Posts Tagged ‘email’
I posted about this last year when I was once again wading through physician credentialing. I recently had occasion to do it again because I’m helping out a friend at a new hospital, and, if anything, the process is even worse.
Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other healthcare facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work history (if any). Copies of key documents — medical degrees, residency certificates, and the like — accompany the application. The applicant also provides the names of professional references who can attest to competency. Also required are declarations that the applicant has never been fired (or asked to resign) from a medical job for competency issues. The applicant also must also swear to a long list of other things. These include not being a drug addict (who would answer yes to that?), a convicted felon, or to have been disciplined for questionable or illegal activity. A committee then reviews the application and grants (or not) privileges to practice medicine at that facility.
Before the committee grants privileges, however, all the information gets verified. This makes perfect sense because, regrettably, there are more than a few documented instances of people embellishing or even outright lying on their applications. I have been on enough selection committees to know that folks occasionally stretch the truth. Flagrant examples of this occasionally make the news. The job of credentialing departments is to check up on all this. Interestingly, in the example I just linked to, the guy hoodwinked all the verifiers; it was only picked up later by accident.
It gets more complicated because not just hospitals and healthcare facilities want their practitioners credentialed. All of the people who pay the bills, such as insurance companies and the government — Medicare, Medicaid — want to make sure they are paying legitimate costs to legitimate practitioners. So they have their own credentialing departments, all different in how they do things. A typical physician has to be credentialed by every single one of the payers covering every single one of his or her patients. That can mean a dozen payers or more. So, for example, besides having privileges at the hospitals at which I practice, my background is verified by all the people who pay the bills for my patients. And believe me, the requirements of all these entities are not the same and all have their own sheaf of forms to fill out and supporting documents to submit.
This situation cries out for a central clearing house for credentialing information. Some examples of this exist, such as this one, if nothing else because collecting all this information is tedious and expensive. Credentialing departments at many facilities are getting larger all the time. Credentialing is also a major industry, with overwhelmed facility credentialing staffs farming out the process to outside contractors. The problem is that, in our disorganized healthcare “system,” no facility or entity wants to surrender the right to collect their own data in their own way. Attempts to institute a more global process, at least in my experience, have simply added another layer of bureaucracy to slog through. The convenience, or even the sanity, of the physicians wrestling with this unholy mess is not their concern. For physicians like me, who practice at several hospitals in different parts of the country with little overlap in who the regional payers are, the expense and hassle of it all are large. And even when you think you’re done, you’re not: many entities require frequent updates, often meaning a whole new application. One that I deal with demands this every three months.
Okay — rant over. But what prompted this was my agreeing recently to help out some people for a few weeks at a new hospital. I’m now four months into the credentialing “process.” During that time I’ve dealt with three separate organizations, none of which communicate with each other. I’ve worn out my fax machine submitting extraneous document after document. Nearly every day my email inbox has strident demands for still something else IMMEDIATELY! If I hadn’t promised my time to people I like, I think at this point I would just say: no, I’m done — good luck.
I’ve been practicing medicine for over 35 years. For my first job I just showed up for work. People checked that I had graduated from medical school, done a residency, and passed my exams, but that was about it. I realize physicians have to some extent brought all this on ourselves by a few of us scamming the system over the years or just lying. I recall a case some years ago of a physician lying about a five year gap in his work history, a gap that turned out to be because he was serving time in prison for third-degree murder. (I looked for a link to this incident but couldn’t find one — it most likely was pre-Google.)
Anyway, I think this credentialing mess has got to get better organized somehow. We need a central authority of some sort, accepted by all. The current trajectory is unsustainable. Healthcare is expensive enough, and all this adds many millions to the total costs for little benefit.
Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.
New Study Shows How and Why Sleep Patterns Change During Adolescence
Every Parent of a teenager knows that they tend to go to sleep later and are harder to rouse out of bed in the morning. It turns out that as elementary school children become early and then mid-teenagers theses changing sleep patterns are a normal result of the hormonal changes their bodies are going through.According the data in a new study, conducted with 94 children in all, children are programmed to get less sleep as they mature.
A typical 9-year-old fell asleep at 9:30 p.m. on a weekday upon first enrolling in the study and would wake up at 6:40 a.m. By age 11, the same child would go to sleep at 10 p.m. The net result for that child – and many others in the cohort of 38 children who joined the study at 9 or 10 years old – would be steadily less sleep every night.
The study is one of the few to track individual kids for longer than a year. It showed wide individual differences in these trajectories. For some children, the data show, the shift to a later bedtime without a later wakeup time was abrupt, possibly putting them at a greater disadvantage relative to their peers in school.
