Doctor, doctor

When people ask me what aspect of parenting has been the biggest surprise to me, my answer is always that I didn’t realize how much time I would be sick.  I’ve been coughing or sneezing pretty much constantly since the new year.  That’s why I don’t buy the argument that exposure to lots of germs in preschool means that kids won’t get sick later on — if that were true, I should be immune to just about everything by now.

It hasn’t been a terrible winter in terms of illness — no one has ended up in the hospital or the ER, which is my primary measure of success — but it hasn’t been a great one.  D’s been on oral steroids twice for his asthma, which doesn’t make me happy, although he seems to be doing much better now that we’ve increased his maintenance dose of Qvar.  We also have an appointment for him to see the allergist next week.  And N’s now on oral antibiotics for an ear infection, as well as a topical antibiotic for impetigo.  I feel kind of guilty about that one — we had assumed that he had just rubbed the skin under his nose raw from the constant drippage, but as soon as the doctor saw it, she said it was an infection.

And N was complaining about an ear ache for several days before we finally brought him in.  We got the memo that many ear infections will go away without antibiotic treatment, so were giving him advil and waiting and seeing.  But when his fever started to come back, I concluded that this wasn’t going away on its own.

I hate having to make these decisions.  This is why the Republican argument that the problem with our health care system is overuse drives me crazy.  I’m smart and well educated, but I didn’t go to medical school.  I probably err on the side of avoiding going to the doctor, because I know that there’s not much they can do for routine colds.  But this means that sometimes with hindsight I wish I had gone sooner.  It’s nuts to make it more expensive to bring a kid in for a doctor or nurse to take a look, just in case.  Because the one night that D spent in the hospital with asthma two years ago cost our insurance company more than all the medical treatment everyone in the family has received put together since.

Update:  N puked in the middle of the night.  Is it the Amoxicillan?  Or another bug?

24 Responses to “Doctor, doctor”

  1. jen Says:

    We also try to avoid the pediatrician, in no small part because we get the looks of death from the primary nurse if she deems the issue not important enough. You always live in fear of being tagged a high-maintenance parent … with all the crappy treatment and presumption of idiocy that goes along with it.
    So fine, we’ve taken the hint and only call when absolutely necessary. But then we also get the *flip* side of it! Two years ago we let a cold go for a while with our oldest, and when we finally brought her in she had double pneumonia. We got the standard b*tching out. Which I thought was a bit much, personally — not so much that particularly b*tching out, but the fact that we seem to get “spoken to” regardless of what we do. No wonder we avoid them! Breathtaking to watch the health care system at work, isn’t it?
    Hmm, this is making me wonder if we actually need a different pediatrician? Does anyone else have these sorts of experiences?

  2. EdgeWise Says:

    We bought an otoscope, to be able to check if our kids have ear infections, and it really has saved unnecessary trips to the doctor. Totally worth it for the little ones when it could just be teething.

  3. Christine Says:

    My view is that it is impossible sometimes for a parent to decide whether or not a trip to the pediatrician is warranted. If my husband, who is a physician, is unsure about our daughter due to the fact he is not trained in pediatrics how is a parent with no medical background expected to diagnose? Elizabeth, I really agree with your logic – “That’s why I don’t buy the argument that exposure to lots of germs in preschool means that kids won’t get sick later on — if that we’re true, I should be immune to just about everything by now.” I had not had the stomach virus since elementary school and last year several family members were stricken with it and most likey the result was from school. Every new teacher I am friends with says that the first year of teaching is one of the worst because the teacher catches alot of illness from the students.

  4. merseydotes Says:

    When Petunia was a baby, she got pink eye. Trying to be responsible about antibiotics, we gave it a day or two to see if it would get better. By the time we finally took her into the doctor’s office, Petunia’s eyes were almost swollen shut. She had to go on powerful oral antibiotics to get rid of the infection. We felt so awful for having waited.
    It’s such a hard thing to gauge when to bring them into the doctor’s office. Our pediatrician’s office, Children’s Medical Associates of Northern Virginia, works really well. They have a one hour call hour with a doctor every morning, and they always have nurses answering the phones so someone can help you make a decision over the phone. We have been saved plenty of trips just by calling and talking to someone before making a sick appointment.
    And about the preschool thing, I’d disagree. Petunia was in a large daycare center from the age of four and a half months. It is immune system boot camp. We went through every kind of cold and rotovirus you can imagine, including a trip to the ER for dehydration for her and viral meningitis for me, for the first two years of her life. Last year, neither she nor I missed a single day of work or school for illness. We seem to have turned a big corner.

  5. Elizabeth Says:

    Jen, yes, I think you need a new doctor.
    Merseydotes, our HMO has a 24 hour advice line, which is nice. But especially for kids, I think they err on the side of “bring them in” to get checked out. So my husband is reluctant to even call them unless he’s already convinced that the kid needs to see a doctor.

  6. dave s Says:

    We are big users of our kids’ pediatric practice. And I feel sort of bad about it, but, yeah, I don’t know enough to know when to go in, when not to (our guys have a call-in line, and a nurse will tell you whether to come in or not for absolute no-brainers, and that is a big savings in time and money). I have heard that in Minnesota there are nurse practitioner clinics in department stores, etc. (‘Doc-in-a-box’) and they have identified something like twenty conditions they can diagnose and prescribe for. People get those things diagnosed and treatment identified, big savings, and the things for which you need a more sophisticated diagnostician get you referred.

