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Wednesday, February 10, 2010

Well-child Care Appointments-- Are they Necessary?

I am often asked this question:

What is your opinion of well baby visits? I was recently reading "How to raise a healthy child in spite of your doctor" and that guy is totally against them. We decided against immunizations and I've gone twice to the ped and it just seems totally pointless. I know nothing is wrong with my baby so why am I taking him to the doctor?

Capt'n Amazing Wife specifically asked this time. She is out of state and I am going to answer this question in that context.

I am in Family Medicine because I enjoy relationships with my patients and families. Getting to know my patients when they are well goes along way. When an illness or injury comes along, often I am able to accommodate you quicker and provide more individualized care because I know your preferences. This applies especially in the evening hours. I am much more likely to initiate an evening or weekend treatment (or reassurance) until I can see you if I have current records. I have come into my office or practice medicine on the go (whereever I am! ) after hours to help someone out who has taken the time to keep their appointments. Much of my practice emails and texts me (I prefer email, btw, for medical questions.) Someone with a current chart probably will get a fast evening response from me. If you are way overdue for an appointment (or have missed appointments), I am more likely to ask my staff to handle it in the morning. It just depends. After living in the area for over 15 years I have come to know many families who have active "medical" times and fortunately quiet times. I really respect the families who take good care of themselves.

I am happy to give some advice or initiate evening treatment. In fact I tend to think of myself as accessible and can help nip things in the bud before they get worse or lost sleep. I have a few local families ask if they need to keep a well-child schedule or can they come in just when they need something. I've been right upfront and told them if they don't bring a baby for well-care don't expect me to take call for their baby in the evening. It's not fair to me (and my family )to answer questions about a baby who changes so quickly whom I am available for during the day and family chooses not to keep appointments. Fortunately most of those families pretty much understand that and don't take issue with that negotiation. It's kind of like what they are looking for anyway.

I have read that book 11 years ago. The book was out-of-date then and removed from the LLL library. I understand that the author is trying to reform pediatric care. Just be careful because 1/2 the specific issues didn't apply anymore when I read it.

I happen to disagree with him on weights checks. I think they are very important. Sure I can eyeball a baby and see if he is growing. I look at the baby before I look at the weight. Weight questions is one of the most common questions parent have-- about adequate weight gain and poor gain. It is also important for physicians to know what to do with the weight checks and when to worry. And many physicians don't (so I understand his desire for pediatric care reform).
The biggest impact I can make at a well-child visit is preserving the breastfeeding relationship. I didn't do a study, but I am pretty certain my breastfeeding rates are the highest in my area. :)How it irks me when a mom who doesn't believe in well visits finally comes in later for a sick visit and stopped breastfeeding because of some simple-to-resolve problem. I suppose if she really was interested she would have asked. But there is also other issues that come up that parents don't recognize as a breastfeeding issue, but is, For example colic, gas, loose stools may be oversupply, NOT lactose intolerance or reflux. There is also some things not likely to be breastfeeding related. For example, baby acne will pass and is not an allergy to breastmilk. For many families I am the only voice (or the first voice) reminding mothers of their inner strength and reminding them to listen to their heart and their baby and not to others.

As far as the well-child schedule. I imagine my schedule is much more relaxed compared to the AAP's. I have seemed to find what works in my office. 1st week, 2nd week, 4 weeks, 2, 4, 6, 9, 12 months. 15, 18, 24, yearly after that. I am flexible yet. First breastfed baby may require more visits initially. I often reduce the schedule for an experienced mom or one coming a very long distance if all is well. It also depends where the mom is on her journey with all the current issues surrounding well-child care and how her emotional recovery from birth is going. I do a lot of work with healing. All moms with babies under one have an active chart in my practice so I can get to know them too.

All this and we haven't gotten to vaccines yet because not having vaccines is not a reason to keep well-child visits. I answer lots of vaccine questions in the office. ( I do not take vaccine questions via blog.)

