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Old 08-11-2010, 07:37 PM   #11
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Re: how to get off the "well-child" radar

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have you talked to the dr?
It is a large practice, so we don't always get in to see her. I work during the day, so my husband took my son to the last appointment. The next appointment is with her at the end of the month, and I will take him so I can talk to her then.

I really don't want to change away from this doctor because she "gets" my son, who is very high end on the ASD spectrum. She actually thinks he is pretty cool. We think very much alike. When I would tell her stories of some of the things that he would do, she could finish my sentences because she really UNDERSTOOD him and how his mind worked. It was AWESOME and a rare jewel to find her.

For the most part everything is good, but the hounding about the well-child visits, the frequent vax reminders, and the vax upselling trophy things are getting to become the norm.

Honestly, it is like they are under new management. They also started using an outside service to give normal test results. You get an automated call telling you to call the number to get the test results and to be sure to have your child's chart number when you call. Problem is that they haven't given you the child's chart number at the office visit. This happened three separate times at three separate visits at two different locations with two different kids; so this is a system-wide problem. When I notified the nurse that you cannot retrieve test results when you don't have your children's chart number, she seemed surprised that I was not given it.

It is really a clearly a management issue that needs to be addressed, but it is causing clinical problems.

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Old 08-11-2010, 08:40 PM   #12
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Re: how to get off the "well-child" radar

Mamas, an honest question...

Is it not medical neglect to skip all well child visits? We would love to skip them, too considering the same basically verbal abuse we go through about vaxes and growth percentiles. However, I would die if skipping well child appointments was ever held against me in any situation. I do not know what the future holds, and I have heard of this being used to claim medical neglect.

It's just sad that we live in a world where a co-pay must be dropped for a well-child appointment. Our ped comes in to pester us about vaccinations, feeding schedule, sleeping through the night and crying it out, too much weight gain and growth percentiles, etc. and only spends 1 minute with DD! He looks her over as well as I do and that's it.

Frankly, we can't afford to drop a co-pay every month to every two months when we don't utilize any special attention from the ped himself. But they do not care. I dread the appointments and even get chest flutters with anxiety over it as we are always not doing something right in his eyes. Then we are questioned about every facet of our personal and religious beliefs so that he can judge our religious exemption illegally.

And no, we can't switch peds as he is the only one who won't dismiss us from the practice for non-vax.

Sorry to de-rail the OP. My question was... medical neglect?
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Old 08-11-2010, 08:53 PM   #13
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Re: how to get off the "well-child" radar

It is absolutely not neglect to skip well child visits. If you are making the decision to skip them and still meeting your child's medical needs (taking them in when they are actually sick) it is no different than making the decision to not get physicals for yourself. These are your kids, you get to make the choice. Now I will admit I do well child exams mostly because I like having the paper trail. WE do make a lot of "different" parenting choices, from not vaxing to home schooling and many things in between. I am also incredibly paranoid and have some health issues that I worry will make me seem "unfit". But if I didn't love our pedi (who was my pedi as a child and I would still see if he treated adults) I wouldn't do it. It wouldn't be worth it. I do have a special needs child which means far more appts for us anyway and our pedi has been a great ali when it comes to getting his needs met, but for my youngest I often just skip on the well child checks. Our office doesn't even bother with reminders. I get a call from my own Dr's office once a year to remind me, and it is probably good because I would never remember on my own (not that I usually go anyway) but the pedi's office doesn't send anything. I just finally made Kearnan's physical appt for the end of this month. He hasn't seen his pedi in almost 2years. He is hardly ever sick and I kind of skipped the well check last year because we were so caught up in specialist appts. Tharen didn't make last year's either because his b-day is in December and I don't like going to the office in flu season. No reason to expose them.
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Old 08-11-2010, 10:45 PM   #14
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Re: how to get off the "well-child" radar

Whenever I get asked to make an appointment for something I don't want to be seen for, I just say I'm handling it privately. I get the whole, "Oh, but you'll need a referral from us if you want insurance to cover it," speech, but I just reiterate that I'll be handling it privately and no longer need their assistance on the matter. Not sure how well that would work with general physicals, though.
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Old 08-12-2010, 01:02 AM   #15
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Re: how to get off the "well-child" radar

