What Is A Well Visit?

As a pediatrician, I often have expecting parents who come in to interview me or my partner to decide if they want to use us as their pediatricians.  At the visit, we talk about how our practice works and we present them with the recommended schedule of well visits (established by the American Academy of Pediatrics).  This schedule can be found here:  http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity%20Sched%20101107.pdf

Parents are often surprised at the number of visits that are recommended.  If they want more information, we explain a bit about what goes on at a well visit and why they are important.  We mention that we review the growth and development of their child, perform a head to toe physical exam, provide guidance on things like feeding and safety, give immunizations, and perform a variety of screens, labs and other assessments depending on the age of the child.

If you look at the Bright Futures schedule linked above, you can see how involved some of these visits are.  As a result of all that is required, the visits (including paperwork, tests, and vaccines) can take anywhere from 20-60 minutes, so parents should probably plan that it will take approximately an hour to complete the visit.  Some of the visits that are less involved (like the 9 month visit) may be faster and a few may take longer (like the 4 year and 11-12 year visit).

Another thing that sometimes surprises parents is how these well visits are billed and what charges are incurred during a well visit.  Medical billing is complex and is based on a process called coding.  I will address that in an upcoming post.  For the time being, think of your medical bill for an office visit as being similar to the bill you receive at a restaurant. 

Saving a Place

Thought I'd share this post that I wrote a couple of months ago, but forgot to publish:

Has there ever been a time where you were supposed to meet someone at a crowded dinner or a show and you were late getting there?  Isn't it such a relief to know someone is saving you a seat?  It might make you feel that you are important to the person who is waiting on you.  

Perhaps you have been on the other side.  Perhaps you have been the one waiting on your friend or family member to join you.  Isn't it nice when your friend arrives and he can take the place you have saved for him?  You feel like the party can finally start for real and you can begin enjoying the fellowship with your friend and have a good time.

This is where our family is right now: we are saving a place for someone.  We have things to do while we are waiting and life goes on in the meantime, but we can't wait for that place to be filled.  Our family is in the process of adoption and we are greatly looking forward to meeting our new son and welcoming him to his place with our family.  We don't know who our son will be, but God already knows who he is and when we will get to be with him.  To us, he is already a part of this family and we are eagerly anticipating the day when he will take his place with us at the table.

The empty seat at our dinner table will hopefully be filled in the next 6-12 months.

BTW, this is not my family or my image.  Just appropriate for the situation.

"I will not leave you as orphans; I will come to you."  John 14:18

First Ethiopian Food

We had our first experience with Ethiopian food last night and it was delicious.  We have been wanting to experience what we can of Ethiopian culture in preparation for our adoption, which led us to Desta in Atlanta.

In the photo are steak tibs, which were wonderfully flavorful.  The roll of bread in the photo is injera, which is a spongy, slightly sour bread that you use to pick up and eat your food (with your right hand).  Because Italy occupied Ethiopia for a short while, pasta became part of Ethiopian cuisine. The kids ordered one of the pasta dishes, which was also quite tasty.  If you have never eaten Ethiopian food, you are missing out.  Give it a try!

Opening Ceremony Observations

Like so many others, I spent a few hours Friday night watching the Opening Ceremonies of the 2012 London Olympics.  I imagine that I was not the only one that found the ceremonies, well, interesting.  Thanks to the extreme narration skills of Matt Lauer and Meredith Vieira, there was very little room for the television audience to watch the ceremonies and form their own impressions of what was happening.  

Facebook post during the Opening Ceremonies:  Watching the Opening Ceremonies being narrated by Matt Lauer and Meredith Vieira is far too similar to watching the Macy's Thanksgiving Day Parade with its extreme overnarration. "The Voldemort puppet is over 100 feet tall and his wand shoots real sparks!". Thanks very much, Matt. I had difficulty interpreting the fact that I just watched a huge Voldemort puppet shooting sparks from his wand.

I doubt that an artist such as Danny Boyle would want someone telling his audience what to think, but perhaps I am wrong about that, since he probably had a hand in the script that Matt and Meredith used.

The narration team told us that the bizarre hospital scene was a tribute to Great Britain's National Health Service.  The children in the hospital beds were then tormented in their nightmares by a handful of iconic British literary villains until the Mary Poppins army came to the rescue.  Had I not been told how to interpret the scene by Matt and Meredith, I would have assumed that the NHS was part of the nightmare.  