The American Academy of Pediatrics has suggested later school start times for teenagers, advising school start times no earlier than 8:30 for middle and high school students.
For Kids With Simple Concussions, a Couple of Days Rest is Enough
The past few years have brought increasing attention on concussions, particularly the long-term effects of repeated concussions. We need to take them seriously. But they are common, and the vast majority of children recover without any further brain issues. The optimal way to care for children following a concussion is still unknown, although there is one key principle: a child should not do anything that could lead to another head injury, such as returning to contact sports, until the symptoms of the concussion have resolved. Common symptoms are headache, vomiting, and difficulty concentrating.
Some authorities have long recommended extensive bed rest following a concussion. A new study indicates that this is not needed and does not help the brain heal any faster. In fact, the authors noted that children placed on strict bed rest tended to focus on their symptoms even more, which is not surprising to me.
You can read more about concussions — what they are, what they mean — in a blog post I wrote here.
Stress During Pregnancy Can Effect Fetal Development
This study is in mice, not people, but it has very suggestive findings. The bottom line was that pregnant mice who had high levels of stress hormones had smaller offspring, and low birth weight is an important marker for later problems in infants. The effect was not because the stressed mothers ate less — they actually ate more. Although the causes of low birth weight are many, it makes sense that a stressful environment for the fetus might be one of them.
Starting Serious Contact Football Before the Age of 12 Linked to Later Brain Problems
While we’re talking about concussions and head injury (see above) another important study in the journal Neurology found, at least in NFL players a correlation between later degenerative brain problems and the age at which the player first began to play. At least minor head injury is almost inevitable in football. It is likely that there are many injuries that don’t reach the level of concussion but which, over time, add up. The identification of age 12 as the threshold for increasing risk for later problems makes sense from what we know about brain development in children.
Small Screens in a Child’s Bedroom interfere With Sleep
We should probably file this one in the common sense department, but if you allow your child to have a small screen in the bedroom, such as from a smart phone, it will interfere with his or her sleep. I know we found that to be the case with my own son. I guess it’s good to know that research confirms that.
Massive Study Confirms Safety of Measles Vaccine
Measles is very much in the news these days after the outbreak of the infection in California, which was linked to higher numbers of unvaccinated children. An inevitable byproduct has been the resurrection of fear of the vaccine. Multiple past studies have debunked any links with autism or any other serious ailments. So this study is timely.
Researchers at Kaiser-Permanente studied a total of nearly 800,000 vaccine doses over 12 years and found no serious issues.
Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.
How much of autism is caused by genetic factors and how much by environmental ones?
Autism is always very much in the news. There is intense controversy about its cause, although the bottom line is that we don’t know. It also appears to be increasing, although we don’t know how much of this is what we call ascertainment bias — finding something more when we look for it more. A big part of the controversy is the relative contributions of genetic vs environmental factors.
A recent study from Sweden offers useful information about this. The study was immense, over two million children, far larger than any previous ones.
The bottom line is there appears to be more or less a 50/50 split in the relative contributions of nature and nurture. That is, genetics contributes 50% of the causative factors, environment 50%. This is an important finding. Overall, a child with a sibling with autism has a 10-fold higher chance for getting the disorder than does a child without such a family history. The middle part of the article is dense, but the first part and the conclusions are understandable by non-physicians.
Those laundry detergent pods can be quite dangerous for your toddler
A recent study examined how common poisoning or other injuries are from those convenient laundry detergent pods. I have seen one severe case myself, causing breathing problems bad enough to land the child on a mechanical ventilator. This study surveyed poison control centers to find out the extent of the problem. It is not trivial.
Between 2012 and 2013 there were over 17,000 exposures to these things, a 600% increase from the previous year, indicating how popular they have become. I can see why they are popular — I use them myself. It’s a lot easier to toss one of them into the wash than pour out detergent from a bottle.
But that convenience comes at a potential risk. Toddlers put anything and everything into their mouths, and the alluring, brightly colored pods quickly dissolve when wet. The survey revealed that there were over a hundred children who required emergency placement of a breathing tube and one death.
So if you use those convenient items, make extra sure your toddler can’t get at them.
Finally we have vaccines for all strains of the deadly meningococcus
Infections from a bacteria called Neisseria meningitides (aka meningococcus) are horrible and often fatal. I have seen probably 20 children die in my career from this, and at least as many suffer terrible complications, such as loss of arms or legs. This is the bacteria you have probably read stories in the paper about because it can cause lethal mini-epidemics in schools and any place children and adolescents come together in close contact. The infections come in a couple of varieties: meningitis alone, meningitis with septicemia, or septicemia alone. Of the three, the last is generally the worst, with a high mortality rate and serious aftereffects in survivors.
