Monday, June 25, 2007

Crossing the Line

Would you break the law to get your child what he or she needs?
Consider this story in today's Los Angeles Times. . .

Schools Call Roll at a Border Crossing
"Children who are U.S. citizens or legal immigrants but live in Mexico cross every morning to get a better education for free in Arizona, breaking the law that requires them to live within the boundaries of the district. To many of their parents, who have ties in both countries, not living in the district is the educational equivalent of jaywalking."

Parents do it all the time.

Consider this article as well - Would you break the law to get your child an education?

Do we stretch the truth with our pediatrician so he'll write a prescription for an antibiotic when it isn't quite time for one? Do we lie about our child's age to get him on a particular sports team?

This is such a difficult topic, but it is so common. I'm not here to judge. I just would like to hear your justification for why you do what you do.

I'm not innocent here, but I made a choice a number of years ago to let that tactic go from my life.

Just curious about your thoughts.

Saturday, June 16, 2007

Do You Have the "Right" Doctor?

Even though we didn't go to medical school, we are ultimately responsible for our own healthcare as well as our children's. We have to learn how to advocate for health needs, and that requires asking the right questions. If you are getting ready to choose a physician or you have a physician and you're not happy with him or her, there are some questions or concerns for you to consider and you look for ways to stand up for child in the exam room (or even the waiting room).
  • The waiting game - how long do you find yourself waiting in the outer waiting room for your appointment? Does it seem like your appointment time is just a "suggestion"? How does the front office staff respond to inquiries about when you should expect to be seen? Do they voluntarily offer reasons for the delay or do you have to pry it out of them? How about once inside the exam room? Do you find yourself waiting there just as long? By itself, this isn't a reason to change doctors, but if it one of many complaints, you'll want to consider it.
  • Appointments - is it difficult for you to get an appointment when you or your child is sick? This is a problem. Many doctors schedule in "sick" appointments so they can squeeze last minute patients in. Don't you hate it when it's Friday and you call and they can't get you or your child in to be seen and you know you have the whole weekend to get through in hopes you can get in on Monday? This shouldn't happen. Consider it a red flag.
  • Second Opinions - there are medical issues that require a second opinion. Is your physician discouraging about getting one? If so, find a new doctor!
  • Bedside Manner - personality does play a part in patient care. If you don't get along with your doctor; if his manner is too abrupt or makes you uncomfortable, switch. You have to trust this person if you are going to trust his diagnoses and advice.
  • Record Keeping - your medical records are just that - YOURS. If a doctor does not permit you to see or have a copy of your records, there's a problem.
  • Is the Doctor in? - Do you find that you spend most of your time with the nurse or the nurse practitioner? Does your doctor only show up the last few minutes of the appointment? Remember that you are paying to see the doctor, and not his nurse or physician's assistant. Consider this a red flag as well.
  • Can You Hear Me Now? - is your doctor a good listener, or does he barely acknowledge your words or concers? A good doctor is a good listener and respects his patient's words.
  • Front Office Staff - are they friendly or rude? The front office staff are the first ones you encounter and often reflect the doctor. Either the doctor is also rude or doesn't care that his staff is rude. He should care.
  • Follow Up - does your doctor return your calls or queries or do you find yourself waiting and then always being the one to follow up with him instead? Good doctoring is also about relationship.
  • Too Many Prescriptions - sometimes doctors push drugs and/or vitamins on patients when it is not necessary in order to push products the drug companies "encourage" them to push. Often these drugs are more expensive or don't have a generic alternative. If you don't need it, don't fill the prescription and find someone who isn't a pill pusher.
  • To Treat You is to Know You - don't expect your doctor to remember everything about you, but he should be familiar enough with your medical history to ask about specific instances. If it feels like a first meeting every time you see him, find someone else.

Only you can decide which issues are hot buttons for you and your family. Each in isolation may be worth persevering through, but three or more in conjunction should make you take pause and reconsider your healthcare provider.

Monday, June 04, 2007

When Illness Forces You to Stand for Your Child

Guest Columnist: Ellen Schneider

Our daughter, Abigail, was diagnosed with Type 1 diabetes when she was in the second grade.

My husband and I immediately sat down with the assistant principal and the school nurse to discuss Abby’s medical condition and what care she would need while in school. For the two years that Abby attended this school, we never had a problem. I would visit Abby’s class every September and explain to her classmates what Type 1 diabetes was, how it would affect Abby, symptoms to look for, and how to treat them. I asked them to take turns being her buddy and escorting her to the nurse whenever she needed to test her blood sugar level. I worked with Abby’s teachers and the homeroom parents to ensure that Abby would have suitable snacks to eat during school events and the ever popular birthday parties.

I obtained information from the Juvenile Diabetes Research Foundation’s website on advocating for your child in school and printed out their recommended wording for a 504 Plan, which we modified and discussed with school personnel. The 504 (Health) Plan allows you to make special requests and we modify the plan and discuss any changes with the school administrators and nurse each June. Second graders ate lunch at 10:30 am and had a snack in the classroom at 1 pm. Having lunch so early would negatively affect Abby’s blood sugars, so we included a request that Abby eat snack at 10:30 am and eat her lunch when her classmates were eating snack. Since exercise lowers her blood sugar, Abby’s 504 Plan states that she have gym scheduled before lunch.

Any time Abby feels “weird” due to blood sugars being too high or too low, she leaves her classroom and visits the school nurse. It was very important to us that this also be written into the 504 Plan. While not critical in second grade, this point becomes more important as Abby gets older. It means that if Abby needs to visit the school nurse while the class is taking an exam, whether a subject test or a standardized test, she is allowed extra time to complete the exam. By planning ahead, we hope to prevent any problems when Abby takes the SAT exams.

Abby now attends middle school and the nurse is not comfortable treating Abby’s diabetes. While there are other children in the school with Type 1 diabetes, Abby requires more insulin and more frequently than the other students. This nurse hasn’t always treated Abby and her diabetes appropriately. She has told Abby that her food choices weren’t suitable, that Abby should take more control of her diabetes and finger-test herself (because the nurse didn’t want to do it), and that Abby should use an insulin pump, like some of the other students.

It is the nurse’s responsibility to administer insulin when necessary—not make recommendations as to Abby’s care. We let Abby dictate her own level of involvement. Abby began finger-testing and drawing up insulin when she was comfortable with the procedures. Abby will use an insulin pump when, and if, she decides to use one.

The most serious problem, however, involves the administering of insulin when Abby’s blood sugar levels go over 350. The 504 Plan states this and the nurse has a written protocol, signed by Abby’s endocrinologist, detailing the amount of insulin to administer depending on Abby’s blood sugar level. The protocol requires no thought. If Abby’s blood sugar is X, nurse gives Y amount of insulin, regardless of the time of day. It’s simple. Unfortunately, one day the nurse didn’t give Abby insulin because it was 10:30 am, and “too early in the day” to give insulin. Nor did the nurse call me to ask about it. What made this even more frightening was Abby’s blood sugar level was the highest it had ever been, yet I didn’t even get a phone call.

The next day I stormed into the nurse’s office demanding to know why insulin wasn’t given. Totally unsatisfied with the nurse’s response, I insisted on meeting with the principal to discuss the situation. He promised to question the nurse and get back to me, which he didn’t. Two weeks later, I sent a letter to the nurse’s supervisor alerting her to the nurse’s extremely negligent behavior. The supervisor called and we discussed possible solutions. I’m pleased to report the nurse has since acted in a more appropriate manner. If you don’t fight for your child, who will?