My personal nightmare regarding socialized medicine, however, is already becoming reality.  The passage of the Affordable Care Act and the fact that it was upheld by the Supreme Court is a giant leap toward socialized medicine in the U.S.  Where is an army of Poppins's when you need it?

Creative Visualization for Seniors

You may have read my post about my paternal grandfather (Granddaddy) and one of the events that happened to him during WWII ("It's raining...mules?").  I thought today that I'd write about my maternal grandfather, whom we called PaPa.  PaPa passed away about 2 1/2 years ago from lung cancer.  I have written about his passing in a previous post ("Cancer").

I thought I'd post a funny story about PaPa tonight (there are a few, so maybe I'll post more of them in the future).


We were visiting him at his home one night in early January of 2010 and he started having a lot of pain and difficulty breathing.  The hospice nurse was called.  She came over and tried to work with him on relaxing.  She told him to "visualize being in a peaceful place, like the beach".  He either didn't get the "visualizing" idea or pretended not to.  


The nurse told him to imagine he was in a peaceful place.  He responded, "I can imagine a lot of places."  Mom then tried to explain and said, "Pretend like you are at the beach".  He then, despite his pain, laid back, closed his eyes, put a smile on his face and pretended to be holding a drink in his hand.  At that moment, especially when he had been struggling so much with his pain, it was a hilarious thing to do.

Greatly Exaggerated

The rumors of this blog's demise have been greatly exaggerated.

I've just been a little busy with life.  Being a husband (depending on who you ask - more on this later), being a father, being a pediatrician.  Working on developing more of an online presence for our practice.  Learning how to put up drywall.  Completing adoption paperwork (though my wife really gets the credit for that) and adoption education.  Just a few things.

In the course of completing our adoption dossier documents we had to obtain a newly issued copy of our marriage license.  The appropriate request was made to the state vital records office and, just like that (well, actually two months later), we received...a divorce verification.  Dated the same day that we got married.  Although we probably would be married by common law by now (16 years later), we thought it would be a good idea to have our state confirm that we are, in fact, actually married.  My diligent and lovely wife worked hard to contact an actual person in the state government and we do now have confirmation that we are married and that our children are not illegitimate.

We are now waiting on approval from US Customs & Immigration so that we can send our dossier to Ethiopia.  We are very excited to be that much closer to welcoming our new child into our family.  Anyone out there speak Amharic?

Major Milestone

I am very pleased to report that our home study for adoption has been completed!  We now have to get clearance from US Customs & Immigration to adopt internationally and then have to complete a dossier to send to Ethiopia.  The journey is far from complete, but we are excited to reach this milestone.  I will periodically post updates as we go.

For anyone considering adopting, domestic or international, let me recommend the book, The Connected Child by Karyn Purvis.  I am only a few chapters in, but it is very insightful.

The empty seat at our dinner table will hopefully be filled in the next 6-12 months.
BTW, this is not my family or my image.  Just appropriate for the situation.

Mistrust

I know it might be a shock to some of you (sarcasm intended), but, every once in a while, there is a parent who gets mad at me.

The reasons are varied. Sometimes it is because I won't do what they want me to do, like giving an antibiotic for a viral illness. Sometimes it is because they had to wait a while to be seen. We try to minimize wait times, but medical problems don't always come in 15 minute packages and waits happen. When parents are upset for reasons like this, it doesn't usually bother me too much because I know that I have done what I needed to do for the children. There are times where a parent being upset with me does bother me. For a while, I wasn't sure why. 

A recent incident helped me understand why I do sometimes take these events personally. Without giving detail about the event itself, what it came down to was that the upset parent(s) did not trust my motives in giving the medical care that I gave. Rather than asking me to explain the situation, they made an incorrect assumption about the motive behind the decision. As I was considering how much this mistrust bothered me, I began to wonder how God feels about our mistrust of Him. Most of us begin to question God's motives when something that we perceive as bad happens to us. We don't trust that His intentions toward us our good. We don't trust that He has our best interests in mind. We don't trust His goodness or love. We don't trust His heart.

If I (fallible, imperfect me) am disturbed when parents don't trust my motives, how must it grieve our perfectly good and loving Father when we don't trust Him? 

For I know the plans I have for you, declares the LORD, plans for welfare and not for evil, to give you a future and a hope.   Jeremiah 29:11

but God shows his love for us in that while we were still sinners, Christ died for us.   Romans 5:8

And we know that for those who love God all things work together for good, for those who are called according to his purpose. Romans 8:28

It's raining...mules?

