastrophic. Vaccines, probably the single greatest medical achievement in history, would not exist. Countless multitudes of people would have already died or been permanently disabled just since the advent of the modern vaccine era in the last century if vaccines had not come to be. Countless more would never have been born to begin with, since one or more of their parents would not have been able to conceive them. You and I might not be around to even have this discussion.

According to the CDC: Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. Before measles immunization was available, nearly everyone in the U.S. got measles.

An average of 450 measles-associated deaths were reported each year between 1953 and 1963. If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected.

Before Hib vaccine, Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation. Since the introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent.

Prior to the licensing of the chickenpox vaccine in 1995, almost all persons in the United States had suffered from chickenpox by adulthood. Each year, the virus caused an estimated 4 million cases of chickenpox, 11,000 hospitalizations, and 100-150 deaths.

Besides the overwhelming success of vaccines, there are numerous other successes achieved by practicing preventive medicine and providing anticipatory guidance (anticipatory guidance is the practice of providing advice to parents to help avoid injury, illness, and other negative events that may compromise the health of children).

Since pediatricians began to recommend putting babies to sleep on their backs, cases of Sudden Infant Death Syndrome have declined by 60%-75%. Since removal of lead from paint and gasoline, cases of true lead toxicity in the U.S. have decreased dramatically, except in certain limited geographical areas.

Preventive medicine is the cornerstone of pediatrics, particularly in the United States of America. It is far better to prevent illness and injury than to treat it once the damage has been done.

Perhaps I should frame this in a way that a politician can understand: Is it better to do damage control once your extramarital affair has been discovered or never have the affair to begin with? Is it better to defend yourself before a grand jury regarding the funds that you misappropriated or is it better not to misappropriate the funds to begin with?

If you would rather that your state and federal governments not interfere with what you can say to your doctor and what your doctor can say to you, please let your representatives and senators know that this kind of intrusive legislation is not acceptable.

Our politicians need to know without a doubt that passing laws such as these will be detrimental to their careers.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


The Nurse Will See You Now

Written by David Sprayberry M.D.

Something has got to change.

In recent years, the practice of medicine has been under attack from a variety of sources. Insurance companies continue to squeeze both physicians and patients in order to increase their already enormous profits. Our federal and state governments have decided to target physicians when an error is made in the exceedingly complex billing process in order to levy fines and recoup some of what they spend on Medicare and Medicaid.

Our federal government purposes to replace physicians with cheaper, lesser trained individuals who have not received nearly the level of education that physicians have. Even other healthcare professionals who have traditionally been a part of the physician’s team are seeking to take on the role of a physician and become your “provider.”

I fear that the best and brightest students will increasingly choose careers other than medicine if we as a nation continue to demean the work that physicians do and continue to attack the physicians who entered the field with altruistic intentions. It is also quite possible that the U.S. will lose practicing physicians to other nations that value their services more highly or at least do not make it as painful to do their jobs.

The American public needs to spend some time thinking about what they want from our medical system. Do they want their primary physician to be merely a coordinator of care or do they want him or her to be the provider of care? Do they want nearly all their office visits to be performed by a nurse who only calls in the physician if something is complicated or do they want a physician who is capable of detecting serious problems based on subtle findings or symptoms? Do they want to see a nurse when they go to a specialist? Do they want the person who is deciding whether they may have cancer to be someone who has never spent sleepless hours at the bedside of someone dying of cancer? Do they want the person who is deciding whether their child should be admitted to the hospital to be someone who has never seen a patient progress from simple wheezing to respiratory failure and death in a matter of hours? Do they want the person counseling them on whether to get that new vaccine to be someone who has never taken care of a child who died from a vaccine-preventable disease?

Our current system continues to march toward having nurses provide medical care and physicians only supervising and taking care of “complicated things”. Is this really what we want?

Dr. Sprayberry is a practicing pediatrician in Watkinsville, GA and blogs at Pediatrics Gone to the Dawgs


Why Your Doctor Chose to Be Your Doctor

Written by David Sprayberry MD

Probably the most common answer in medical school interviews to why someone is interested in entering medicine is “to help people”. The reason it is such a common answer is not that it is the “right” answer. In fact, most interviewers would probably rather hear something different than “to help people”, just to relieve the monotony of the interviews.

The reason it is a common answer, though, is that you have, at a minimum, seven years of physically and intellectually demanding education and training above and beyond your undergraduate education before you begin to practice independently. By the time the training process is completed, you will have devoted 24-28 years obtaining the education necessary to enter your career.

While you are devoting upwards of 100 hours per week for at least seven years to your courses, study, and training, your friends are enjoying their twenties. They are earning a living, going out, attending sporting events, traveling, dating, marrying and starting families. They are no longer accumulating educational debt. They are beginning to pay off the debt they do have. They are advancing in their careers.

You are struggling to get enough sleep to stay awake in class the next day, or during the seemingly interminable internal medicine rounds (which involves a short time seeing patients at the bedside and a great deal of time sitting in dimly fluorescent-lit conference rooms discussing those patients and their extensive lists of problems and medicines).

You are spending your nights and weekends trying desperately to prepare for the next anxiety-producing board exam, the next presentation before your attending physicians who are ready to pick apart whatever you present, or trying to unravel the mystery of the dying patient that just doesn’t seem to respond to anything you do.

The reason “to help people” is the most common reason for wanting to pursue medicine as a career is that you must make tremendous personal sacrifices just to begin your career. Friendships must be discarded or neglected. Entertainment and other enjoyable activities must be greatly reduced for quite a long time. Marriages are strained and often fail during this period. Indeed, certain residency programs have a greater than 100% divorce rate.

You must truly believe that what you are pursuing is a worthwhile endeavor in order to make such great personal sacrifices.

Dr. Sprayberry is a practicing general pediatrician who believes there is more to medicine than shuffling patients in and out the door. Dr. Sprayberry blogs at Pediatrics Gone to the Dawgs

The Joy of Practicing Medicine Outside the U.S.

Written by David Sprayberry MD

I recently spent 3 weeks serving at a mission hospital in Kenya. It was a highly challenging time, with a much greater severity of illness and greater limitation of resources than we have here, but it was the most rewarding thing I have ever done as a physician. The work I did was needed, difficult, and stressful, but I did not have to fight an insurance company once and I did not have to constantly worry about my documentation meeting the minutiae of coding regulations that, if not followed precisely, might lead to accusations of billing fraud. I was able to focus on taking care of patients who needed help without significant intrusions by insurance companies. I was able to document what was important to the care of the patient, not what the insurance company or government wants to see on paper. It was demanding and refreshing at the same time.

In Kenya, I was able to perform procedures and take care of rather complex patients because I was the most qualified person available. In the U.S., I am forced to refer patients to subspecialists for problems I can handle, because I would have great liability if a patient had a poor outcome and I had not referred them out. In Kenya, I took care of premies who required intensive care, I intubated and ventilated babies, and I set up and changed ventilators. I managed kids with severe hypoglycemia, severe malnutrition, severe dehydration, meningitis, sepsis, tuberculosis, malaria, and congestive heart failure, most of whom I would not have had an opportunity to care for here in the U.S. because a subspecialist would have had to be involved.

Despite the limited resources we had to work with and despite the heartbreaking events that occur when practicing medicine in the Third World, I must say that my experience in Kenya is why I went into medicine. It is comforting to know that I can go practice there if our government and our insurance companies ever make practice here unbearable. In fact, I could practice there now.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.