Part I Kids’ Healthcare: 3 Basic Levels of Care
The importance of each of the 3 levels of care your child may need
Healthcare has become a national hot topic, and it becomes a greater concern for parents trying to figure out how to navigate the system for their children. Welcome to my three part discussion series designed as a general overview of how our healthcare system works.
From the moment we discover that we are pregnant, mothers become obsessed with maintaining the health of our children. Regardless of what our personal health standards had been, once we know we are carrying a child, we watch what we eat, drink, how we exercise and how much rest we get. As with the rest of our lives, we spend much more time worrying about the health of our children than we will for ourselves.
Many of you will think this post is simple and unnecessary. It may seem to reflect common sense. But I assure you, after practicing medicine as a pediatric surgeon for over 25 years, TRUST ME when I say this information is needed by many parents. For those of you for whom this is actually a review, please just sip some coffee or tea and consider this a refresher course.
As a specialist, I have been amazed by the different ways that patients come to my office. Many times it is based on the insurance company. If a referral is needed, the time to get to my office may be longer than for patients who can simply choose when they want to see a specialist.
My position is not whether you need a referral, it is whether or not you need a specialist. I have learned over the years that parents want to see specialists very early since …well, we are specialists. We are really, really good at the one thing. I can talk all day long about ENT (Ear, Nose and Throat) problems because I don’t have to know about stomach pain or swollen knees. So, yes! This does make me able to resolve some problems better than your pediatrician. However……
Specialists are pretty much one dimensional. We focus in on our area and keep pushing until we win. We will get to the bottom of it and fix the issue. However, we are not simultaneously monitoring the rest of your child. As you build a relationship with a pediatrician, you are allowing her (yes, girl power!) to learn how your child fights diseases, when treatment is needed and when observation is needed. She will look for patterns in your child’s illnesses and reflect on which treatments were most effective. As cliche as it sounds….each child is different, so using treatments that worked on another child may not work for yours.
As you start to understand how your pediatrician approaches illness and treats your child, you will also need to pay attention to yourself. How do you handle illness? What treatments do you do at home? Are you more influenced by needing treatments due to upcoming vacations and weekends?
Each mother has a parenting style that is uniquely her own when it comes to feeding, sleeping, disciplining and schooling options….managing illness is no different. There is not a clear right or a wrong way to do things, but once you understand your parenting style, you may better understand the recommendations of physicians.
It is fine for you to call the doctor for a temperature of 100 degrees. Yes, you can do this every time it happens. Even when you choose not to give tylenol for the fever because you don’t want to “cover up” an illness. It is valid and acceptable. HOWEVER, you will need to know that this is not the standard way parents treat their children, and as medical providers, we will not be as alarmed as you are. You will need to brace yourself for a reassuring nurse phone call, brace yourself for the physician not calling back personally and brace yourself for not being given an urgent appointment. These are the appropriate expectations.
You see, I believe that when it comes to medically treating your child, there are 3 basics levels of care. Each level needs to be fully explored before progressing to the next one.
1. Momma Medicine
This is an introductory level of healthcare management, and every mother is immediately certified in this level of care as soon as the baby is born. As time passes, each mother progresses through the Momma Medicine healthcare ranks just as one would pass through any other educational process. Most parents use tylenol, motrin, over the counter medications, cold compresses, humidifiers, saline nasal washes and then progress to my favorite category of HOCUS POCUS. I am not making fun of this group of therapies because I had a whole drawer full of them when my kids were young. I call these therapies Hocus Pocus because they seem to magically help but as a scientist, I cannot describe how the heck it actually works! Some Hocus Pocus options include…Vicks Vapor rub, essential oils, herbal medicines, and colloid silver. There is actually another category of therapy that I will not label Hocus Pocus, because they have been studied by other practitioners. These will be called Alternative Therapies because I still cannot scientifically explain how they work, but there are practitioners in these fields who can. These Alternative therapies may include Chiropractor, acupuncture, and heavy metal chelation. Please give them the chance to explain it to you if you seek them out because most traditional physicians do not know these fields. But I feel good about calling Vicks Hocus Pocus since there is no practitioner who vouches for its effectiveness. Nevertheless, I still had a little blue jar of that magical ointment and at the first sign of illness, my girls were slathered in it!
2. Pediatrician Care
After you have done whatever therapies and remedies you feel are appropriate, if you feel your child is not improving, this is when a sick child visit should be scheduled. Since it is the first visit, an initial assessment and introductory treatments are usually started. You may have already spent 2-3 days fighting the symptoms, but your physician will decide if she needs to advance treatments to prescription medications, or simply observe the disease process and continue with supportive treatments. She may not be ready to get xrays or blood work. Do not feel offended when she does not do that on first visit. This also means, you should not be asking for a specialist referral at this time! You should have an open conversation with your pediatrician about your concerns and ask to better understand her thought process and timelines. Yes, you MUST ASK. It would be great if we could tell every patient all of the things we considered at this visit as well as what we might do at next two visits, but that is a difficult task. We do have a plan but sometimes the main part of the visit is helping you to understand what we are thinking on that day. If you feel that you need to know the possible next steps, then ASK. (Yes, repeating this means that I routinely hear complaints from parents who feel pediatrician did not discuss future plans but also report that they never asked). We may not answer questions if they are not asked.
3. Specialty Care (like me!)
Specialists are the end of the line. We may use stronger medications or use them for longer than normal periods of time. We will more likely order CT scans or MRIs. We are ready to consider surgery and procedures like lung and stomach endoscopies for patients who have failed to improve. BUT, we are not ready to evaluate people who have not been treated with first line therapies or have not had recurrent or chronic illnesses. Specialists are not primary care physicians, which is the reason that the level of care your child received before coming to our office is important. Simply wanting to see a specialist because we are good at looking at ears is NOT a reason to see an ENT doctor! We do not need to double check what the ear drums look like. We are needed because the symptoms have failed to improve. The reason for understanding that specialists are the last option is because many parents believe that once surgery is done, their child will be cured. Nope. In some cases this is true. In other cases, surgery allows for medications that did not work before to now become effective at controlling the disease.
Let me just say that again….having surgery (like ear tubes or sinus surgery) does NOT mean you child will not have infections again. Do not seek to have surgery done because you believe medications will no longer be needed. Surgery may reduce the length of time medications are needed, but medicine and surgery have two very different end goals.
Okay then, now that we understand the three basic levels of care that complete the healthcare chain for your child, part 2 of this series will explore the different options of care your child may receive at the Pediatrician care level. After hours and emergency visits may be needed and we will discuss the impact of those visits on your child’s healthcare management.