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Visiting The Pediatrician With Your Teen. What Are They Talking About In There?

Written By Nelson Branco, MD FAAP

As a parent, the teen years can be like a roller coaster ride. Thrilling, fun and scary – and sometimes you just want to cover your eyes and hope it will end soon. Your pediatrician* wants to support you and your family in providing the knowledge and guidance your teen needs to navigate these exciting years.

screen-shot-2016-10-17-at-12-28-48-pmWe are here to educate your teen and monitor their physical, mental and emotional health.

Teen physicals are very different from earlier visits or check-ups.

At a teen visit, we want you to have time to talk to us about your questions and concerns and pass on important information about your child’s health.

Because we want to give teens a chance to talk to us one on one, the parent will be there for some of the visit, but not the whole time. This is so that we can bring up subjects that teens may be shy about discussing in front of their parents.

They need to feel comfortable talking about issues related to their health – it’s time for them to gain some independence and responsibility around diet, exercise, sleep and other health habits.

The time we spend with your teen will be confidential

The pediatrician won’t go over the details of what they talked about. One exception to this rule is when something comes up that makes us worry your teen may be in danger.

If your teen needs help we will find the help they need, and help them talk to you about whatever the issue may be.

After the visit, you should ask your teen what we talked about. It’s a good way to start a discussion about topics that can sometimes be uncomfortable.

Your child may be asked to fill out a questionnaire about their mood and generally how they are feeling.

These questionnaires are important for us to ‘break the ice’ and convey to kids that we are ready and willing to talk about their feelings, especially if they are feeling anxious, down or depressed.

This questionnaire also helps us identify kids who may be having trouble but are reluctant to talk about it.

Insurance companies require us to bill this separately from the visit, but some have decided that this charge should be paid by you as part of your co-insurance or deductible.

Don’t be surprised if you see this noted separately on your Explanation of Benefits (EOB) or bill.

During the visit, your pediatrician will cover a wide range of topics.

We always discuss overall health as well as injuries, complaints or health conditions your child may have. If your child is playing sports we will also ask about family history of heart issues, lung or heart issues while exercising, concussions and past injuries.

We will be talking to your child about their home and school environment and relationships, school performance and goals, and activities, hobbies or sports that they are involved in.

Diet is an important topic, since we want to make sure your child is eating a healthy, appropriate diet and growing well.

We talk about depression, anxiety, mood and social issues with all teens. We all know that the teenage years can be stressful and it’s important that teens have a trusted adult to turn to for help when they need it – we hope to be one of those trusted adults, but also want them to have someone else in their daily life who is there for them.

Drugs, alcohol and tobacco are important topics.

We know that our kids may be exposed to these substances, and a significant number of teens are experimenting with or using nicotine, alcohol, marijuana, prescription drugs or other illegal drugs.

We want to make sure that kids are healthy, safe and making good decisions.

Please remember that your kids are watching and learning about these issues from you.

Think about your own attitudes and use of alcohol and drugs, and make sure you are sending the right message to your teen.

Relationships, gender, sexuality and sex are topics that all teens think about and sometimes struggle with.

Our kids have lots of different sources of information – parents and other adults, school, the media, the internet and friends. Teens need the right information and resources to make healthy choices.

Their relationships with peers – both friendships and romantic – are important for their growth, maturation and happiness. We want these to be healthy, respectful relationships.

From the time your child was an infant we have discussed sleep and screen time. This doesn’t stop in the teen years, but now your child has more control over their digital devices and their bedtime.

We want to make sure that the work, entertainment and social life that is happening on these devices isn’t interfering with school, relationships and sleep.

These visits take a bit longer than checkups for younger kids.

Hopefully this has helped you understand why. Your pediatrician has spent time over the years getting to know you, your family, and your child. Young adults should know that we are here to help them when they are hurt, sick or not doing well.

We also want them to know that we are proud of their good decisions and ready to celebrate their success. Everyone should get off this roller coaster smiling.


*Throughout this article, I’ve used the term pediatrician to mean someone who provides medical care to teens. This can be a pediatrician, adolescent medicine specialist, family physician, nurse practitioner, physician assistant or another medical specialist.


 

Dr. Branco is a practicing pediatrician at Tamalpais Pediatrics. He works in both the Novato and Larkspur offices. Dr. Branco is very active with the local chapter of the American Academy of Pediatrics and is a member of the AAP Committee on Native American Child Health. He is also an Assistant Clinical Professor of Pediatrics at UCSF.

 

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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.

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Is Finding a Pediatrician Like Buying a New Car?

Written By Nelson Branco M.D., FAAP

Several weeks ago, a posting on The Huffington Post by Meredith Lopez titled “An Open Letter to Pediatricians” generated lots of commentary and discussion among pediatricians.  Ms. Lopez described her experiences with her son’s (former) pediatrician, who was apparently not available to answer her phone calls in the middle of the night or on a holiday, and was unable to diagnose and cure her son’s diaper rash despite several visits. When I read Ms. Lopez’s blog post, I see a relationship between a mother and pediatrician that just isn’t working because they aren’t communicating.As a practicing pediatrician, I know that not every visit leads to a definitive diagnosis and cure.  I also know that being available, professional, knowledgeable and compassionate are just as important as how quickly I can come to the correct diagnosis and recommended treatments. Communication is at the heart of all that we do in medicine.  If you can’t listen effectively and let the patient or parent know that they have been listened to, you have not really taken care of them.

