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My Child Has A Fever, Should I Be Afraid?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Everyone gets nervous when their child has a fever. However, fever is not dangerous. There are many myths surrounding fever. Here are some facts about fevers:

Fever helps the body fight infection. Fever helps slow growth of bacteria and viruses. It also enhances the immune fighting cells in the blood.

A high fever does not necessarily mean that there is a serious disease. Many viral illnesses can cause very high fevers. While these fevers might be high, they will go away without any help in three to five days.

Fevers do not cause brain damage.

Again, fever is a normal physiologic response. The only time that fever is dangerous is when it is from heat stroke or hyperthermia. Symptoms of heat stroke are red hot dry skin with no sweating and confusion.

Infections and illnesses that cause fever do not cause heat stroke and are not dangerous. It is true that a small percent of children who get a fever will have a febrile seizure. Febrile seizures occur in about 4% of kids. They can be very scary to watch but they do not cause brain damage.

Medicines to lower fever are not expected to bring the temperature down to normal.

Ibuprophen and acetaminophen are often used to bring down fever in children. However, these medicines will only help the child feel better for a short time.

When the medicine wears off, the fever will return. Your child will continue to have fever for as long as the illness lasts (usually 3-5 days). Also, these medicines will lower the fever but they are not expected to bring the temperature back to normal.

It is expected and helpful to have some fever while your child is sick.

Of course you want your child to be comfortable and you do not want your child to get dehydrated from a high fever but remember that the fever is helping your body fight infection.

Also when your child is sick, he or she should be resting. If you bring the temperature back down to normal with medicine than he will want to run around a play. The goal in using medicine for fever control is to keep your child comfortable while his body is fighting the illness.

Fevers will not continue to rise without treatment. The brain has a “set point” temperature that it will reach and then start to come down, even without medicine.

Medicines to bring down fever will not prevent a febrile seizure.

One in twenty five children will have a febrile seizure. It is impossible to predict and it is impossible to prevent. Remember that while they are scary, they are not dangerous.

Do not use medicine to try and prevent a seizure. Medicine for fever should only be used to keep your child comfortable.

It is most important to determine the cause of your child’s fever.

Fever is just a symptom.

If the fever is from strep throat or an ear infection then he might need antibiotics. If the fever is from a virus, then it will need to “run its course”.

You should bring your child to the doctor to help determine the cause of the fever. Once you know the cause, you can relax.

Medicines come in many shapes and sizes and they are dosed based on your child’s weight. To determine how much medicine your child should take, visit Allied Pediatrics – Med Dosage Resource

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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Expecting a Child? Need to Find a Pediatrician? What Questions Should You Ask?

Written by Natasha Burgert MD

“Who is going to be the doctor for your new baby?”

Your OB wants to know. Your friends have asked. Your mother is wondering.

Finding a pediatrician is on the “to-do” list of all expectant mothers and fathers. New families often begin the search for a potential baby doctor by asking for recommendations from their OB doctor, family, and friends.

Some families begin by looking at the American Academy of Pediatrics website.Regardless of how you find a pediatrician, truly determining if a doctor is going to be a good match for your family is often done by interviewing.

I have seen plenty of glowing mothers-to-be sitting in my office with the seemingly standard “interview sheet” from babycenter.com or WhatToExpect.com.

Parents come to my office with a “recommended question list” because they don’t really know what to ask. This is certainly understandable since, for most families, interviewing a doctor is new territory.

But although these lists of questions are a good start, I don’t think they get to the heart of the matter.

What most parents really want to know is if a pediatrician is likable. Is this person going to be someone I can ask questions? Do we have something in common? Are we going to get along?

Compatibility is what most parents are searching for.

Here are 5 questions I would ask a potential baby doctor during an interview.

1. “Tell me about your office.”

Office hours and locations, contact numbers, hospital affiliations, and basic biographical information is fairly standard on every medical practice website. Use the web to get the basics, but let the doctor tell you where he thinks his office really shines.

This open-ended approach gives the doctor an opportunity to say what he thinks is the most important, interesting, or significant about the place where he works.

If the doctor does not cover any specific question you have about the function of the office, then ask.

2. “Why did you choose to become a pediatrician?”

The million dollar question. This is an opportunity for you to learn about the person behind the white coat. Of all the medical specialties, why did she choose to take care of kids?

3. “What are your thoughts on antibiotics and vaccinations?”

For most doctors in pediatric healthcare, antibiotics and vaccinations are common medical interventions.

