Excerpt
Caring for Your School-Age Child, 3rd Edition
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Maintaining Your Child’s Health
You, your child, and your child’s pediatrician have equally important roles to play in maintaining your child’s health, preventing illness and injury during childhood, and helping establish habits that will promote health and well-being for a lifetime.
Choosing a Pediatrician
When seeking quality medical care for your children, where should you turn? Most parents rely on a pediatrician, a physician (MD, DO) who completed four years of medical school and then three years of residency training in general pediatrics, specializing in the care of children. Pediatricians have special training in the health and illnesses of children through the age of adolescence, and most are certified by the American Board of Pediatrics after passing an initial comprehensive examination covering all areas of health related to infants, children, and young adults, as well as continuing their medical education to maintain board certification.
By your child’s middle years, you probably have already found a pediatrician with whom you are happy. However, the occasion may arise where you need to find a new doctor—perhaps you have moved to a new city, or your pediatrician has retired.
In circumstances like these, try to obtain a referral from your present pediatrician. He or she may know a colleague in the city where you are moving, or one who is taking over the retiree’s practice. Friends and family members might also recommend one or more pediatricians for you to consider.
There are other good sources of names of qualified pediatricians:
■ Find a pediatrician or pediatric specialist at HealthyChildren.org, the official parenting website of the American Academy of Pediatrics.
■ Most local/county medical societies provide referral services to pediatricians in their area who are taking new patients.
■ If you are located near a major medical center, community hospital, or teaching hospital, contact its department of pediatrics for the names of doctors in your area.
Interviewing Pediatricians
With a list of doctors in hand, you can learn more about your options by investigating the website of each pediatrician’s practice. You should be able to learn more about the doctor’s background and training, as well as general office procedures. If you are impressed with what you hear, arrange for an interview during which you can meet the doctor and ask some additional questions. It may be more convenient to do this interview by telephone. Here are some things to consider when choosing a pediatrician:
■ What medical school did the pediatrician attend, and where did he or she undergo postgraduate and residency training?
■ What are the doctor’s present hospital appointments? If it becomes necessary for your child to be hospitalized, where would he be admitted? Would your pediatrician be managing your child’s hospital stay, or does the hospital use in-house pediatric hospitalists (hospital specialists)?
■ Is the pediatrician’s office conveniently located? Is it easily accessible by car or public transportation? Is there accessible parking?
■ Are the office hours convenient for your own schedule? If you are a working parent, you may desire evening or weekend hours.
■ What is the doctor’s policy on taking and returning phone calls? Is there a nurse in the office who can answer routine questions? Who answers emergency calls after hours—for example, overnight or on weekends?
■ Is the doctor in a group practice with other physicians? Does another physician cover for the doctor at times?
■ How often will the pediatrician see your child for checkups and immunizations?
■ Do you sense a genuine interest by the doctor in the problems of your child, including particular health disorders he may have?
■ Do both the physician and the office staff appear amicable and courteous? Do they demonstrate compassion and patience? Or do you feel rushed in the office, as though the doctor is eager to move on to the next patient?
■ How are visits for acute illnesses handled? Can you make an appointment on short notice if your child needs to see the pediatrician because of a sore throat or an infection, for example?
■ Does the doctor communicate clearly, using straightforward language (not medical jargon) to explain illnesses and treatments, and does the doctor make an effort to ensure that all your questions are answered?
■ What are the doctor’s usual fees for sick visits, routine examinations, and immunizations? What is the office policy regarding the processing of insurance forms?
■ In what managed care programs does the doctor participate?
■ Does the pediatrician’s office serve as its patients’ “medical home”? If your child should ever develop a complex illness that necessitates the care of one or more specialists, will your pediatrician coordinate care among all the specialists providing treatment?