I would definitely talk to the pediatrician. However, it may be the office's policy to require well child visits. While I am sure you are not neglecting your children's health, that cannot be said of every patient at that office. Pediatricians aren't just trying to take their patients for an extra co-pay with these visits. They want to see children regularly to track their health and well being and to give them an ongoing basis for what is normal for that particular child. These visits help them to ascertain what is normal for each child for those times when the LO is sick. People are not machines and everyone has slightly different norms.

These appointments are not so much directed at your children because I'm sure you are very careful of their health. But your pediatrician undoubtedly has parents who are less so and who need to hear the rhetoric about carseats, vaccines, back to sleep, etc. But, even for your children it helps the doctor provide better care when they are unwell.

Many doctors will not continue to see children unless they do keep up with those well child visits because it can create liability for them to treat an ill child without a good fix on whether there might be something else going on. You could find your LOs fired as patients for not attending well child checks.

Just another view.
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Old 08-12-2010, 04:03 AM   #16
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Re: how to get off the "well-child" radar

I'm guessing it is really just a change in management. This never was a problem (like for the last 12 years) until just recently.

Honestly, we started dropping out of the well-child exams for a few reasons. The ones listed above and when they started panicking at anything that was slightly out of the norm. We have an incredibly healthy daughter who is very petite. Her father is that way, and it is just her build. They wanted to do all sorts of testing, x-rays, etc. on her, heading in the direction of "what do we do about her size". Well, what do you do it about it. It is just how she is built. You do nothing. She is healthy. She eats well, a wide variety of foods, gets plenty of exercise (is now quite an accomplished ice skater), and is intellectually on par (actually above) her peers. What is the problem?

They haven't said they are required, just that the pediatric associations recommend them. Well, a recommendation is not a requirement.

It has 100% nothing to do with the money. The money issue is no where on the radar at all. We always save aside plenty of money for healthcare costs and pay for them up front and immediately, so that is always a top priority.

The kids are seen an average of 1-2 times a year for colds, ear infections, or general other things. So they are not lost to followup for the practice either.

I do transcription and coding, so I know all of the documentation that goes into these visits. A patient has to be seen in an office within the last 3 years in order to be considered an established patient. After that, they are "lost to followup" and have to be considered a "new patient" to the practice with a new intake physical.

Anyway, I'll probably just ask them if it is now a policy that they require them. If it is not required, we will ask what the opt-out policy is.
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Old 08-12-2010, 04:46 AM   #17
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Re: how to get off the "well-child" radar

I should also mention that the reminders only come when they want them to. My son has not been seen for four years for a well-child, and all of a sudden there is a problem, but they were not concerned the last four years whatsoever.

With my other son, they started sending out the reminders when the MICR system kicked out that he was overdue for recommended vax. Then all of a sudden they seemed panicked that he was overdue for his physical, but not a moment before I got the vax reminder from the state. Even then, it wasn't about the physical, it was about getting his shots done.

If it was actually about their overall health, I would be all for it, but there seems to be an underlying agenda to this push that they are just not admitting to. I'm waiting to see a trophy in the lobby that says "our office scheduled the most well-child visits", like they did with the vaccinations. It really feels like they are upselling the annual exam instead of having it be a standard of care consideratoin. There has to be something medically unethical abot upselling vaccinations the way they did. (yes, that REALLY bothered me...and I was only undecided and still researching at that point!)
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Old 08-12-2010, 06:17 AM   #18
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Re: how to get off the "well-child" radar

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Originally Posted by z2akids View Post
I would definitely talk to the pediatrician. However, it may be the office's policy to require well child visits. While I am sure you are not neglecting your children's health, that cannot be said of every patient at that office. Pediatricians aren't just trying to take their patients for an extra co-pay with these visits. They want to see children regularly to track their health and well being and to give them an ongoing basis for what is normal for that particular child. These visits help them to ascertain what is normal for each child for those times when the LO is sick. People are not machines and everyone has slightly different norms.