As far as my boys go, I worked for the big dominant hospital system when William and Scott were babies. I was programmed to have well-child visits from residency. They kept their appointments because it was easy. It was there. I was showing my babies off to my colleagues at the same time. I often felt like I had to remind the pediatricians that breastfeeding works and for them to prioritize it. I left interesting pamphlets with them hoping to leave an impact. I guess you can say I was hoping to do them a favor. When David was born, I had a likeable and popular pediatrician in Rome, Georgia who previously was a classmate. We kept a few visits for David. Scott had a visit once that year.

I often wonder who I would go to if I had to take my kids somewhere now. They each have had one peds visit in the last 5+ years at the time when one of them needed clearance before dental work. I understand the pointless part. ( I wonder what physician I would go to if I needed something.) Fortunately the minor things that come up, are the kind of things I have access to supplies and pharmacists knowledge. Prior to this practice I was employed in urgent care and didn't necessarily have access or the well developed skills of well-child care I have now. As you know from reading my blog we do a lot of prevention in my house. Exercise, eat better than most, breastfeed for years and years :), avoid large crowds of sick kids. Our house, car, and property are NO SMOKING ZONES. Smoking is absolutely not tolerated. I know a lot of my readers feel the same way.

Like everything else, keeping well-child visit is a parents decision. Explaining how I see things may help you locate one in your area who may share ideals and you could have a better rapport with. Ideally there would be a physician in your area that you could have a good relationship.


fitncrafty said...

Thank you for this post! I think so many think of 'well baby' as shot times, however I think it is much more than that. I agree with everything you said about developing a relationship with your patients. I also think that if I baby/child knows you and has an emergency, they will be more at ease with you treating them in that crisis moment!

Not to mention, I think that the key is prevention and education. We can only do so much once a person is chronically ill, in poor health and has terrible habits (poor diet, no exercise, poor stress management, smoking etc) The key is to encourage our youth and teach them prevention.

We are so blessed to have good Docs. We are keeping on eye on Zach because his weight gain is a bit slow. The doctors aren't overly concerned but they are aware and want to be sure. Other things were overlooked with him (like his eye) and it's too late to treat!

I know you are my sister, and I may be biased (a bit), but your patients are so lucky to have a doc that is so patient caring and concerned!

Great post, I really enjoyed it!

ScienceGeek said...

I realize this post is meant mainly for well checks during the baby years, but I had to make a comment. I know families who don't feel the need to take their kids for well check ups (kids in the 5-10 age range). I've never found it a hassle to make that one appt per kid per year. 2 years ago, during a well check, our ped. found a previously undiagnosed (and serious) hernia problem in one of my sons that required surgery. It wouldn't have been found had we not had his well check up appt. So, I'm firmly rooted on the side of finding value in well check ups, even beyond the baby years.

Permission to Mother said...

SG, I was going to extend this to cover well child visits, but had to wrap it up. Some things I would look for or ask for at that annual PE that parents don't always think to bring up is sleep, bedwetting, soiling, nutrition, nutrion, nutrition. I now ask specifically about handwritng and reading. Most of the stuff I ask is topics parents are often embarrassed to bring up or don't know there are approaches for resolution.

And for Carrie, I am doing visual screenings on 3- 4 year olds and more if it hasn't been done. I like to check that everyone can see out of both eyes.

Capt'n Amazing's wife said...

So I read this before but didn't get around to commenting since my baby was fussing. I think if you were my doctor then I wouldn't be asking this type of question. My doctor is a good doctor. But I kind wonder how she remembers every health status of every child she visits with when she asks me the same questions every time but never writes anything down. It'd be great if I could find a doctor who I liked more but you can't exactly go around interviewing hundreds of doctors these days and not expect a huge amount of money to disappear from your wallet. I appreciate your thoughts on the subject though. I'm going to try and get some other opinions on it as well before I make up my mind. Thanks!

Permission to Mother said...

Did you ask LLL or your midwife? Yuu probably did, but just in case...

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