I just realized that I had never officially posted on my old blog in order to alert people that my blog has moved!
Come over and check it out on it’s new home: http://www.checkupnewsroom.com/thedocsmitty/
I just realized that I had never officially posted on my old blog in order to alert people that my blog has moved!
Come over and check it out on it’s new home: http://www.checkupnewsroom.com/thedocsmitty/
Before you jump all over me, I have already outlined why I think we (doctors and medical offices) are the biggest part of the wait time problem. But, there are some reasons why you are part of the problem…ok, let me soften it up a little bit…
Here are 3 ways you can help avoid long wait times at the doctor’s office:
#1-Don’t request peak times during the day.
Every office has busier times and not as busy times throughout the day. If you don’t know when they are for your office, ask the receptionist when you check in if there is a time when the waiting room is less full. No one wants to get up and get kids ready early for an 8AM visit so if you will, you probably won’t have as much of a wait. Every single parent of a school aged child wants their child to be seen after school. We simply cannot accommodate those patients in a reasonable time during the 1.5 hours we have that a typical office is open after school times. We can help by extending hours (and I think more offices should) but if your child is not in school please book an earlier time or expect longer waits. Alternatively, you can drop the emphasis on perfect attendance (I’ve written about this before also: Roll Call-Doc Smitty’s thoughts on perfect attendance policies).
#2-Don’t request peak times during the week/year.
If you need a sports or camp physical, it can usually be done in the spring or early summer. If you wait until the week before school starts you’ll be thrown in the mix of all the other procrastinators who have waited until the last minute. Even if your child isn’t school age or needing a school physical, keep this busy week in mind. There’s no reason to come and see us for a long standing problem that week, just wait one more week and enjoy the fact that the office is quieter the first week of school (also use STAR testing weeks-it’s like a ghost town).
Mondays are always busy in a pediatric office. In addition to the standard check-ups, same day illness, etc there is a build-up of illnesses from the weekend that need to be crammed in. Plus, stuff always seems to happen on a Monday, amiright?
Don’t come in on “miracle days.” Dr. Strong (my former partner) always called the days before holidays miracle days. The conversation usually goes something like this…”I wouldn’t normally have come in but we’re going to be getting on an x (plane, cruise ship, long car ride) and I wanted to get something done sooner or try to prevent y from happening.” There are lots of problems with this logic…First, illness is no respecter of your vacation. Rhinovirus could care less if you bought trip insurance for your trip to the Caribbean. Second, many illnesses in pediatrics are viral which means that avoiding a bad trip is more a function of bad luck than anything I can or cannot do. So, the moral is, don’t come in expecting a miracle and if you have something that can wait, wait.
#3-Come ready with everything.
Here are a few examples:
Bring your insurance card every time you come. We took our 4 year old to see his doctor 2 weeks ago and his insurance had been inexplicably canceled. (It’s like the plumber with a leaky faucet.) Things change without your knowing it. If you have your card and we have the latest copy on file, it’s easier to get issues straightened out.
If you can’t bring your child, send a detailed note with your concerns so it doesn’t go like this…Me: How long has this been going on? Aunt June: “You know, I’m not really sure…let me call mom…oh, she’s not answering…I’ll try her work number…”
Bring a shot record to the first appointment. There are shot records available online and they are usually accurate and up to do which is great, when they are accurate and up to date. If they aren’t, finding shot records is a disaster. Offices typically won’t do it the same day so you have to come back once we have them…if we ever get them. People do shots differently (especially at 1 year and beyond) so I can’t always predict what they’ve had.
These are some examples of things I can think of that you can do (or avoid). What tips or tricks have you learned?
Painful wait times at the doctor’s office… It’s an old story with few exceptions.
As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (My wife did it once, I think, then she promptly retired from this job.). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize with you on this one….
Because you guys know me and know I’m not one to defend the status quo…I’m going to go ahead and defend the status quo a little bit. Or, at least, sound like I am (whether I am or not).
