Saturday, December 1, 2007


OK. Another teaser title. I am definitely pro-life, make no mistake, but this is about other choices, not the life and death ones.
Parents want a say in their kid's medical care. I understand and respect, and even expect, that. They can go and get another opinion, they can challenge diagnoses and medication choices. In this day and age of insurance Nazi tactics, they are forced to do things they don't want to do to get to where they need to be. But that's another rant.
My wife likes to decorate and design, to put her "touch" on things to make them more beautiful or functional or both. She is very good at it. In buying or building a home, she has definite ideas. She knows what she wants and why she wants it. I've learned, at least most of the time, not to argue. The builder or tile-setter or painter or concrete guy or landscape designer or plumber can give her good reasons why her ideas can be done or cannot be done. And she's good at listening to them and usually agrees if they disagree. She doesn't, however, usually inspect the work of the guys who dig and lay the foundation and pour the slab, prepare the ground before these things occur, or have much input into the earliest stages, stages that make a house stand up to high winds and rain and tornadoes, etc. She trusts that they are doing that part right. They are experts, and she's chosen them because of that expertise, and her (and definitely my) lack of it in these areas.
To my point: Parents can participate in all decisions about their kids' healthcare if they like, but there are some areas in which the expertise of the physician should be trusted and left to faith since they (usually) chose this physician because of his or her expertise and reputation. Let them pick the wall colors and ceiling fan stuff. Stuff like which formula to feed, or whether to breast feed, but one must feed the baby. They can choose the crib and bedding, but let the doctor tell them how to let the baby sleep there. To school or not to school, fine. But you must teach. But it's interesting how people seem much more willing to argue with a doctor vs. a plumber over the best course to take to solve a certain problem. Granted, the parents live with the child. Well, at least one of them usually does, and when divorce happens, it's like two people whose interests couldn't be reconciled together trying to build a house apart and wondering why it looks like neither of them wanted. Once again, another rant. So, firsthand experience with the child and the behavior or illness is very important, and should be something the doc takes seriously. But then let the doctor tell you what to do some times. Not every time do you have to go with that, but the vast majority of times we know which ceiling fan will work in this room and why, and if you insist on the one you want because you heard about it on Oprah or the Today Show, don't come running to me when it falls out of the ceiling or gives you a buzz haircut because the ceiling isn't high enough for it. Parents are fearful, for instance, of steroids for asthma. Concerns about growth failure and immune suppression abound. Same with immunizations. But docs do have a little experience dealing with asthma and what works and why and why an inhaled steroid might work better for your kid than Singulair or vice versa regardless of what you read or saw or your neighbor told you or your good friend the urologist whose asthma expertise never materialized to begin with. Deep breath. It might do parents some good to listen to their docs more before putting in their two cents, and I agree the reverse is true as well, but if parents listened and did what the doc said, then if things don't work out as forecasted, it's the doc's fault. If I recommend a course of action and you take it and do it as I've prescribed, and it doesn't work, shame on me. I'll be doubly invested in finding another way that works for your child. If, however, you've already picked the road to take and I let you go down it, when it dead ends into failure, my first response is going to be outwardly, "gosh I'm sorry that didn't work out like you and Oprah thought it would", but inwardly know that I'm saying "if you had just listened to me this might have worked out differently". Those who know me recognize the "good luck" theory in practice, and I'm more than willing to be the "parent" in this scenario, but I hope that the "kids" learn from their mistakes.
I absolutely do not want total control of my patients. It scares me to think that some people go home and do things just like I told them to because I am so not used to that that most of my advice is 50% tougher than it needs to be to compensate for the 50% compliance rate expected of most parents. And I expect my parents to have, and use, brains. Theirs, or someone else's if need be. If they are seeing a problem that worries them, they are to call, or email. If it's a bad problem, like an allergic reaction to a medicine, they should stop it and call. But to follow my instructions blindly is not my intent. To tailor them to their liking is also not my intent. It's amazing how many constipated kids on miralax get better so guess what? Their parents stop the miralax, then they call and wonder what happened. Did you ever think the reason billy was better was the miralax? Or that the Singulair they've been taking is why they've not had any cough or wheezing? I'm all for keeping kids off medications if possible, but if not possible, and proven not possible, then just give it! It would be like me telling the builder that we haven't had any water problems yet so don't go ahead and put that roof on that we had planned, we don't seem to need it, and it really costs alot, even though there has been no rain! Or since we haven't had any burglaries we can just get rid of our security system - maybe that's why we haven't had any problems!
Enough on this. If the point isn't obvious, let me restate/summarize. The doctor is at least allegedly the expert in medicine, so let the doctor decide what's best, given your input, and go with what the doctor says, and see how things go. Your doctor might faint if you say "you're the doctor, just do what you think is best", but he/she will appreciate it. That may be why my dad, a pediatrician in another era, could see 80 patients in a day, and I'm busy with 40!

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