How a doctor chooses to use antibiotics, and for what illnesses, does vary. With the increasing concern of antibiotic resistance and super-infections, having a physician who can clearly define when antibiotic use is appropriate for your child is important.

Vaccinations are a fundamental building block for child health. A physician’s beliefs and attitudes towards vaccinations will effect the recommendations they may or may not provide.

Also, some physicians will not see patients if the recommended vaccination schedule is not followed. Allowing a doctor to openly express his opinion on immunizations can begin productive dialog about this very important topic.

4. “What do you love about your job?”

Does this doctor have a passion for the underserved? Does he love to see kids with chronic illnesses, like asthma or ADHD? Does she love to teach?

Asking a doctor to share the best part of his job may reveal a common interest. Or, allow you to determine if your family’s needs will be best supported.

5. “What do you like to do outside of work?”

Pediatricians often look alike on paper. We all go to medical school, complete a pediatric residency, and get certified by the American Board of Pediatrics.

Asking the doctor what she enjoys doing outside of work may be enough to make the person on paper become a new partner in the care of your family.

Good luck in your search!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

5

Five Reasons Online Review Sites for Doctors Stink

Written by Suzanne Berman MD

The Internet provides plenty of opportunities for consumers to rate the quality of professional services they receive. A quick search can help you find recommended plumbers in your area, or suggest that you steer away from a certain roofing contractor.

Similarly, there are lots of online physician rating websites that offer the same service to consumers: check and see which doctors in your area are recommended by other patients.

I’ve watched the mushrooming of these “rate-the-doctor” websites with interest. While they provide an opportunity for patients to provide feedback to doctors and other patients, some elements could use improvement.

1 – They’re anonymous

Who is writing the reviews? While most come from true patients, there’s nothing to limit one single patient from sending 8 reviews about the same experience. For that matter, who’s to say good reviews aren’t from the doctor, trying to boost her image?

Physicians who are also small business owners (like me) from time to time terminate poor-performing employees. After a firing, does a spike in negative reviews of our practice reflect coincidence, or an ex-employee trying to retaliate anonymously– especially if the review contains “insider information” that our average patient wouldn’t be aware of?

2 – It’s not clear the patient is really a patient

When I read travel reviews online, I’m struck by how many reviews come from people who admit in their review that they didn’t actually stay at the hotel or eat at the restaurant. The review will read something like “I wanted to stay at this hotel because I’ve read so much about it, but when I clicked on the Reservations tab, I was shocked at the room rates. I couldn’t believe this hotel would charge so much for so little.

“They will never get my business!”

While the consumer is giving feedback to the hotel (“I think the market won’t sustain your prices”), this one-star comment hardly addresses what most travelers want feedback on (cleanliness of the rooms, friendliness of the staff, quality of the restaurant), since anyone can look up the prices for rooms.

Similarly, anonymous patient reviews don’t distinguish between a patient who came once, a long-term patient, and a prospective patient who has never been seen.

The latter’s comments are usually about a perceived access barrier to care, like: “I was new to town and needed a pediatrician. My son had terrible ear pain so I called to see if anyone could phone him in some antibiotics before the weekend. They were so rude and refused to help me out. I will never go there.”

Since I never had an opportunity to meet the family myself, never established a physician/patient relationship, and certainly never had an opportunity to explain, I don’t really consider this a review from a patient – but it’s in there with the rest of them.

3 – There’s no way to respond.

Some consumer rating websites, like Trip Advisor, allow the hotel or restaurant to respond or comment to a particular review. Many doctor rating websites don’t have a similar feature.

I don’t have an opportunity to apologize, or set the record straight, or offer to make my patient’s bad experience right. The patient can vent, surely, but I’d rather to try to reconcile the relationship.

4 – Patient privacy is protected.

Even if I can figure out who wrote a particular negative review, I can’t respond specifically in public with patient-specific information. Let’s say a mother posts a comment that I misdiagnosed her child’s ear infection: “even though Dr. Berman said Caleb’s ears looked great — later, when I took him to the ER, they said his ear was terrible.”

I review the child’s record: indeed, I examined the child in my office, who had clear ears. The child indeed went to the ER for worsening ear pain — five days later.

To me, this doesn’t speak to misdiagnosis as much as it does a common medical problem of kids: good ears sometimes go bad. I’d like to post something to clarify this online – to take the opportunity to educate families that ear exams can change over a period of days – but I can’t.

Simply, if I post any public health information about Caleb on the Internet, I’ve violated patient privacy laws (HIPAA). I can try to contact Caleb’s mother privately to make this same point, but she may or may not see fit to alter her online statement.