Here are some (in my mind) acceptable reasons why wait times are long:
Here are some (in my mind) unacceptable reasons why wait times are long:
Now, you can read over this and take it however you want, but keep this in mind: you almost always have a choice in medical care. Unless your child needs a specialist for which there is only one in town or you live in such a rural area that there is only one provider, you have a choice. When we make any choice, we prioritize what’s important…someone might choose to see a doctor they love and tolerate the fact that their wait times are longer (but continue to complain on Facebook about it-I get it, it’s ok). Other people might drive more miles to see one they love. The choice still lies in the hands of the parents.
Ultimately, waiting anywhere is hard. Waiting in the doctor’s office is especially hard when you have a sick child, no one slept the night before, and the only appointment available was right in the middle of nap time.
I promise to keep working on those things that I can do in order to shorten your wait time and you can stay tuned for tomorrow’s post:
The Doctor Will See you Now…ish-It’s Your Fault (Not Really, But Here’s How You Can Help)
When we moved to Irving and I decided to join a practice in Lewisville, I realized I wanted to know more about the schools in the area and get a feel for the culture of the teachers that would be teaching my patients and kids. I searched online and found great and encouraging information about Carrollton-Farmers Branch, Irving and Lewisville school districts. I also looked up several teachers and administrators.
While I expected to get good information, I never expected to learn a concept that I hope to incorporate into my medical practice, but that is exactly what happened. I followed an educator on Twitter (@LaurenBibby) who is the Technology Integration Specialist for Lewisville ISD (@LewisvilleISD) and she has since “introduced” me to a concept known as the flipped classroom (even though she doesn’t know it yet).
Wikipedia describes flipped learning as “a form of blended learning in which students learn new content online by watching video lectures, usually at home, and what used to be homework (assigned problems) is now done in class with teachers offering more personalized guidance and interaction with students, instead of lecturing.”
So, students watch lectures at home in the afternoon then come to school the next day to do homework and other projects during class time. This gives the teacher time and opportunity to address what the student doesn’t understand from the lectures rather than have students turn to their parents for their Calculus homework (when dad had trouble passing Algebra).
So, how does this apply to me and my practice?
I’d like to have more patients to do “flipped check-ups.”
In the flipped classroom, student listen to lectures at home and come prepared to do work and application related to the material. In a flipped check-up, parents would read and learn about the upcoming checkup (check out this page on my blog: Check-Ups for an example), develop specific questions and then allow me to get into deeper, higher-level education when they come in for their check-up.
Yes, contrary to the stereotype, you did just hear a doctor advocate that his patients do on-line research prior to their visit (but I want it to be good information). In fact, it’s the reason I started my blog in the first place. I wanted my patients to be able to access my advice (in effect, access me) when I wasn’t there beside them to answer their questions. I wanted them to have a place to go that had accurate recommendations that fit with my philosophy (so, why not have them actually be my recommendations, right?).
Here’s an example of how it could go:
Family has 4 months check-up scheduled.
They review the 4 Month Check-Up Blog Post.
Family comes in for a 4 month check-up.
They say, “We read your blog 4 month check-up blog post and are ready to start solids and he seems to be developmentally ok but we did have some more questions about helping him sleep through the night.”
This allows me to touch on the other areas for clarity and completeness but spend the majority of the rest of the visit discussing in depth about sleeping and some options for sleep training (or not, depending on the family’s preference).
When the child is older we could cover the topics located in my Masters in Parenting Series to cover some topics of development more deeply.
So, this leads me to some questions for you…
1) Is this something you’d be interested in?
2) If you wanted to do it, how could I make it easier for you?
I know just by seeing the picture above I’ve peaked a significant amount of interest…
I get asked a lot about essential oils. I answer very little. Why?
The answer is simply that we don’t know much about how or if they work. Except for anecdotal stories about how they have helped certain people in certain situations, no one has done a large studies to truly evaluate their effectiveness or safety.
