Back to school time

It's that time of year when I am soooooo glad I don't have an outpatient practice.  All the parents who haven't bothered scheduling their kids' back to school physicals are frantically calling, and they don't understand why they can't get in immediately.

But all is not wonderful on the inpatient side, either.  The little dears who can't bear to go back to school are showing up in the ER complaining of abdominal pain.  They put on award-winning performances that get them admitted to the hospital after the million-dollar workup.

Once school starts, the kids who have kept their germs to themselves all summer start sharing generously with their classmates, and we start seeing the fall viral surge.

Oh well.  The pediatrician summer vacation is over.

The little "angels"

Whenever you see a kid on TV with a chronic illness-whether it is a real kid in a fundraising ad or a fictional character in a show-that kid is portrayed as being a sweet, brave soul, enduring medical torture with no complaints at all.  A few of them really are that way.  But, dear readers (if any of you exist), please let go of that mental picture.  Nothing about chronic illness automatically makes a child into a saint.
How a kid responds to chronic illness depends on the kid's underlying personality as well as what kind of parenting he gets.  Some parents spoil their sick kids rotten to "make up for" the illness; those kids are just pure evil for health care professionals to deal with.  Some are just scared of painful procedures, and who can blame them?  But the uncomplaining ones are rare.

"Affordable Care Act"--affordable for who?

I saw a news article this week saying how some insurance companies are starting to get nervous about the requirements of the "Affordable Care Act," aka "Obamacare."  The companies knew they would no longer be allowed to refuse to cover pre-existing conditions, and that there would be a cap on how much they could charge sick people in premiums.  But all that was okay, because everyone was gonna have to buy insurance.  All those young healthy people paying premiums and not making claims would balance the books.

But the young healthy people can do math.  When insurance premiums are $3000 per year, and the fine for not having insurance is $100 per year, their choice seems simple.  And the insurance companies are starting to sweat.

Know your child's history!

I get so pissed off at parents who know nothing about their child's medical history, their medications or what symptoms they have been having.

I am not referring to parents who don't know all of their teen's symptoms; that's normal.  I am also not referring to foster parents.  My experience with foster parents is that they are given very little useful information.

I am talking about parents who don't know if their infant's diaper has needed changing more or less than usual.  I am talking about parents who don't know if their young child has had trouble breathing.  I am talking about parents who have no idea if THEIR OWN child has ever been hospitalized, or what that surgical scar is from.  I give a little slack to non-custodial parents (although they should find out information like that if they are keeping the kid for the weekend).  But it's amazing how many parents with full custody of their children have no freaking clue about their health status.

While I am on the subject, let's talk about teenagers.  It's great that some parents are letting their teenage kids start to manage their own health.  But 14-year-old kids are not adults!! As parents, you need to know what medicines your kid is supposed to take, and make some effort to make sure they take them.

Expectations

So many families seem to have unrealistic expectations of their hospital stay.  While it is annoying, I have to concede that perhaps no one  has told them what to expect.  So, I feel the need to do myself and my fellow staff a favor and provide an education.

1. You can expect to see a doctor once a day. Unless you are in the ICU, or something changes with the child, once is likely all you're gonna get.  We have lots of patients to care for as well as our own families.  So, don't be offended when the doctor isn't available on four seconds' notice at 2 am, or if he sounds groggy and exhausted if he does come in.

2. You may or may not see your regular doctor.  Many practices rotate which doctor sees hospital patients.  Whichever doc is assigned to hospital rounding while you are there is the one you will see.  In other places, hospital specialists (creatively called "hospitalists") see all admitted patients.  They don't have office practices, and you will follow up with your regular doctor.  If the doc who comes in isn't your regular one, feel free to ask if he or she will be coming in.