These appointments are not so much directed at your children because I'm sure you are very careful of their health. But your pediatrician undoubtedly has parents who are less so and who need to hear the rhetoric about carseats, vaccines, back to sleep, etc. But, even for your children it helps the doctor provide better care when they are unwell.

Many doctors will not continue to see children unless they do keep up with those well child visits because it can create liability for them to treat an ill child without a good fix on whether there might be something else going on. You could find your LOs fired as patients for not attending well child checks.

Just another view.
I appreciate your view, and I know it's true that parents who don't take their children's cues and watch for milestones have ruined it for everyone else. You know, when my brother, sister, and I were younger we saw the pediatrician only when sick or before the school year. That goes for younger as well as an older child.

(RANT): Personally, I would like to go to well child visits. However, I shouldn't be charged for those visits and some insurances don't charge for them. If I wasn't being inappropriately pestered at every visit then I wouldn't be emotional when choosing to see the ped over choosing to pay for a tank of gas and going out with family on the weekend, etc. Our co-pay can put our car on 3/4 full even in today's economy. My DH drives two hours on commute and return from work daily. I feel like telling the pediatrician to get off my you-know-what by letting him know this. (/RANT)

Anyways, I have long ago discovered that my parenting choices will always have someone pestering me. So I try to remind myself that if it isn't their office, it will be a family member, another mother, etc.

"Bean," that does not surprise me. They can't leave well enough alone. Another issue with these visits is that they will find something to pick at if there is nothing obvious.
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Old 08-12-2010, 06:56 AM   #19
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Re: how to get off the "well-child" radar

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It is absolutely not neglect to skip well child visits. If you are making the decision to skip them and still meeting your child's medical needs (taking them in when they are actually sick) it is no different than making the decision to not get physicals for yourself. These are your kids, you get to make the choice. Now I will admit I do well child exams mostly because I like having the paper trail. WE do make a lot of "different" parenting choices, from not vaxing to home schooling and many things in between. I am also incredibly paranoid and have some health issues that I worry will make me seem "unfit". But if I didn't love our pedi (who was my pedi as a child and I would still see if he treated adults) I wouldn't do it. It wouldn't be worth it. I do have a special needs child which means far more appts for us anyway and our pedi has been a great ali when it comes to getting his needs met, but for my youngest I often just skip on the well child checks. Our office doesn't even bother with reminders. I get a call from my own Dr's office once a year to remind me, and it is probably good because I would never remember on my own (not that I usually go anyway) but the pedi's office doesn't send anything. I just finally made Kearnan's physical appt for the end of this month. He hasn't seen his pedi in almost 2years. He is hardly ever sick and I kind of skipped the well check last year because we were so caught up in specialist appts. Tharen didn't make last year's either because his b-day is in December and I don't like going to the office in flu season. No reason to expose them.

I agree 100%. As long as you get the appropriate medial care when it is needed (ie if they get sick or fall, etc...) it is NOT medical neglect. I asked my mom (who is a child and adolescent psychologist who works in the court system occasionally for custody cases in divorces if that could be held against me should something happen between DH and I and she said that not in the state of IL (I assume it would be similar for other states as well). She said as long as I could prove to the judge that they got the necessary medical attention when they were sick or injured, and that I consciously made the decision to not go to well child visits (and what my reasoning was) that it would not be an issue.
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Old 08-12-2010, 08:02 AM   #20
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Re: how to get off the "well-child" radar

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She said as long as I could prove to the judge that they got the necessary medical attention when they were sick or injured, and that I consciously made the decision to not go to well child visits (and what my reasoning was) that it would not be an issue.
I wouldn't be lying if I gave the state my reasoning as not being able to afford the co-pay when no illness requires it.

Or... this is funny... I could play the ignorant bully card for non-vaxers that they play on me by saying "Well, I was under the impression that my child is easily susceptible to diseases on word of her own pediatrician, so I feel it could be harmful to wait amongst sick children."

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