The main explanation for why they are used is that people (parents) are simply looking for something that’s an alternative to using what I’m going to call from now on “conventional” medicines.
Going forward, I’m not going to rely much on my knowledge as a doctor, I’m just going to be using common sense and asking a series of questions that I hope will get you all thinking.
What is medicine?
This is the dictionary.com definition: any substance or substances used in treating disease or illness.
Doctors prescribe conventional medicines that enter the body from many different avenues. I have patients that take Zyrtec (cetirizine) by mouth, inhale albuterol, sniff steroid nasal sprays. There are conventional medicines that are delivered topically but they aren’t as commonly used (especially in kids). The most common example was the Daytrana patch for ADHD but I haven’t seen it used in years (I’ve never prescribed it.) because topical medications can have unpredictable rates of absorption which makes determining how much medication actually gets into the system difficult to estimate. I only really use topical creams for things that need to be treated topically (rashes).
I see friends recommending essential oils on all my social media accounts for many different ailments and it’s not always clear to me what they are recommending-topical application, diffusion or ingestion. But, if medicine is “any substance or substances used in treating disease or illness” and medicine can be inhaled, applied topically or ingested, then why aren’t essential oils considered just another type of medicine?
What does it mean that they are more natural?
Another discussion that is centered around essential oils is that they are more natural. I get this concern. In a world where everything is processed (down to a lot of our food), why wouldn’t you want something that is more natural for your family? However, just because something is natural, doesn’t mean it’s a good thing…
Let’s take formaldehyde. Parents cite this preservative as a reason they don’t want to use conventional medicine. I’m not particularly concerned about formaldehyde because it is a by-product of metabolism inside our own bodies. It is formed during metabolic processes and can then be converted into CO2 and exhaled or urinated out. Keep in mind that it is a known carcinogen when the dose gets to high but we know (from history) that it requires a very high level of exposure to get to the point where it causes cancer. Ultimately, the concern I have with formaldehyde is this…it is commonly used as a reason by families who don’t vaccinate even thought it’s made in the body (Is there anything more natural than that?).
A more simple argument against using essential oils based on the reason that they are more natural is this: “Oh, it’s more natural? Well, so is marijuana.”-@mrsdocsmitty.
Do doctors prescribe medicine for every little thing?
I commonly hear this: Doctors just want to prescribe a drug for everything. I want something different for my family.
The whole thing that motivated me to write this post was a posting I saw on a social media account last week: It is a picture of a line of essential oils across a bathroom counter (about 10 bottles-not sure if they were all used this morning or not) and part of the caption below: “He uses oils for allergies, eczema, acid reflux and stress.” I’m not attacking this person at all and I’m not actually sure who it belongs to (so don’t take it personally). But, does trading a “conventional” medicine for an essential oil make any difference? Are essential oils becoming the new “take one for everything”?
I personally have occasional struggles with allergies, acid reflux and stress but I might take medicine allergies or reflux every few months. I do modify my diet, sleep habits and exercise to help with reflux and stress. Therefore, taking essential oils would not be an alternative to taking a medicine for me at all because I’d rather take nothing. I think people assume that because I’m a doctor, my wife and I shove medicine down ours and our kids throats for just about any and every symptom imaginable. This is simply not true. Our kids occasionally get cetirizine for allergies (on average less than once a month), acetaminophen or ibuprofen (on average less than once a month) and my asthmatic gets inhalers (1-2 days per year). They take antibiotics only when absolutely necessary. Other than that, our kids take vitamins every day.
So, be wary of using the reasoning that doctors use medicine for everything. Some may, but this doctor doesn’t and I don’t consider it any different to be using an essential oil for every little thing.
Do doctors stand to benefit when they prescribe a medication?
