Wednesday, June 22, 2011
The left side is more pro-vaccine choice.
The right side is more for the complete schedule.
A long time ago, I read making an Informed Vaccine Decision: A Parent's Guide to Childhood Shots by Mayer Einstein MD and How to Raise a Healthy Child in Spite of Your Doctor By the Robert Mendelsohn MD. Both of these books would be far to the left opposing vaccination and actually coming right out and saying "Don't Vaccinate".
Whether or not we agree on vaccinations, I know the issues. I'd rather you concentrate on learning about empowering birth and breastfeeding if you don't have time to read everything. I can help you make a good choice.
I've often wondered if pediatricians or other doctors visit my blog with an open mind or if the critical type follows me. All are welcome. Please come back.
Posted by Denise Punger MD IBCLC at 10:49 PM
Saturday, June 11, 2011
Many assume physician practices make a lot of money off vaccines. Maybe there is a lot of profit for some doctors. I am naive as to how they are making the vaccine profit (that makes them so stubborn). I know the manufacturer gets the product sale, but I am not sure what drives the Pediatrician to be so insistent on the full vaccine schedule. Capitalism motivates and perhaps that's why it is so hard to find doctors who are flexible with vaccine choice. Or is it really the fixed-firm altruistic belief that the complete schedule saves lives. ( I realize I am really putting myself out there....)
I'd like to consider the financial incentive:
Medicaid distributes vaccines to participating pediatricians (I think), but I am not a part of that program. I don't know much about it. Is there incentive for the provider to push?
The physician gets to bill for the office visit, but that's the office visit and not the immunization. Would some visits be lost if there would be no vaccination administered. Sure, there would be. But that's the families choice and I am not responsible if they don't choose to see me (It should be clear if you are missing appointments without mutual agreement, I am not repsonsible for after hours care.). In my practice situation, many still come in for the recommended visits for questions, concerns, education, breastfeeding, nutrition without the pressure to vaccinate and the reassurance in having my emergency availability. The visits equal out. At least for me it does not make a case.
I have never been given (or even offered) a bonus or any kind of incentive for vaccination children. If I've been indirectly offered a bonus for vaccinating adults, I am oblivious to it and focused on what I am (not) doing. I am not eating their free-lunch either. I'd rather have my smoothie.
I am not saying these incentives are or aren't out there. I am just not sure.
Perhaps it's in the volume. Maybe in bigger, multi-physician practices the financial incentive is in the quantity. I am just relatively small volume seeing patients of all ages in the mix. "Vaccine-volume" doesn't work to my benefit. We don't have one nurse dedicated to vaccines all day.
Health Insurance reimburses for administration. They do not reimburse for these items regarding vaccines.
Refrigeration (including keeping cool during storms)
Needles & Syringes
Staffing & Training
Extra time needed for chart-work
Production of Forms for the Chart
Education of Families
Expired Products (if anything expires, its a complete wash-out)
Our purchase (and reproduction) and distribution of School Forms
Follow-up phone calls regarding side-effects and complaints. (Fortunately, I don't get many of these calls).
Quite honestly from an overhead standpoint it would be just as well if you did not vaccinate at all and I can simply document DECLINE VACCINATION on the office visit note.
I like to disclose this. Because it's not what you'd expect.
Perhaps, without significant financial incentive to my small practice, it is easier to be opened-minded to accept patients in my practice who do not fully vaccinate because it's a monetarily neutral decision. Let me just say, maybe I'd even come out ahead in overhead if I did less immunization (My nurses might like it too.). Really, it would be very hard to truly analyze this. I am just glad I am able to offer flexibility and feel good about it.
Posted by Denise Punger MD IBCLC at 9:21 PM
Thursday, June 9, 2011
When I started my Breastfeeding Practice 7 years ago, I mistakenly thought, I had to provide pumps for sales and rentals to be successful. I thought I could not have a breastfeeding practice without pumps. I loaded up with the two leading brands and rentals.
I am totally wrong. I hardly sell or rent a pump.
- When I sell my last Medela Pump (which happens to be cheaper than Targets price) I am not going to stock up on pumps anymore.
- When my contract for hospital grade rental pumps expires I am sending my rental pumps back.
I will continue to provide replacement parts for Medela. I have some parts for the Ameda style pump, but overall Ameda and other promising new pump brands don't seem to be in too much demand in my area.
