Get what you need from family doctor
Everyday amazements - May 2005
Sunday, April 24, 2005
What parent hasn’t felt pain, helplessness, even anger at the doctor’s office when his child gets a series of immunization shots?
Today, however, shots are not the foremost thing on my mind—even though my daughter Ally is about to receive three.
I’m also thinking about how to cope with the ordinary irritations that go on in the doctor’s office we are about to enter, such as struggling to get an appointment and putting up with routinely long waits.
In short, I’m thinking about how to advocate for our family in a health care system that often seems like a mess.
My family is lucky. We have health insurance and a doctor we trust. Still, why is taking a child to the doctor so often a hassle? When is the right time to get angry about it? Or is it best to just put up with a little nonsense if our kids are receiving adequate care?
I have plenty of time to think about these things today.
After the nurse weighs Ally, we all wait for the doctor. Ten minutes pass, then 15.
Where’s the doctor?
Thirty minutes! My wife, Nancy, and I are annoyed, and I wonder: Where else but a doctor’s office can a professional get away with making you wait this long?
Finally, our doctor knocks on the door.
I think about telling him how angry I am. But I don’t. Why? Because getting ticked off may not help my daughter at all, especially when I already know what she doesn’t—this visit is going to be painful.
It doesn’t help that the only appointment we could get comes during her nap time, and she’s a little tired. The best thing to do today is make sure she’s comfortable, cared for and out of here as soon as possible.
Our doctor apologizes and shows us again why we’ve generally been pleased with him since the day our oldest daughter, Dina, was born five years ago: He’s sensible, loves kids and is easy to talk to.
There’s so much I want to ask him about my child’s development, nutrition and sleep. But there is simply not enough time to ask all of those questions.
Just before he leaves, I realize that we’ve waited 30 minutes and talked to him for about 13. (According to the Brookings Institution, a nonpartisan think tank in Washington, D.C., my experience is fairly typical. Research shows that the national average for routine well-child visits is actually less than 13 minutes.)
Still, my wife and I find time to make one more request before our doctor leaves the room: We want to hold our daughter while the nurse gives her the painful immunizations.
We decided this after the last visit, when a temporary nurse who was giving shots wasn’t as gentle with our daughter as we would have liked.
It all seemed to happen so fast that we didn’t stop her. As we left, though, we vowed we’d speak up the next time.
That next time comes today. Whether we hold our daughter during these shots may seem like a very tiny detail, but it’s hugely important to us. Our doctor, who’s clearly in the middle here, wedged between parents and staff, nods that he understands.
Soon after he leaves, the nurse walks in. We tell her we will hold our daughter while she’s getting the shots.
The nurse is skeptical and pauses for a moment—long enough for me to wonder whether she’s thinking, “These parents sure are demanding, aren’t they?”
We’re not about to budge, though. My wife and I hold our daughter and are able to calm her after she screams.
The entire visit was a little more than an hour—five minutes in the waiting room, five minutes of my daughter being weighed and measured, 30 minutes waiting in the examining room, 13 minutes with the doctor and 10 minutes waiting for the nurse and suffering through the shots.
I am so used to this routine after years of going to the doctor that I don’t fully acknowledge how much it bothers me until I’m out the door.
Later, as we drive home, I wonder: Why do we have to battle over who will hold our child in the doctor’s office? Why do we put up with the routine, business-as-usual long waits and short visits?
I call a doctor who has worked for two decades in a range of settings, and he suggests an alternative.
Dr. William Coleman, a pediatrician with the Center for Development and Learning in Chapel Hill, N.C., and a member of the American Academy of Pediatrics, stresses a basic and seemingly simple concept. He focuses on the importance of parents and doctors improving the way they communicate with each other in a medical setting.
Coleman, who sits on the pediatrics academy’s Committee for Psychosocial Aspects of Child and Family Health, has developed a model and textbook called Family Focused Pediatrics that “brings families in when they are frustrated, gets more families talking and tries to come up with remedies that make sense to families.”
“In today’s world, doctors are often under pressure to see a certain number of patients and parents often feel shuttled into tight protocols,” Coleman says. “[My] model is essentially a family focused interview. You focus on improving a specific issue by getting the family involved.”
He suggests that parents request a 30-minute visit with their doctors if they think they need more time or that they be open to the possibility of finding another doctor in the same practice who “fits their style.”
Coleman acknowledges there may be a range of difficult issues standing in a family’s way here, such as time constraints and family insurance plans that limit a family’s choices.
Luckily for my family, our doctor has been the right choice for us to this point. Whether it’s easy or not, we’re also learning how to ask him and others in his office for what we think our children need.
Next time, I might even ask for an extra 15 minutes.
Dan Baron is an Evanston writer. You can reach him at firstname.lastname@example.org.