Fortunately and unfortunately, I don’t practice medicine in a time where I can get flown to Hawaii for a long vacation with my family for prescribing a certain medication. I’m very glad I didn’t because working in that environment would have been very difficult. When I first started practice, drug reps could bring lunch and some pens but even these two practices have stopped. At this point, I have no incentive to prescribe a medication except the desire to see my patient improve. In fact, soon I will be incentivized to not write for medications as insurance plans become more focused on cutting expenses by decreasing their cost of prescription drugs (I will be encouraged to use cheaper alternative when available but nothing is cheaper than not writing for anything.). So, the argument that doctors are pushing drugs in an effort to profit is simply not true for most doctors. There are doctors who are paid consultants and speakers for drug companies, but most are not.
Now, think for a second about your Young Living or doTERRA rep. How do they stand to benefit when they recommend a treatment for you?
Finally, for my distributors and reps out there: Are you practicing medicine without a license?
This is the definition of practicing medicine without a license from Michigan (I’m sorry I couldn’t find the one from Texas for my Texas people):
An individual who practices or holds himself out as practicing a health profession subject to regulation without a license or registration or under a suspended, revoked, lapsed, void, or fraudulently obtained license or registration, or outside the provisions of a limited license or registration, or who uses as his own the license or registration of another person, is guilty of a felony. For the purpose of the offense of practicing medicine without a license, the “practice of medicine” means the diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do, any of these acts. (emphasis mine)
The last part is the interesting part: the practice of medicine means the diagnosis, treatment, prevention, cure or relieving of human disease…by attendance, advice…or holding oneself out as able to do, any of these acts. You’ll have to read it closely for yourself to see what you think. Think about what would happen is something did go wrong with one of the oils you recommended or sold. Would your company back you? Maybe you should ask them and see what they say. Many people feel that the reason that the most profitable essential oils companies are structured as direct marketing is because the company can hide behind their individual representatives’ claims.
Now that I’ve kicked the ant pile, I will now sit back and see what happens. People who know me personally know that I am one of the most open-minded pediatricians they know about calmly weighing evidence on either side of a discussion or debate. I try very hard not to bring my preconceived ideas into consideration when I make a decision. I have extensively studied essential oils personally and am confident that, at this time, I cannot recommend them for my patients until further studies come out regarding efficacy and safety in children. I just pray now that you will consider my questions in the same way I have considered yours over the years. Regarding comments on this post, based on the way I have structured this blog to provide relevant and scientifically accurate information, I cannot allow the comments to become a marketing ploy for essential oils. If you want to debate some of the logic or concepts that I have presented or cite real scientific evidence, that is fine, but I will not allow comments that tout anecdotal evidence of how essential oils have helped you or your family.
If you have preschoolers, think back to 10 years ago…there were many things you were worried about:
You could probably look forward to 10 years from now and predict some things you would be worried about:
Where you’ll send your child to preschool probably didn’t crack your top-4 list, but fast forward to today and… guess what? For many people this time of year with school enrollment going, it’s #1, #2 and #3 on the list.
Here are some tips in helping you find the best preschool:
1) Prioritize what is important to you by asking yourself questions.
Do you want a particular curriculum or teaching style (some examples Montessori, classical or something else)?
Do you want certain extra activities such as music, art or dance?
Do you want a certain set of values taught (Christian school vs not)?
2) Research schools in your area.
Search the internet for schools in your area (remembering that the coolest website is not always the best place).
Ask your (wise) friends. Don’t get advice from any and everyone, or you’ll just end up confused. Find 2 or 3 friends who you trust that have walked through this process recently and see what they know.
3) Visit a few schools.
Keep your eyes peeled the whole time you are there. Are the kids and teachers smiling and having fun?
Pay attention to the teachers other than the one you are scheduled to meet with. It’s easy to fake it for a minute if you know you have a parent visiting. How are other teachers interacting with their students as you walk past their rooms or across the playground?
Finally, you can basically throw everything I have said out the window and focus on the real criteria that we used to choose schools for our children:
We’ve picked 4 schools in our time as parents and couldn’t be happier with what each one provided all based upon using this criteria.