Managed Care
Many Americans receive their healthcare in managed care plans. These plans, typically offered by employers and state Medicaid programs, provide services through health maintenance organizations (HMOs) or preferred provider organizations (PPOs). The plans have their own networks of pediatricians and other physicians, and if you or your employer change from one managed care plan to another, you may find that the pediatrician you have had a relationship with is not part of the new network. Once you have a pediatrician you like, ask what plans she is in, and see if you can join one of them if there’s a need to switch from one HMO or PPO to another.
Managed care plans attempt to reduce their costs by having doctors control patient access to certain healthcare services. Your pediatrician may act as a “gatekeeper,” needing to give approval before your child can be seen by a pediatric medical subspecialist or surgical specialist. Without this approval, you’ll have to pay for part or all of these services out of pocket.
To help you maneuver effectively through your managed care plan, here are some points to keep in mind:
■ To determine what care is provided in your managed care plan, carefully read the materials provided by the plan (often called a certificate of coverage). If you have questions, talk to a plan representative or your employer’s benefits manager. All plans limit some services (e.g., mental health services, home health services), so find out what’s covered and what’s not.
■ When you are part of a managed care plan, primary and preventative care visits usually will be covered, including well-child checkups, treatment for illnesses or injuries, and immunizations. In many plans, you will have a co-payment—a fixed charge that you pay—for each primary care visit.
■ Once you’ve chosen a pediatrician, it’s best to stay with her. But if you feel the need to switch, all plans allow you to select another doctor from among those who are part of their network. The plan administrator can give you information on how to make this change. Some plans allow you to switch only during certain periods, called open enrollment.
■ If you feel that your child needs to see a pediatric subspecialist, work with your pediatrician to find one who is part of your plan, and obtain approval to schedule an appointment with her. Check your plan contract for details about whether your insurer will pay at least a portion of these costs. Also, if hospital care is needed, seek your pediatrician’s guidance in selecting a hospital in your plan that specializes in the care of children. Most hospital procedures and surgeries require prior approval.
■ Know in advance what emergency services are covered, since you won’t always have time to contact your pediatrician. Most managed care plans will pay for emergency room care in a true emergency, so in a life-threatening situation, go immediately to the nearest hospital. In general, follow-up care (e.g., removing stitches) should be done in your pediatrician’s office.
■ To file a complaint—for example, if coverage of certain procedures is denied—start by expressing your concern to your pediatrician. If she is unable to resolve the problem, contact your plan’s member service representative or your employer’s employee benefits manager about filing a complaint. If a claim has been denied, you typically have fifteen to thirty days to file an appeal, and you could receive a decision about the appeal within thirty to ninety days of the request. If you still are dissatisfied, you may decide to seek help from the office of your state insurance commissioner, or you can take legal action.
Resolving Problems
Your child can continue to be treated by a pediatrician through adolescence. However, no matter how carefully you have made your choice of a pediatrician, sometimes the chemistry between doctor and patient or between doctor and parent may become less than ideal. After several office visits you may decide that your expectations are not being met. In these instances, make an effort to discuss the problem with the pediatrician. Most difficulties can be smoothed out and resolved. On occasion, you might make a decision to switch physicians if the relationship continues to be unsatisfactory.
When to See Your Pediatrician
The American Academy of Pediatrics recommends that your middle-years child have a routine well-child examination every year. During these doctor’s visits, your physician will conduct a number of evaluations, such as measurement of height, weight, and blood pressure, a check of vital functions, a vision and hearing screening, and a complete physical examination. The doctor will ensure that your child’s immunizations are up to date, and ask about your child’s diet, exercise habits, and sleep patterns. He or she can also refer you to other health professionals; for example, children should receive regular dental checkups twice a year, and if a pediatrician detects eye problems during routine screening, he or she may refer your child to an ophthalmologist for further evaluation and care.
Your pediatrician is interested not only in your child’s physical health but also in his or her mental and emotional well-being. It is appropriate to discuss such concerns as your child’s school experiences, relationships with peers, family transitions or difficulties, and daily stresses.