5 – Even the “neutral” information can be wrong.

“Rate-the-doctor” websites usually contain some basic demographic information, like the physician’s address, board certification status, age, gender, and so on. This information is often out-of-date, if not completely erroneous.

I’m amused to sometimes find that, according to some websites, I’m not board certified or that I practice at an address I haven’t worked at in seven years. Again, there’s often no mechanism for me, as the actual physician, to contact the site administrator to ask that my information be corrected.

So patients who come to these websites to get information about physicians may read bad information even before they look at the reviews.

Once it’s on the Internet, it’s there forever.

Our office periodically reviews our online reviews. A while ago we found one from a dissatisfied patient, rating us 2 stars out of 5, and concluding, “If there’s another place to take your kids, you should probably take them there, and not to this office.” The review was dated about 9 months prior to our discovering it.

The mother had left enough personally-identifiable information in the review for us to figure out who had posted it. Interestingly, in the 9 months since she felt dissatisfied with us, she was continuing to bring her son to us, and in fact had had a newborn daughter, whom she was bringing to our office for care.

We were puzzled that, if she were that displeased with our office, she hadn’t followed her own advice and transferred care to another practice. The next time she was in the office, we gently asked her about her review.

At first she looked blank; she’d completely forgotten she’d posted it! Finally she said, “Oh – that. Yes, I was dissatisfied with your office a couple of times, but since then I’ve kept coming, and now I’m much happier to be a patient here.”

We’re happy that she’s now more comfortable with us. Unfortunately, her review is still on the Internet, forever, and possibly no longer able to be amended.

Doctors are starting to fight back, and it’s not pretty.

While patients have the right to post opinions on the Internet, doctors who feel an opinion crosses the line have sued for defamation, slander and lost income. Doctors who respond in this way have drawn a lot of media attention – and many of them have a sudden increase in negative reviews posted.

This suggests that many of the newer respondents perhaps aren’t patients at all, but rather many readers are angry that a doctor would try to sue a patient for expressing her opinion. As far as a doctor trying to enhance her online reputation, it doesn’t seem to be a very effective method.

So what’s better?

Our office collects anonymous periodic surveys of our patients to learn how we’re doing and how we can improve. We ask patients to rate us on timeliness, friendliness, professionalism, and so on while they’re in the office as part of a visit.

This assures us that the reviews are being completed by actual patients, and that they’re being completed at the time of the visit, while impressions are still fresh.

Because we design the survey, we can make it specific as needed to help us identify problem areas: for example, rather than asking if “staff” are rude or friendly, we can ask for separate feedback on receptionists, nurses, doctors, billing staff, etc.

We’ve started sharing the results of our surveys with our patients, and we’re going to post future results on our practice website as well.

While our patients are free to comment about their experiences on rate-the-doctor websites, we believe posting results of our surveys will provide an equivalent service, and will be a more complete representation of our patients’ impressions of our practice.

Suzanne Berman is a practicing general pediatrician in rural Tennessee.

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My Child Has a Cold, Should I take Her the ER, Urgent Care or the Pediatrician?

Written by Kristen Stuppy MD

As cold and flu season approaches, I have been thinking about how our kids are managed when they become sick. Not only what we do to treat symptoms, but how, when, and where patients get medical advice and care.

We are a busy society. We want things done now. Quickly. Cheaply. Correctly. Resolution so we can get back to life.

Illness doesn’t work that way. Most childhood illnesses are viruses and they take a few weeks to resolve. There’s no magic medicine that will make it better.

Please don’t ask for an antibiotic to prevent the runny nose from developing into a cough or ear infection.

Don’t ask for an antibiotic because your child has had a fever for 3 days and you need to go back to work.

Don’t ask for an antibiotic because your teen has a big test or tournament coming up and has an awful cough.

Antibiotics simply don’t work for viruses. They also carry risks, which are not worth taking when the antibiotic isn’t needed in the first place.

Urgent Cares are not always the best choice

Many parents in this community have grown accustomed to using after hour urgent cares because they are convenient.

Convenient isn’t always the best choice. Many times kids go to an urgent care after hours for issues that could wait and be managed during normal business hours. I know some of this is due to parents trying to avoid missing work or kids missing school, but is this needed? Can it hurt?

Some kids will get unnecessary tests, xrays, and treatments at urgent cares that don’t have a reliable means of follow up. They attempt to decrease risk often by erring with over treating. Our office does have the ability to follow up with you in the near future, so we don’t have to over treat.