Young Children’s World (Highland Church of Christ)
All of our children went to YCW when we were in Abilene. With 2 young children and our crazy schedules, we had very specific timing issues regarding when we could drop them off and when we could pick them up. They were always very supportive. Noah and Caden both love to look at their year in review books and can name all their class mates (even from multiple years). We always felt our children were safe and loved.
Noah did pre-K at St John’s. We agonized over where to put him for his pre-K year (one of the hardest decisions we have made as parents). When we met Mrs. Rebecca McMillon we were full of angst and fear about the upcoming year. She immediately put our minds at ease when we realized that she really cared for Noah (nearly as much as us- which is a tall order!). The school mission statement reads: St. John’s Episcopal School shall provide an enriched academic program that emphasizes the development of each child’s potential within a caring and Christian environment. Noah was placed Ms. Westervelt’s (ahem, Mrs. Sitzes) class PK4 class. Mrs. Sitzes and the rest of the SJES staff nurtured Noah’s mind but, more importantly, she ministered to his little soul. We couldn’t have asked for anything more.
Since we were new to the area, we chose Lakeland based on recommendations from friends, Trey and Stephanie Suire (@foodfit4real). Because we were only looking for a place for our 1 yr old daughter, there were a couple of things we were looking for…fun and safety. We have been very pleased with Lakeland and they have exceeded our expectations. Hannah had some initial separation anxiety but has since blossomed into a little girl who can be put down and runs into the room to Mrs. Sharon and her friends. We were very impressed on orientation day to hear that Lakeland has made some parents or caregivers really mad (who were not the normal pick-up parent) by making them prove who they were before letting them leave with the child. My babies safety chosen over making some grumpy dad mad…ummm, yes please.
This was another situation where we had to rely heavily on the recommendation of friends. Several different people mentioned MES as a great place so we had to check it out. Rachel was struck as she toured the school by how much joy there was all around. From the headmaster to the front office staff but, especially after we met our child’s teacher, we could tell that MES was a place where children where enjoyed, not simply tolerated. He is missed when he does not make it there and celebrated when he is. They provide a unique blend of Montessori education with some structure that we think serves our children well in preparing them for their future transition to Kindergarten.
Dr. Justin Smith’s daughter currently attends Lakeland Christian Academy and his son attends Montessori Episcopal School. Look forward to seeing the Newborn Baskets that he and @mrsdocsmitty have created for the upcoming silent auctions. He will be seeing patients in the Cook Children’s Lewisville office every Tuesday afternoon until June, when he will transition to be working there full time, 5 days a week.
Photo credit: (Almost) 5 year old
April is National Child Abuse Prevention and Awareness Month!
April 4 is wear blue today to bring awareness to the cause.
Remember that there are 4 different kinds of child abuse: Physical, Sexual, Emotional Maltreatment and Neglect
If you have any concerns about a child there are 2 main ways to report:
1) Call 1-800-252-5400 (or 911 if imminent danger)
2) Online at https://www.txabusehotline.org/
There are lots of different things I could write about child abuse. I served on the Child Advocacy Center board for Abilene for 3 years while I lived there. I have heard countless stories of children who were abused. It is both heartbreaking and devastating.
I usually don’t like to give wrote statistics and lists because I feel that the power of storytelling is much more compelling. However, this is a case where, if you take your time and ponder, you can feel the gravity of the situation by see what effects are caused when a child is abused. As you read each consequence think about how each one would affect the child’s long-term future:
Effects of Abuse and Neglect (from texprotects.org)
Child abuse and neglect extorts an enormous toll on society and greatly impacts the victims in numerous ways. The stress, trauma and persistent fear that occur at an early age from the result of child abuse causes children to have lifelong health, psychological, and behavioral consequences.
Physical Health Consequences:
Abused children are:
Persons who experienced childhood abuse and neglect have:
So, what can you do?