The mothers who come to me who legitimately need a pump, seem to have them before coming to me. Someone in the area is doing well with pumps sales/rentals. Target? the Hospitals? the Medical Supply? They are doing so well at selling pumps, I don't need to.
No pump. NO PUMP. I can't sell a single pump. I want the baby to nurse.
Mothers of preemies, the hospital will certainly supply you with the highest quality rental pump.
Others with medical problems (sore nipples, fussy babies, under or oversupply), be leery of what you are purchasing. If you need lactation support, get the right information.
Posted by Denise Punger MD IBCLC at 11:42 AM
Tuesday, June 7, 2011
I am getting more and more babies and families from Miami to Melbourne (both 2 hours away in either direction) coming to the office. This is a typical question I get asked.
How does well-child care work with your patients living so far away?
This is what seems to be working for the healthy family that needs a medical home.
Best if I get to meet the parents before the birth. Nearly 100% of the time this is very beneficial to you because knowing you have a medical home for your family that supports your choices is a big obstacle out-of-the-way. I like to see both the mom and baby together at first visit after the birth. I like to see the baby breastfeed and reassure you that feeding is normal (or solve problems). If time allows, I can help you with your wraps or sling and cloth diapers. If feeding is working, likely everything else will fall into place.
The baby's well visit schedule :
1 week -2 weeks (or sooner) (Mom is seen, too, as breastfeeding and family lifestyle are discussed.)
4 weeks-2 months
From 1-2 years old every 3, 4 , 6 months depending on circumstances
From 2-3 years IF a problem every 6 months
3 years an older, once a year
This is probably less well child visit appointments than most traditional pediatric practices who have you coming back for everything. One mom from Miami, told me, " I just should have driven to you in the first place because I sat three hours in another doctor's office, only to not get any help (and the discouragement caused me continued distress) ." If this well-child schedule seems to be too much, I am open to discussion up front. I understand homebirth, midwives, and doula care. Even if you eventually want to have a Pediatrician closer to home, I am a good transition from midwife to well-child care. Often older children come in only once-a-year. The whole family can come in together and be done with it.
Vaccination Status is not an issue. I don't require pediatric blood draws.
I find that breastfed, stay-at-home babies don't get sick as often as we are conditioned to think kids do, so I don't think that moms are making the long drive too often with acutely sick kids. Many times I have called in something to hold you over until you can safely drive to the office. If it turns out you have a chronically fussy baby or very sick-kid, the arrangement with me may not work.
For many parents, they prefer my style of well-child visits (and will go to the urgent care locally if it is that bad that one time). Obviously for injuries and emergencies it is appropriate to go urgent care or ER no matter who or where your pediatrician is. That may never be necessary for most kids and it is most important to have the professional support in the meantime for your breastfeeding, co-sleeping, babywearing, vaccination choices, etc...
I find when I get to know families, walk-in clinic visits for fever and illness are less frequent. I can usually manage an illness with close communication. I try to empower families to need less visits overall. I take pride in that I can offer after hour care, but please not there will be charges or follow up required for after hours care. I have utilized flexible services like phone consult and E-care services to accommodate different needs and after-hour needs for families near and far. In-fact if you live close I am very flexible, too. All this applies to you too!
Posted by Denise Punger MD IBCLC at 10:30 PM
Monday, June 6, 2011
I haven't posted an update on David's speech therapy and reading since Nov 6. Wow does time pass!
David is an emerging reader finally at 7 1/2 (practically 8). After a long break from structured lessons, we got started again in Level 3 of Barton.
I took a break because one thing after another kept me busy and I couldn't focus myself on teaching him. He didn't seem ready. He kept fighting me everytime. I decided it wasn't worth the attempt.
Neither of his brothers read ANYTHING at 7 so I decided not to be so hard on ourselves and relax.
David has coninued to go to speech therapy nearly twice a week. He has made enourmous progress since I started taking him in October. I am not sure how much longer he'll need. His speech is pretty clear, but I still feel their is benefits to be gained. He really likes Libby his therapist. She's found lots of ways to reward him with motor activities, puzzles, and games. He has benefitted in more than on way from speech therapy.
Posted by Denise Punger MD IBCLC at 3:09 PM