Since it is Memorial Day, I just wanted to share again one of my favorite stories about my grandfather.  Granddaddy served in the U.S. Army's Air Force in the second World War.  During the war, he was, at one point, helping transport a load of mules to China over the Himalayas.  During the course of the flight, the plane lost one of its two engines and began to lose altitude.  The crew needed to unload their four-legged cargo to keep the plane from going down.  Crew members attempted to move the mules, but were unable to coax them off the plane.  Granddaddy, who grew up on a farm in Mississippi, saved the plane and crew because he was the only one who knew how to get the mules to unload and successfully backed them off the plane.  You have to wonder what the Tibetans thought as mules began to rain down from the sky around them.

Spurring on Fathers - What Pediatricians Can Do

Several of my recent posts have addressed the problem of absent fathers, the consequences of absent fathers, and the benefits of involved fathers. Today we turn our attention to what my profession can do to encourage fathers to be active in the lives of their children.

The Role of the Pediatrician

It is certainly true that more moms than dads bring their kids to the pediatrician’s office. Pediatricians should remember that encouraging the involvement of the father (even if he does not have custody) will promote the child’s well-being. Pediatricians should encourage fathers to engage and have direct involvement and interaction with their children as often as possible. Fathers should be accessible, available to their children even when not directly interacting (like what I am doing as I write this post). Fathers should also be encouraged to be responsible, providing for the physical care and welfare of their children.

Not Just a Substitute Mother

Pediatricians should convey to fathers that they play a different role than mothers. They interact in different ways than mothers. Fathers are more likely to engage in play with children and this play is more likely to be physical and stimulating. Fathers influence the child’s gender role development more strongly than mothers. They also increase the likelihood of academic success.

Child Support

Pediatricians should encourage noncustodial fathers to provide child support. The child’s cognitive development, academic achievement, and behavior are all improved when fathers provide child support. The provision of child support by the father provides greater positive outcomes than equivalent income derived from other sources.

Visitation

Pediatricians can also encourage mothers to increase fathers’ access to their children.  The former spouse often poses the greatest obstacle to increased father involvement.  Forty percent of mothers reported they had interfered with the non-custodial father’s visitation on at least one occasion to punish the ex-spouse.  One study found that 77% of non-custodial fathers are not able to visit their children as ordered by the court, as a result of “visitation interference” perpetuated by the custodial parent (a more frequent problem than failure to pay child support).

Additional Advice for Pediatricians from the American Academy of Pediatrics

From Pediatrics,vol 113, number 5, May 2004 “Fathers and Pediatricians: Enhancing Men’s Roles in the Care and Development of Their Children”

Ø  Offer flexible/extended office hours to accommodate working parents and encourage their attendance

Ø  Actively encourage fathers to come in for at least one visit in the first 2 months of life, and more if possible

Ø  Welcome dads and express appreciation for their attendance

Ø  Speak directly to the father and solicit his input and opinions

Ø  Politely explore the relationship between mom and dad

Ø  Discuss the father’s opinions about his role as a father

Ø  Recognize that mothers and fathers may not always agree on how to best raise their children

l  Consider mediating discussions about these differences, but attempt to avoid siding with one parent or the other

Ø  Be sensitive to and informed about diverse cultural and ethnic values and customs regarding the role of the father

Ø  Take a “parenting history” to encourage parents to understand their own behaviors by understanding how they themselves were parented

Ø  Explore the quality of relationships between each parent and their children, as well as each other

Ø  Empower, engage and inform fathers of the importance of their involvement

l  Remind the family that dads are not just workers or breadwinners

l  Give fathers responsibilities for caring for and making decisions regarding the child

l  Encourage fathers to assume at least some child care responsibilities

l  Encourage mothers to let the father be involved and learn from his own mistakes

l  Early time alone with the child allows dad to gain confidence and develop his own style while letting mom have some time to herself

l  Reinforce dad’s support of mom

•          Explore ways the father can help decrease maternal stress

•          Discuss the normal stressors that the family will experience (decreased sleep and energy, less time alone as a couple, less individual free time, changes in intimacy and the sexual relationship, etc.)

•          Look for signs of maternal depression and be able to offer resources for help

•          Explore marital stress and discuss the parent’s relationship

•          Educate fathers about breastfeeding and how they can support the mothers’ nursing

•          Encourage dad to protect some time for mom to be alone

•          Encourage dad to take a paternal education class