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Wednesday, October 10th, 2012
A growing trend in pediatric care may be in the technology devices teenagers carry with them everywhere they go: doctors are using text messaging and other communication strategies to communicate better with their patients. From The New York Times:
But using social media also raises questions about doctor-patient boundaries, privacy laws and confidentiality. Should doctors “friend” young patients on Facebook? What rules should doctors establish about texting with teenagers: content, hours and expectations of speedy replies? How should doctors take into account the reality that teenagers’ cellphones are often missing in action, only to be found — and pored over — by friends and parents?
For these reasons, many doctors stop short of texting. Because texting is not encrypted and does not comply with privacy laws, “my clinic rules forbid me,” said Dr. Wendy Sue Swanson, a pediatrician who treats teenagers at the Everett Clinic, which is outside Seattle, and at Seattle Children’s Hospital.
But teenagers follow her on Twitter and her Seattle Mama Doc blog, on which she writes commentary and posts health news and videos.
During visits, she will ask a teenager the safest way to pass along private information. For those on birth control, she’ll say, “Take out your cellphone and put in a daily alarm about when to take your pill. Call it…‘strawberry.’ ”
Dr. Swanson won’t answer individual questions on her blog. “But if they ask a question in my office that I think a lot of teens would like to know about,” she added, “I can put the content on the blog without identifying the patient.”
In New York, Mount Sinai Hospital’s Adolescent Health Center uses a program called Text in the City to send patients tips and reminders about medications and appointments. Patients can also text questions, understanding that answers may not arrive for 24 hours. Dr. Katie Malbon, who writes most of the responses, said she cautions: delete an answer after reading it….
….But many doctors cannot imagine adding social media responsibilities to an already exhausting practice. Dr. [Natasha] Burgert, 36, is a juggernaut: With two children, she has a busy practice, keeps a blog on her group’s Web site, posts Twitter messages, texts her teenage patients and still sticks to an 8-to-5 workday.
She carries a paper notebook to jot reminders, and spends 15 minutes a day sending texts and e-mails. It saves her hours of phone tag with patients.
The teenagers don’t overload her with exchanges, she said. “They understand it is a privilege, that not all physicians will do this. Actually, I have more problems with first-time parents.”
Image: Doctor texting, via Shutterstock
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Thursday, September 27th, 2012
While most parents whose low income qualifies them for health coverage through Medicaid fill prescriptions for antibiotics and other medications for acute illnesses, many fail to fill pediatricians’ orders for vitamin and mineral supplements, a new study has found. Reuters Health reports:
Antibiotics and other drugs for infections were filled 91 percent of the time, versus 65 percent of prescriptions for vitamins and minerals, for example.
“When your child has an ear infection and is in pain, you have much more of a sense of urgency,” [lead researcher Dr. Rachael] Zweigoron [of the Medical University of South Carolina in Charleston] said. But if a doctor recommends a vitamin D or iron supplement, she added, parents might not see the immediate need.
That raises the question of whether parents always know why a pediatrician has prescribed a medication or supplement. “Are we, as pediatricians, doing a good enough job of explaining the importance to parents?” Zweigoron said.
The findings, which appear in the journal Pediatrics, are based on 4,833 kids seen over two years at two clinics connected to Lurie Children’s Hospital of Chicago.
All of the children were on Medicaid, the government health insurance program for the poor. So it’s not clear if the findings would be the same for U.S. kids with private insurance.
Image: Child taking medicine, via Shutterstock
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Thursday, February 16th, 2012
A growing number of pediatricians are refusing to treat families who choose not to vaccinate their children, according to a report in the Wall Street Journal.
Medical associations such as the American Academy of Pediatrics don’t recommend that doctors “fire” families who opt out of vaccines. Instead they encourage pediatricians to bring the topic up at multiple visits but continue to work with families. Yet research shows that it’s increasingly common for practices to push these patients out.
From the Wall Street Journal:
In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.