There are five strains of meningococcus that cause disease. We have had a vaccine for four of them for many years. But one of them, group B, has been difficult to develop an effective vaccine for, and this strain is a common cause of disease. The big news, and it is big, is that we now have a vaccine for group B. Meningococcal vaccine is recommended for adolescents — see your doctor about getting it for your child.
All about caffeine: what is it, where is it, and how does it work?
This one is more for you parents than it is for your children. I ran across an excellent and readable summary of what we know about caffeine. First of all, the stuff is everywhere. It is a brain stimulant that is found in many food and drink products, although the most common sources are coffee, tea, and now energy drinks like Red Bull. Here are some fun facts about it.
- 68 million Americans drink 3 cups of coffee per day
- 21 million Americans drink more than 6 cups per day
- 50% of caffeine users experience unpleasant symptoms when they stop, typically headaches, which can last for a week
- 5 grams of it can be fatal, but that is 30-40 cups of coffee
Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other healthcare facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work history (if any). Copies of key documents — medical degrees, residency certificates, and the like — accompany the application. The applicant also provides the names of professional references who can attest to competency. Also required are declarations that the applicant has never been fired (or asked to resign) from a medical job for competency issues. The applicant also must also swear to a long list of other things. These include not being a drug addict (who would answer yes to that?), a convicted felon, or to have been disciplined for questionable or illegal activity. A committee then reviews the application and grants (or not) privileges to practice medicine at that facility.
Before the committee grants privileges, however, all the information gets verified. This makes perfect sense because, regrettably, there are more than a few documented instances of people embellishing or even outright lying on their applications. I have been on enough selection committees to know that folks occasionally stretch the truth. Flagrant examples of this occasionally make the news. The job of credentialing departments is to check up on all this. Interestingly, in the example I just linked to, the guy hoodwinked all the verifiers; it was only picked up later by accident.
It gets more complicated because not just hospitals and healthcare facilities want their practitioners credentialed. All of the people who pay the bills, such as insurance companies and the government — Medicare, Medicaid — want to make sure they are paying legitimate costs to legitimate practitioners. So they have their own credentialing departments, all different in how they do things. A typical physician has to be credentialed by every single one of the payers covering every single one of his or her patients. That can mean a dozen payers or more. So, for example, besides having privileges at the hospitals at which I practice, my background is verified by all the people who pay the bills for my patients. And believe me, the requirements of all these entities are not the same and all have their own sheaf of forms to fill out and supporting documents to submit.
This situation cries out for a central clearing house for credentialing information. Some examples of this exist, such as this one, if nothing else because collecting all this information is tedious and expensive. Credentialing departments at many facilities are getting larger all the time. Credentialing is also a major industry, with overwhelmed facility credentialing staffs farming out the process to outside contractors. The problem is that, in our disorganized healthcare “system,” no facility or entity wants to surrender the right to collect their own data in their own way. Attempts to institute a more global process, at least in my experience, have simply added another layer of bureaucracy to slog through. The convenience, or even the sanity, of the physicians wrestling with this unholy mess is not their concern. For physicians like me, who practice at several hospitals in different parts of the country with little overlap in who the regional payers are, the expense and hassle of it all are large. And even when you think you’re done, you’re not: many entities require frequent updates, often meaning a whole new application. One that I deal with demands this every three months.
Okay — rant over. But what prompted this was my agreeing recently to help out some people for a few weeks at a new hospital. I’m now four months into the credentialing “process.” During that time I’ve dealt with three separate organizations, none of which communicate with each other. I’ve worn out my fax machine submitting extraneous document after document. Nearly every day my email inbox has strident demands for still something else IMMEDIATELY! If I hadn’t promised my time to people I like, I think at this point I would just say: no, I’m done — good luck.
I’ve been practicing medicine for over 35 years. For my first job I just showed up for work. People checked that I had graduated from medical school, done a residency, and passed my exams, but that was about it. I realize physicians have to some extent brought all this on ourselves by a few of us scamming the system over the years or just lying. I recall a case some years ago of a physician lying about a five year gap in his work history, a gap that turned out to be because he was serving time in prison for third-degree murder. (I looked for a link to this incident but couldn’t find one — it most likely was pre-Google.)
Anyway, I think this credentialing mess has got to get better organized somehow. We need a central authority of some sort, accepted by all. The current trajectory is unsustainable. Healthcare is expensive enough, and all this adds many millions to the total costs for little benefit.
Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.
About those physician rating sites: do parents use them to find a physician for their child?