I’ve practiced in cities, suburbs and rural areas.  Many times, patients, family and friends ask “Should I go into the city for this?”  For me, that city has been Boston, Providence, Albuquerque, Denver, San Francisco and Phoenix.   Which city doesn’t matter – what drives them is the desire to get their care from “the best” for whatever problem they are having.  My answer to them is always the same – the best doctor for your problem is the one you can communicate with, the one who is available to answer your questions and the one who makes you feel like they can take care of you and your problem.  Sometimes that person is right here in your own backyard, and sometimes that person is at the biggest hospital in the biggest city with the biggest reputation.  But you should do your homework to find out who that is, and part of that homework is calling your pediatrician.

Part of my job is to direct my patients to the right specialist.  In the days when HMO insurances were more popular, primary care doctors were the so-called ‘gatekeepers,’ and many patients felt that their doctor was trying to deny them access to specialists.  Now, with PPO and EPO insurance plans being the norm, primary care doctors are not necessarily involved in their patients decision to visit a specialist.  That isn’t good medicine or good care for your child.  My job as your primary care physician is to take care of all your problems – including getting help from a specialist when we need it.  I need to know where you are going for your care so that I can get information from the specialist, help you understand it and integrate it with any other issues or conditions you might have.  It’s also my responsibility to lead you in the right direction, and send you to the specialist who will help you get to the bottom of the problem.  Often, that means referring you to the person that fits your needs and personality; I know you and usually I know the specialists.  I may not be a professional matchmaker, but I usually have a good idea who you’ll work well with.

The other advantage to local care when it is appropriate is that it can be much easier to get.  All physicians know that a medication prescribed twice a day will be taken much more consistently than a medication prescribed three or four times a day.  So it is with visits, tests and follow up visits that you can do close to home.   What about when those specialists aren’t available close to home?  Or if there is only one choice for a particular specialty?  That’s the time when it’s most important to have me working alongside the specialist.  When there is only one Child Neurologist, they will be busy and won’t be able to see you frequently.  Then it becomes my job to communicate with them about questions, concerns or issues that may come up.

The bottom line is that it is important to pick the right pediatrician for you and your child.  Their personality, communication style, office setup and availability are all important.  Ask your friends, your family and co-workers.  Check the practice website, call the office and see if they are set up to do a prenatal or ‘meet and greet’ visit and meet with the doctor if you can.  Most pediatricians are kind, caring and dedicated – you’ll find the right one for you, if you look.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.
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Why do I have to wait so long to see the doctor?

Written by: Herschel Lessin MD
Recently I had a frank conversation with a mom who told me “I have been dying to ask a doctor this question for years and I think you might be able to give me a reasonable answer, so here it goes:  Why do I have to wait so long to see the doctor? Is there any good reason? A patient’s time is valuable too! 

During my 30 years of practice, Our office has been trying our best to remedy this chronic problem with some degree of success, but some degree of failure as well.  As I thought about the question, I realized that it has a multitude of answers and explanations, as anyone who has ever worked in a medical office realizes.  When I run behind schedule, it makes me absolutely crazy.  The patients are angry, the staff is harried and I hate feeling rushed.. Here are just a few of the factors, which add up to a most difficult problem:

1.  Unpredictability – When I walk into a room to see a child, I have no idea whether that child will have a minor illness or a major problem.  Most kids are healthy, but when they are sick, they are often VERY sick.  All it takes is one of these complex patients to completely disrupt a patient schedule.  It is not like you can tell a family that you don’t have enough time to admit their child to the hospital today.

2.  Seasonality – If you come in the middle of winter, there are going to be lots and lots of sick kids.  We rarely, if ever, refuse to see a sick child on a same day basis. While we leave open many slots for same day calls, and are open until 9 pm every night, if it is winter, it will be busier and you may have to wait longer.  If you come in the summer months, it seems every child in the universe needs a physical for camp or school.  Certain laws and misguided insurance company policies make this problem even worse.   If you can do your check up any other time, please do so. In summer it will be busy, and you do not want to be told that you cannot have your form filled out because we are completely booked up.  We try to hire more doctors when we seem busier, but when the crunch time comes, we just have to get the job done.  You don’t want your child to be ineligible for sports or miss the first day of school.

3.  Human nature – This issue applies both to patients and doctors.  Some doctors seem to think that it’s OK if they are late, but not if the patients are late.  Your doctor should show up on time and start on time.  But patients are subject to human nature as well.  No one wants to take their child out of school or miss too much work, so I am often sitting around doing nothing from 1-3 pm while it is totally swamped from 3-5 pm. It is kind of like rush hour.  If you don’t want rush hour traffic, try to drive some other time.  It is always busier on Mondays and after school than any other times of the week.  If you have an infant, don’t schedule your check up in the late afternoon for the reasons above.  Our office does time and motion studies to try to figure out where the problem lies.  We have discovered that a good part of the problem (assuming the doctor is arrives and starts on time) is patients coming 10 minutes early or 10 minutes late.  That doesn’t seem like much, but it has enormous impact on the ability to see patients in a timely fashion. This will blow the schedule out of the water and disruption builds as the day goes on. Believe it or not, if everyone actually showed up on time both doctors and patients, things would be a great deal better for everyone.

So, I ask all of you to try to understand.  Running an office on time is better for patients and their doctors.  Scheduling enough time to discuss the problem is critical.  You cannot expect to have your child’s chronic stomachaches for the past 6 months be properly addressed in a same day sick visit.  There is not enough time scheduled.  A good doctor will make you come back and schedule enough time to evaluate your child properly.  Most doctors hate running late as much as their patients do.  If we all could try to understand the above issues and work together a bit better, we would all be much happier.

Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group