By comparison, in 2001 and 2006 about 6% of physicians said they “routinely” stopped working with families due to parents’ continued vaccine refusal and 16% “sometimes” dismissed them, according to surveys conducted then by the American Academy of Pediatrics.
Many pediatricians see administering vaccines as one of their main duties in keeping children healthy, and say it’s difficult to work with families when parents and doctors don’t see eye-to-eye on this key issue.
Pediatrician Allan LaReaux of Kalamazoo, Mich., stopped treating non-vaccinating families in 2010, in part because he worries that children who have not been immunized could make others in the waiting room sick. From the Journal:
“You feel badly about losing a nice family from the practice,” [said] Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated.
Pamela Felice, an Atlanta mom whose family was dismissed by their pediatrician for refusing vaccines says it’s been difficult to find another doctor. One of her children has gastrointestinal problems and regressed development that she believes is related to immunizations. At least four practices have denied them a first appointment when Felice explains her opposition to vaccines.
What do you think? Do doctors have a responsibility to treat patients even if they refuse vaccines?
Image: Doctor, baby and mom via Shutterstock.
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Thursday, January 5th, 2012
The American Academy of Pediatrics issued a policy statement this week urging pediatricians to ask questions–and listen carefully–to identify warning signs that children are suffering under “toxic stress,” a chronic stress condition that can have serious health implications later in life.
Toxic stress is different from everyday stress, as it is the result of prolonged exposure to intensely difficult situations, such as abusive or neglectful family relationships, poverty, or parental substance abuse or mental illness. Health conditions including mental illness, obesity, diabetes and heart disease are linked to toxic stress.
The Boston Globe’s child development blogger, Dr. Claudia M. Gold, argues that the new statement should be seen as a call to respect–both with time and wages–the work of primary care physicians, particularly pediatricians, as they can be the first line of defense in identifying and easing toxic stress:
As a culture we need to value the primary care clinician, not only in the form of payment equal to the more lucrative subspecialties, but in the form of recognizing the role of relationships in healing. It makes sense that if we are recognizing the importance of family relationships in preventing poor health outcomes, that we should recognize the importance of doctor-patient relationships in supporting these families.
When primary care clinicians take time to carefully listen to stressed parents, parents feel supported in their efforts to carefully listen to their children, thus promoting healthy development. In turn, our culture needs to support and value primary care clinicians ( and its not only pediatricians, the subject of this policy statement, but all those entrusted with primary care of children.)
Image: Upset child, via Shutterstock.
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Monday, December 12th, 2011
Few parents of overweight children–fewer than one in four–say that their pediatricians have raised concerns over their kids’ weight, according to a new study published in the journal Archives of Pediatrics & Adolescent Medicine.
But researchers are unsure as to whether doctors are truly not raising the issues, or whether the parents are unable or unwilling to process what they’re being told. MSNBC.com reports:
“It’s tricky to say, and it’s tricky to hear,” says lead researcher Dr. Eliana Perrin of the University of North Carolina. She analyzed government health surveys that included nearly 5,000 parents of overweight children from 1999 to 2008.
Parents tend not to realize when a weight problem is creeping up on their children. When almost a third of U.S. children are at least overweight, and about 17 percent are obese, it’s harder to notice that there’s anything unusual about their own families. Plus, children change as they grow older.
The new study suggests when parents do recall a doctor noting the problem, it’s been going on for a while.
About 30 percent of the parents of overweight 12- to 15-year-olds said a doctor had alerted them, compared with just 12 percent of the parents of overweight preschoolers. Even among the parents of very obese children, only 58 percent recalled a doctor discussing it, says the report published Monday by the journal Archives of Pediatrics & Adolescent Medicine.
“Many pediatricians don’t worry until children are very overweight, or until they’re much older,” says Perrin, whose team has created stoplight-colored growth charts to help doctors explain when a problem’s brewing. “If we can notice a concerning trend early, we’re more likely to be able to do something about it.”
Image: Overweight boy, via Shutterstock.
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