3. Your doctor's rounding time may or may not be consistent.  Most of us try to round at *about* the same time every day.  However, when you hear that your doc usually rounds around 8, don't take that as an 8 am appointment.  Rounds may be early if the doc has a busy day ahead.  Anything from traffic to personal issues to emergencies with other patients can make them late.  I once got yelled at by parents for being late to round on their child; what I could not ethically tell them is that I was late because I was attempting to resuscitate another child.  A friend of mine got his ass chewed for being later than expected when his wife was getting an emergency, preterm c-section.  His partner was out of town so he had to see the hospital patients himself.  He had no idea if his wife or child was going to survive, but went in because he had to.  So, please, remember that you don't have any way to know what is happening.

4. You will probably be expected to help care for your own baby.  Just because your baby is in the hospital doesn't mean you can kick back and do nothing.  Hospitals are employing fewer people these days, in order to keep spending under control.  Also, the role of nurses has expanded greatly.  Long gone are the days when nurses just fluffed pillows and handed out meds.  Today's nursing staff is way too busy assessing patients, making sure the doc didn't do something dumb and charting endlessly to do the fluffy pillow thing.  Want to piss off a peds nurse? Call out to ask one of them to change your baby's diaper while you sit there texting.

5. This is  not a hotel. A hospital's first priority is the medical care of its patients.  We will do our best to make parents comfortable, but there are limits.  We don't have Memory Foam mattresses or room service.  Sorry.

There are more but this damn post is too long.

Patient satisfaction: why your hospital stay is so damn expensive.

I understand why people would want to make sure people are "satisfied" with their hospital stay.  I understand why hospitals would want to make changes based on these scores.  However, the system is flawed and jacks up your healthcare costs.
For one, hardly anybody actually returns these things.  Essentially, only the pissed off people send them back.  I have been a patient in the ER and I ignored my survey.  There was nothing special about my visit.  I came, waited my turn, got treated, and went home. I didn't think there was anything worth bothering with the survey.
For another, the survey doesn't focus on what is important.  My hospital got dinged on the fact that the kids didn't like the taste of the food they were offered.  News flash, it's a hospital.  We serve balanced meals, which means fruits and veggies on the plate.  Every meal can't be chicken nuggets, mac-n-cheese, and french fries.  That seems to be what the kids want, though.
We also got dinged because the sleeper chairs were uncomfortable.  I am somewhat of a connoisseur of hospital sleeper chairs.  They're ALL uncomfortable.  They're hard and flat.  They gotta be durable, since thousands of people use them.  They gotta be easy to disinfect, because, well ew. Those things come before comfort.  Oh, and they don't accommodate two adults.  That's because they tend to want to make more kids on them.  We got really dinged on the color scheme.  No one who filled out the survey liked the color scheme.
Did I mention that we had maybe 5 surveys, out of hundreds of patients?  None of them had any problems with nurse or physician communication skills, clinical skills, or anything important like that.  So, to get higher satisfaction results, we are spending a buttload of money to redecorate, including replacing practically new sleeper chairs.
So, the next time you or a loved one are in the hospital, please fill out the survey.  Be honest, but try not to rage on things like the wall color that have nothing to do with your medical care.

Kids and guns

Imma start this post by just sayin: I am a gun rights advocate.  I see nothing at all wrong with teaching kids about guns and even letting them shoot small rifles of their own with proper supervision.

That being said, when the recent incident where a toddler was shot by a sibling playing with his first rifle hit the news I was livid.  What dumbass lets their kid play with a real gun while they do housework??  And the excuse that they didn't know it was loaded?  Pure stupidity.  One of the first rules of gun safety is treat all guns as if they are loaded, all the time!

This would not have happened if the child had only been allowed to handle the gun under supervision, and if it had been locked up at all other times.  Little kids don't have the ability to understand lethality.  That's why you can't just let a bunch of 5 year olds play next to a busy street without supervision.  Granted, some kids are more responsible than others.

Bottom line:  If you want to teach your kids to shoot, that's fine.  But you can't teach safe firearm handling if you don't understand it yourself.  Even though Crickett rifles are meant to be handled by kids, they aren't toys and shouldn't be treated like them.  Period.