Urgent cares don’t have a child’s history available.

They might choose an inappropriate antibiotic due to allergy or recent use (making that antibiotic more likely less effective). They might not recognize if your child doesn’t have certain immunizations or if they do have a chronic condition, therefore leaving your child open to illnesses not expected at their age.

We know that parents can and should tell all providers these things, but our own new patient information sheets are often erroneous when compared to the transferred records from the previous physician… parents don’t think about the wheezing history or the surgery 5 years ago every visit. It is so important to have old records!

To treat or not to treat?

There is some evidence that treating things too soon does not allow our bodies to make immunity against the germ. A great example of this is Strep throat. Years ago we would go to a doctor when our sore throat didn’t get better after a few days. They would swab our throat and send the swab for culture, which took 2 days. We would treat only after that culture was positive. That delay in treatment allowed our bodies to recognize the Strep and begin making antibodies against it.

Now kids are brought in the day they have symptoms, and if the rapid test is positive, they immediately start antibiotics. The benefit? They are less likely to spread Strep to others and they can return to school 24 hrs after starting the antibiotic. The negative? They might be more susceptible to recurrent illness with Strep, so in the end are potentially sick more often and end up missing more school.

Receiving care at multiple locations

Receiving care at multiple locations makes it difficult for the medical home to keep track of how often your child is sick. Is it time for further evaluation of immune issues? Is it time to consider ear tubes or a tonsillectomy? If we don’t have proper documentation, these issues might have a delay of recognition.

Urgent cares and ERs are not always designed for kids.

I’m not talking about cute pictures or smaller exam tables. I’m talking about the experience of the provider. If they are trained mostly to treat adults, they might be less comfortable with kids. They often order more tests, xrays, and inappropriate treatments due to their inexperience.

This increases cost as well as risk to your child. We have been fortunate to have many urgent cares available after hours that are designed specifically for kids, which does help. But this is sometimes for convenience, not for the best medical care.

What About Cost?

As previously mentioned, cost is a factor. I hate to bring money into the equation when it comes to the health of your child, but it is important. Healthcare spending is spiraling out of control. Urgent cares and ERs charge more. This cost is increasingly being passed on to consumers.

Your co pay is probably higher outside the medical home. The percentage of the visit you must pay is often higher. If you pay out of pocket until your deductible is met, this can be a substantial difference in cost. (Not to mention they tend to order more tests and treatments, each with additional costs.)

So what kinds of issues are appropriate for various types of visits?

(note: I can’t list every medical problem, parental decisions must be made for individual situations)

After hours urgent care or ER:
  • Difficulty breathing (not just noisy congestion or cough)
  • Dehydration
  • Injury
  • Pain that is not controlled with over the counter medicines
  • Severe abdominal pain
  • Fever >100.4 rectally if under 3 months of age
Your Primary Care Pediatrician Visit:
  • Fever
  • Ear ache
  • Fussiness
  • Cough
  • Sore throat
  • Vomiting and/or diarrhea
  • Any new illness
Issues better addressed with an Appointment in the Medical Home:
  • Follow up of any issue (ear infection, asthma, constipation) unless suddenly worse, then see above
  • Chronic (long term) concerns (growth, constipation, acne, headaches)
  • Behavioral issues
  • Well visits and sports physicals (insurance counts these as the same, and limits to once/year)
  • Immunizations – ideally done at medical home so records remain complete

If your child gets a vaccine at any other location, please send us documentation (including the date, brand, lot number, and place administered) so we can keep the records complete.

Remember your pediatrician’s website might offer trusted answers to questions and many treatments to try at home for various illnesses and conditions! Be careful of surfing for answers though… the internet is full of bad advice! Go only to trusted sources (such as your doctor’s website or HealthyChildren.org).