There are now a multitude of web sites on the internet that allow consumers, that is patients and their families, to rate physicians. And why not? There are rating sites for many other products and services. But these sites can strike fear into the hearts of doctors because, when you look at them, the number of ratings for a particular physician is usually quite low. In my own case, for example, a popular rating site only lists one for me even though I’ve been practicing for 30 years. So there is the fear that one disgruntled patient can tank your rating. But these sites are here to stay, I think. A big question is if parents use them to find a doctor for their child: or, if they haven’t used them, would they? A recent survey asked that question and found that parents are beginning to use the information on the sites. My concern is that, if this is the future, they be run a little better. For example, Angie’s List, a popular one, has contacted me several times to ask me to rate myself. I assume it was a computer glitch, but the potential to cook the books is always a concern with anonymous rating sites.
Long term treatment of ADHD with stimulant medications does not affect growth
Pediatricians are always concerned that long term treatment with any medication could affect a child’s growth. This is true for any medication, but it is a particular concern for attention deficit/hyperactivity disorder (ADHD) because there are so many children taking these medications and they often take them for many years. A recent study in the journal Pediatrics is reassuring on that point. The authors studied a large group of children through childhood and on into adulthood and found no effect on growth.
A related, and important point, is how common is ADHD? A recent report from the Centers for Disease Control (the CDC) used surveys of parents to assess that issue. What they found is that 11% of all children between the ages of 4 and 17 had at one time or another been given the diagnosis of ADHD, and 83% of those still carried that label. And 69% of the total were currently taking ADHD medication. That represents a whopping 43% increase over the past decade. For myself, I find it hard to believe ADHD is increasing at that rate; it’s more likely increased awareness of the condition, but there also may be a component of you find what you look for.
What is my advice to parents about this? I’m not an ADHD expert, I’m a critical care pediatrician, but it seems to me to be a stretch to categorize 11% of all children as abnormal — that even defies the definition of what the word normal means. If your child’s teacher wants you to get ADHD medications for your child, I would first carefully look into the details of the concerning behavior. How troublesome is it really? Could there be other explanations? Could more structure help? Then see a physician or psychologist with experience with ADHD. If the recommendation is for medication, for myself I’d seek another opinion and see if they agree. This is an area in which parents should be the ones driving the bus.
Most parents don’t know how to use a car seat when they leave the hospital with their newborn infants
There is no question that car seats save lives. Since their use has been mandated by law, the death and injury rates of children involved in motor vehicle accidents have fallen dramatically (40-50%). But the seats need to be used correctly. A recent report suggests that new parents need more help in figuring out how to install and use them. In fact, 93% of new parents made at least 1 critical error in using the seat. So if you’re not entirely sure if you’re doing it right, have someone check. Our hospital, like all hospitals delivering babies, has specially trained nurses that can look at your seat, your car, and make sure the seat is installed right. There are also quite a few good online sites (like this one) telling you about different kinds of seats, which children need which ones, and how to install them.
Lower vitamin D levels found in children who drink non-cow’s milk
Many children do not drink cow’s milk. This may be because of a sensitivity to cow’s milk protein, a common condition, or because of parental preference. Parents of children in this situation should know that this brings a risk of reduced vitamin D levels in the blood. Commercial cow’s milk is fortified with vitamin D, as are infant formulas that don’t contain cow’s milk. A recent studymeasured vitamin D levels in children who don’t drink commercial cow’s milk and found that many of these children had low vitamin D levels.
Vitamin D has long been known to be crucial for bone growth. Rickets, a once common bone disease in children caused by low vitamin D, is now extremely rare since milk has been fortified with the vitamin. We also know now that vitamin D has many other functions, such as in cardiovascular health. Our body can make vitamin D if exposed to sufficient sunshine, but this is not a reliable source. Of note, the above study comes from Toronto, and rickets was once much more common in climates where children get less sunshine exposure.
The bottom line is that if your child does not drink fortified cow’s milk he or she is at risk for low vitamin D. Your child’s doctor can help you with identifying the best way to supplement this key nutrient.
Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.
Coming soon: A smartphone app to see if your baby is too jaundiced
This bit of news is pretty interesting, although the product is still in development. These days babies typically go home from the hospital when they’re a day old or even less.Newborn jaundice is very common, especially in breast-fed babies. Nearly all the time it means nothing and passes without treatment. Once in a while, though, the blood bilirubin, which causes the jaundice, gets dangerously high. We treat it with phototherapy. It takes a blood test to measure the blood level, although we’ve used devices for years in the hospital that estimate it from the skin color, identifying those babies that need the blood test. Now it looks as if there will be a way to screen your baby at home using your cell phone and then sending the results to you doctor. I think it’s a cool concept.