  7. Sandy D. Says:

    We’ve had a relatively healthy year (only a few fevers, several colds that went through every one, no puking, knock on wood) but I’m still on antibiotics for the third time in a year because EVERY time I get a bad cold I get a sinus infection afterwards. This wasn’t a problem until I had kids that brought home every cold out there. Ack.
    Jen, I would dump that pediatrician faster than a stinky diaper. We’ve had an absolutely wonderful guy for the past 10 years, and even after moving 30 minutes away, I drive the kids back there because I appreciate his manner with the kids, his patience with my questions, etc. If there is a local parenting listserv or yahoo group, that is a good place to get recommendations (or almost as important, warnings).

  8. bj Says:

    What’s surprised me about being a mother is how selfish it’s made me. I’ve always been one to be willing to wait in lines, take my turn, and my share of the pie. But at the venal level, I’ve found myself willing to snatch food from buffets to make sure my children get what they want, with little concern for waiting my share. And, that’s at the venal level. At the deeper level, I find that when I think about the world, at the back of my mind, there’s the knowledge that I’m going to protect my kids first.
    Maybe not a surprise to every parent, and, I think, not really a surprise to me. But, it’s one of the reasons why I never understood when people said that people who _didn’t_ have children were the selfish ones.
    What does this have to do with doctors — well, it’s another example. When it comes down to it, I’ll grab that last bottle of penicillin (or the doctor’s time) for my own kid, if I think it matters. In spite of that, I’m pretty laisez faire about doctor visits, but, that’s ’cause my children are healthy.
    bj

  9. MCMilker Says:

    Great post. Personally, I believe that medical care is now in the hands of the consumer. Buying a otoscope is a great idea! I have a variety of medical books, picked up second hand and my network of doc friends but, still end up going in far too often to the pediatrician to find out….”it’s a cold.” For perspective I checked in with Mom who said she ran in with us all of the time too. The difference is the cost…Hilary, you were right 15 years ago!

  10. dave.s Says:

    Interesting article about doc-in-a-box clinics. Big money savers, for most conditions, and should be able to recognize the ones which should send you elsewhere:
    http://www.galen.org/ownins.asp?DocID=1027

  11. dave.s. Says:

    More about Doc-in-a-Box. And, Walmart – to ring everyone’s bells even louder!
    http://www.ft.com/cms/s/5b301a64-093c-11dc-a349-000b5df10621.html

  12. dave.s. Says:

    Doc-in-a-box comes closer!
    http://mjperry.blogspot.com/2007/12/target-opens-clinics-in-minnesota-and.html

  13. dave.s. Says:

    http://freemanhunt.blogspot.com/2008/01/rediclinic-review.html
    SOMEBODY loves doc-in-a-box!!

  14. dave.s. Says:

    Mayor Menino doesn’t like ‘em!
    http://www.boston.com/news/local/massachusetts/articles/2008/01/11/menino_decries_clinics_in_retailers/

  15. dave.s. Says:

    a pediatrician who likes doc-in-a-box, to get the routine stupid stuff out of his practice:
    http://www.salon.com/mwt/feature/2008/02/19/retail_health_clinics/

  16. Amy P Says:

    My favorite pediatrician line is “It’s a virus.” Like that narrows it down. I guess that’s med-speak for “We don’t know what it is, but there’s nothing we can do, so it will have to take its course.” (We also went through viral/bacterial hell when our oldest went to preschool at 3. When we did the rotovirus thing, our oldest spent several hours at ER on an IV, while our youngest (an infant) had to spend a night at the hospital in order to be properly rehydrated.

  17. dave.s. Says:

    Cross & Shield likes doc-in-a-box in Minnesota!
    http://www.businessinsurance.com/cgi-bin/news.pl?post_date=2008-07-31&id=13582

  18. dave.s. Says:

    drugstore-in-a-box! This makes a LOT more sense than having a pharmacist sitting around in a tiny town waiting for the three-times-a-day customers, or than having the tiny-town people have to wait for drugs they need NOW to come in the mail.
    http://mjperry.blogspot.com/2008/09/nd-telepharmacy-project-takes-off.html

  19. dave.s. Says:

    Clearly, there are savings in looking to the barefoot physician model: http://www.overcomingbias.com/2008/10/more-deafening.html
    “a deafening silence. Dozens of studies over decades consistently find no patient health differences between expensive docs and cheaper clinicians, but there is zero momentum to let clinicians replace docs – policy trends go the other way. The “establishment” complains about flaws in existing studies, but feels no need to do better studies. What is the point of social science if even relatively clear important results are ignored? ..”

  20. dave.s. Says:

    happy workers at doc-in-a-box
    http://philadelphia.bizjournals.com/philadelphia/stories/2009/01/19/focus4.html?b=1232341200^1761376

  21. dave.s. Says:

    Obama likes doc-in-a-box!
    http://news.yahoo.com/s/nm/20090303/us_nm/us_obama_healthcare_centers_1

  22. dave.s. Says:

    “..I feel sort of jilted..”
    http://www.boston.com/news/local/massachusetts/articles/2009/03/12/sick_flocking_to_in_store_clinics/?p1=Well_MostPop_Emailed1

  23. dave.s. Says:

    Texas Medical Association really HATES doc-in-a-box! http://www.mysanantonio.com/business/45878497.html

  24. dave.s. Says:

    Mark Perry thinks doc-in-a-box will kill Obamacare: http://mjperry.blogspot.com/2010/03/why-obamacare-wont-work-it-will-be.html
    I think he’s got a point. If my health care weren’t paid for by work, I’d think about going bare.

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