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1/9/14blog post

that which does not get better… needs to be rechecked.

By: Dr. Melissa King

I strive to conclude every visit with my patients and their families with the following comments:

  • Here is what I think is going on with your child today.
  • Here is what I recommend you to do for your child.
  • Here is what I expect to happen to/for your child over the next few hours/ days/ weeks.
  • Here is why I would want you to contact our office or take your child to the emergency department.
  • If things do not progress the way that I have outlined, things don’t resolve or they get worse, please return to the clinic for another evaluation.
  • What questions do you have for me?

One of the key elements to that conversation is the part where I say, “If things do not get better or they get worse, then I want to see your child again.” I honestly mean what I say.

When determining an evaluation of a complaint I take into account many factors including: risk of something serious going on, most likely diagnosis, most detrimental diagnosis, and step-wise evaluation to determine diagnosis. Sometimes an initial costly, invasive work up is indicated. Most often it is not. Most often I recommend a course of action, request that a log/ diary of symptoms are kept for more chronic complaints, and then a follow up plan.

When I tell you that results initially are negative or normal, this does not translate into, “I do not think there is anything wrong with your child.” This means that as we go through my steps of evaluation and treatment, everything is normal — so far.We may need to wait and watch things for awhile, we may need to order more tests, or we may need to go and see a different health care provider and ask their opinion.

If you do not return to me and instead seek care from somewhere else two things happen that are not necessarily in your favor.

  1. You spend your time and energy and money explaining to a new person all of the background that you have already given me. Although they may not provide the exact same recommendations or complete the same evaluation, they likely will have their own initial step at which they start that may not take into account what has previously been done. This may lead to duplication of treatments or tests. Plus you are starting over at step 1 again.
  2. I do not have the opportunity to move to step 2. I have a plan that I share with you that may involve one step or many steps. If you do not return to my clinic then I do not have the opportunity to further my evaluation. Also, I am led to believe that things have resolved. I do not know that your child is out there with a persistent / worsening problem.

By: Melissa King, DO “Dr. Mom Sqaud”

Hopefully all of your concerns will be addressed and problems solved within one visit. However, please, follow up with your health care provider and give them another chance to work through your problem if things do not resolve after the initial visit. Remember medicine is an ART and a SCIENCE. Medicine requires constant continuing medical education and we gain some of that education from you, the parents and the patients.

Stay happy and healthy!

Dr. King is a general pediatrician in the Children’s Health Clinic at Dayton Children’s and the mother of two kids. As part of the “Dr. Mom Sqaud,” Dr. King blogs about her experiences as both as doctor and a mom and hopes to share insight to other parents on issues related to both parenting and kids health. Learn more about Dr. King!