Is There A Doctor In The House?

This week’s guest columnist is Dr. Meighan Anderson, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

She’s 10 years old.  She has asthma and eczema, but hasn’t seen her regular doctor in a year- her pediatrician retired and mom hasn’t found a new doctor yet- life’s so busy!  Yet the girl has had several asthma flares requiring Emergency Department visits. The itching from her eczema is also making life miserable, with sleepless nights and scaly skin.  Visits to walk-in clinics have yielded treatments that haven’t worked.

Many kids don’t visit their regular doctor enough.  When they get sick, Urgent Care clinics are so convenient.  Sometimes the family’s moved and not found a new doctor locally.  Sometimes their doctor has retired, or doesn’t take the family’s new insurance.  We also hear a lot of “he’s never sick, he hasn’t needed a doctor,” in the ER.

Having your own doctor is more important than many realize, especially for kids with chronic conditons like our 10 year-old asthmatic.  For kids with these issues, only their doctor has reliable records of what has already been tried, what worked and what hasn’t.  Office-based doctors are better trained and more experienced with these conditions too, rather than Urgent Care or ER providers, whose focus is acute illness.    Finally, office doctors are where to go for vaccinations, school physicals, and specialist referrals.

The first step to find a doctor is your insurance.  If your child has medicaid, only certain practices accept that, though most pediatricians take some medicaid patients.  If you have private insurance, that company will provide a list of accepting doctors.  Office location is important too- shorter trips from your home are helpful with busy lives.  Then you need to decide what kind of doctor to pick.  If your child is newborn through teenage years, a board-certified pediatrician is best.  If your kid is a late teen, soon to be 18 years-old, a Family Practice or Internal Medicine doctor is better, since they can take care of him into his adult years.  They take care of parents too!

“The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul.  Although the two cannot be separated.” -Plato

Though Plato wrote this over 2000 years ago, it’s still relevant.  Above we discussed finding your child a doctor- insurance accepted, location, and specialty (Pediatrics, Family Practice, Internal Medicine).  But is the physician right for your child’s body and soul?  And your soul too?

Cultivating the doctor-patient relationship is important to successful care.  One of the  determinants in this is a practice style called “shared decision making.”  This is where you and a doctor negotiate what is possible for care, rather than the doctor dictating what you should do, and you being expected to follow blindly.

What does shared decision making look like?  In some cases, there isn’t much sharing.  Technical issues are decided by the expert- the doctor.  For example, your child has a sore throat.  It could be a virus and resolve in a few days, or strep throat, requiring an antibiotic.  A strep test is done, it’s negative, and the doctor doesn’t prescribe an antibiotic, because it won’t help and may have side effects.

But what if your child always has a sore throat and it seems allergic?  With chronic illness like allergy, where lifestyle affects your kid’s illness, shared decision making is a must.  Should you go to an allergist, or would this be too much trouble, or does the thought of skin pin-prick allergy testing freak you both out?  Should you try some anti-allergy medication first?  Which one- inhaled, sprayed in the nose, or swallowed liquid, or a pill?  Which will your kid tolerate, and which is most effective?  Can you afford to tear up your carpet and put in hardwood floors for better dust control, and what about the smokers in the house?  Will they quit, can they quit?

All these questions should be explored with your doctor.  What is doable, what is best for your child, what can you and your kid tolerate, to optimize your child’s care?  Together you all decide on realistic goals and expectations.  In the old days, the doctor was always the boss.  These days, to deliver the most effective care, sometimes she’s boss, sometimes you are, often you’re co-captains of the team 

Who Do You Trust?

Sometimes when seeing a patient in the Emergency Department, I discover the kid isn’t vaccinated.  The parents often say “I researched it” when explaining why they don’t vaccinate.  When I hear the word ”research,” I picture protocols, test subjects, and data assessment.  Which makes me want to say something snarky to the parents, like “Oh, by ‘research’ you mean you pulled the original data, did your own statistical analysis, and found their study design wanting?  Or you just read some crank on the internet?”  But of course I don’t.

Where can you go these days for good medical advice?  The internet, when it came out, was meant to be an “information highway,” where everyone could get knowledge fast.  However, it’s now sometimes the “misinformation highway,” where non-facts spread quickly.  Like when “anti-vaccers” use wrong material to scare people from vaccinating their kids.

People used to get their medical information from TV, magazines, newspapers, and books.  However, who buys books and magazines anymore, or watches TV news?  Newspaper circulation is way down too, and papers are getting thinner and go less in-depth with their articles.  People often go to friends for advice, but like the internet, friends’ information is only as good as their own sources.  Some people listen to celebrities for advice.  We always hear from celebrities, either on old platforms (TV and magazines), or new ones (Twitter, Facebook, TMZ).  Since interviewers cling to celebrities’ every word, sometimes those celebrities use their media soapboxes to expound on subjects where they have no expertise.

There’s also a trend where institutions like medicine, news media, or government aren’t as trusted as they used to be.  In the twentieth century, when medicine was making great strides with inventions like antibiotics, vaccines, and cancer treatments, lives were obviously being saved, and people listened.  Government was also showing its competence, winning World Wars, putting men on the moon, and establishing social safety nets for the poor and elderly.  Now the pace of medical breakthroughs has decelerated, and we find it harder to trust medical science, especially when one month the news reports that coffee, eggs, or butter are bad for you; then the next month they’re healthy again.  And since the Vietnam war and Watergate, government has become suspect as well.

Back to our non-vaccinating parents from above.  Instead of saying what I really want (“So when you did your ‘research’ on vaccine safety, that means you read some yahoos on the internet?”), I go more constructive.  I ask about their specific fears- what exactly worries you about vaccines?  Then I address those worries with facts, and stories from my own practice.  People appreciate education when it’s presented in a positive, non-judgemental manner.

Data on patient-doctor encounters shows that people still generally trust their own doctor, more than the medical establishment as a whole.  As we discussed above, public confidence in medicine, government, and the press has declined over past decades.  So like your local doctor, trust me when I say that these institutions are trust-worthy themselves.  I worked at a pillar of medicine- Johns Hopkins Hospital- and knew medical researchers, there and at the CDC and NIH.  These are earnest guys whose ambition is to serve people and do good science.  There’s no conspiracy between these doctors, government, or drug companies to line pockets and hide good data from the public.

I also have friends in media, from  local TV stations and newspapers, to the New York Times.  Again, they’re hard-working professionals who get facts straight and provide good information.  Allegations that they make “fake news” is the fake news itself.  Bottom line: you can trust institutions as sources for good information.

So where can you go for clearly written, fact-based medical information for your decision making?  First, if you’re reading this column on-line, you’re already there!  Go to the tabs at the right of this paragraph to read more on each subject.  If you’re reading this in the newspaper, go to parentsdontfret.net for the blog version.  Other good websites are at major university-based children’s hospitals, the NIH, or the CDC.  Also, there’s good ol’ books.  Barton Schmitt is a pediatrician who’s written some of the best books on caring for sick children.  The “What To Expect” series is also very good.

If it’s vaccines, rashes, emergencies, or what-the-heck-is-my-baby-doing-now-is-this normal, go to these places for help.  They’re tried, true, and fake news free.