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

10 Tips To Help Your Child Make The Medicine Go Down

Written by Denise Somsak MD
Explain that medicine needs to be taken to make your child feel better.  Around the age of three years old, this explanation will have much more meaning and may increase ease of compliance. In the words of Yoda, “Truly wonderful, the mind of a child is.”  They sense your compassion and conviction.  You don’t need luck.
  1. Ask your doctor before you start.  Better to avoid screaming than to manage it.  Some kids do better with liquid others chewable.  Many medications can be crushed and put in food.  Pharmacist can add flavoring to liquid medications.  This is usually better than adding the medication to juice or milk because not all meds can be mixed in other beverages and more importantly, the child might taste it and refuse the rest leaving you with an even larger amount of liquid to get down.  Rectal medication is sometimes an option, but few medications other than tylenol, anti-emetics and seizure medications are made for this route.
  2. Know you can.  There is no try.  Only Do or Do Not.
  3. You need a syringe.  No, not to give the child a shot.  An empty syringe that you can fill with the correct amount of medicine.  The pharmacy should have given you one.  Always ask especially for children less than 3 years old.
  4. Make sure the child is not afraid of the syringe.  Let him hold it.  Fill it with water and let him sip it and drip it into his hand.
  5. If the child will try a little medication willingly, give a little more.  If the Force is with you, that’s all it takes.
  6. If the child does not like it, promise a chocolate milk chaser or some other highly desired treat that the child can only earn after the medication and at absolutely no other time.  This technique only works for children who can understand cause and effect and delayed gratification, about 2.5 to 3 years old and up.
  7. If the child spits the medicine back at you immediately or vomits within 10 minutes, you need to repeat the dose.  Call your doctor with variations on this theme.
  8. To avoid the spitting, lie the child on her back.  You might need a holder to steady her head.  Slowly drop the medicine in a little at a time by putting the syringe at the back of the throat, but DO NOT GAG the poor girl.  A few drops at a time even during crying should get the job done.  It will feel like forever, but I promise you it is less than a minute.  She might cough a little.  Go slow.
  9. If she will not open her mouth, gently hold her nose until she does.
  10. Do not reward the child for protesting.  In other words, refusing and protesting the first dose should not mean that he never has to take it again.  In the words of Mary Poppins, “Be firm but kind.”

Always keep medicine safely out of the reach of children and never confuse them by calling medication candy.  Apparently this is confusing enough according to recent research presented at the National AAP conference which showed that both kindergartners and teachers had difficulty telling the two apart.

 

Dr. Somsak was born and raised in the heartland. She describes herself as a no frills, practical gal.  She writes regularly at http://www.pensivepediatrician.com

Doctor, Back Slowly Away From That Sandwich!

Written by John Moore MD

In American health care, the era of the free drug-company sponsored lunch is definitely over. Gifts from companies to physicians and hospitals have essentially vanished. Samples have disappeared from our offices. Corporate-sponsored CME budgets have dried up. Next year, as a part of the Affordable Care Act, companies will be forced to disclose any gifts to physicians that cost more that $10. Physicians who accept those small gifts will be listed on a searchable database. No more sandwiches for us!

I am not an apologist for drug companies by any means. The negative impact they have on health care cannot be ignored. There is a lot of scientific data that support the claim that even small items may influence prescribing practices. Our journals are unfortunately full of bogus scientific studies claiming to “prove” one product is better than another with poor scientific support. We have all heard prepared lectures from paid physician spokespeople which provide no educational value beyond brand recognition for the sponsor. Transparency in any industry is good; patients should be able to know whom their physicians are taking money from.

However, we need to bring some balance back into this discussion. First, the headaches of maintaining such a database for small gifts seem far out of proportion to any benefit that patients can receive. Second, we need to remember that pharmaceutical companies can provide useful information to doctors. I know that it is out-of-style to mention anything positive that can come from talking to the local drug rep, but let’s think about it. I learn from my reps what vaccination strategies have worked in other practices in my area. I learn how disease-specific recall notes have worked for the group across town. I am not naïve enough to believe the slick brochures left on my desk (and in fact I throw most of them directly in the trash), but I do use them as a starting point to my own research.

We also should examine the effects of industry sponsorship on organized continuing medical education in America. While the potential biases are real, the positive impact of pharmaceutical industry money on CME is huge! From the most prestigious national conferences all the way down to local community hospitals, budgets for CME have been slashed, in part due to the lack of industry funding. Fees for participants have increased, and not surprisingly attendance has decreased at live CME events around the country.

The bottom line is that pharmaceutical companies and physicians have a complicated relationship, one that is not inherently good or bad. Like any business relationship, the association between pharmaceutical companies and physicians relies on real people on both sides doing what is right. No amount of oversight can force someone with questionable ethics to follow the rules. No amount of bribery can sway an honest doctor to prescribe a medication not in the best interests of their patients. The vast majority of pediatricians are caring advocates for their patients whose loyalty cannot be purchased by a pen or a sandwich.

 

Dr Moore is a pediatrician in Roanoke, VA. He schedules drug rep visits only one time per week and always ignores lunches, preferring to meet his family instead!

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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.