Let them sleep in more: American Academy of Pediatrics recommends delaying school start for adolescents
Every parent with a teenager knows they like to sleep more. To no one’s surprise, this is because they need more sleep to be healthy and sharp for school. Research has shown real benefits for mental and physical health. Starting school at 7:30 in the morning, or even earlier, is particularly hard for adolescents. Recognizing this, the AAP has come out with new recommendations for middle and high school start times, suggesting 8:30 am as more appropriate.
Who knows if this will go anywhere because the logistics of getting kids to school and parents to work on time can make it tough to change things. After school activities, such as sports, would also be affected if practice times are pushed back. But it seems pretty clear that a later start would be better for teenagers.
Children who use digital media a lot may be less able to read actual human emotions
This one is interesting. All of us, especially children, are spending a lot more time staring at digital screens — computers, smart phones, video games. A research report coming out next month suggests this may not be a good thing for emotional development. Children, who have not yet fully developed human interaction skills, may be less able to read emotions on actual human faces if they spend a large amount of time with screens.
The researchers found that children whose access to electronic devices was limited were better able to read other people’s emotions. The authors concluded: “Decreased sensitivity to emotional cues – losing the ability to understand the emotions of other people – is one of the costs. The displacement of in-person social interaction by screen interaction seems to be reducing social skills.
“I’m not surprised by this, really, and I find it concerning. It’s one of several reasons my wife and I monitor and limit our son’s computer and smart phone time.
High levels of physical activity linked to early academic achievement
Every parent knows that physical activity is good for children. Among other things, being active and not parking in front of the TV is linked to a lower level of obesity. A new study from Finland suggests that a higher than average level of physical activity is also linked to improved academic performance in elementary students, particularly among boys.
The authors observed 186 children during recess for the first 3 years of schooling and also collected other information on physical activity, such as riding a bike to school: “The improvements in academic attainment were most striking in male participants, especially with reading skills. Boys with higher levers of physical activity, and in particular walking or cycling to school, had better reading skills than the less active boys.
“I was interested to see this research but it seems to me to be confirming common sense. What it is really saying is that if you encourage children, especially boys, to run around a lot and work out their energy, they concentrate better in the classroom. It reminds us that old-fashioned recess is getting rarer and rarer. A half-hour of unstructured play time used to be common; it no longer is.
Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.
At what age to overweight and obese children start getting that way?
Most parents are aware that the average weight of America’s children is going up — more and more kids are overweight or obese. Experts debate the reason for this but we know it is happening. We have piles of data documenting the percentage of children who weigh too much, but until now we haven’t known the answer to a key question: When did they start to become that way? This is a key question because it would tell us where to concentrate our intervention measures. Now we know.
To understand this better you need to understand the difference between two key terms — incidence and prevalence. Incidence is the number of new cases of something in a year; prevalence is the overall number of cases of something in the population at a given time. We have known a lot about the prevalence of childhood obesity but, until now, nothing about the incidence. That is, we didn’t know when the large number of obese children first got that way.
This research article, which got wide coverage in the medical press, contains the important information. It uses year by year weights of several thousand children to see at what age individual kids became overweight and obese.
The answer? KINDERGARDEN! That is, age five is when the largest number of children who were to become overweight and obese first started becoming that way. More than that, it may be even younger because the number of overweight and obese five-year-olds was already pretty high.
The article is in a medical journal but is worth a look if you are interested in the topic. You can see the summary without a subscription and it is quite clear.
If you want to know the scientific definitions of what the categories “overweight” and “obese” mean, and how to measure your own child, the Centers for Disease Control has a good source here.
Football concussions in high school players: how you tackle matters
If you have a son who plays football you probably have heard a lot about concussions, which we now know are much more common than we previously thought. We also now know that they can be much more serious than just “getting your bell rung.” Getting multiple concussions, or another one before the symptoms of the first one have gone away, is very bad for the brain.
Although any blow to the head can cause a concussion, we don’t know if the location of the blow matters much. A recent study in high school players looked at the question. It turns out that a blow to the top of the head, such as when a player rams another player head-on, is more likely to cause one. I’ve never played football, but the authors point out that correct tackling technique is with the head up. It appears that the correct way to tackle is also the safest.
Why are teenage boys so fearless?
Every parent of a teenage boy knows that their ability to judge risks is often not good. Why is that? Why do they seem to think they are immortal, and that bad things won’t happen to them? Is there something special about the teenage male brain? The answer appears to be yes.
A recent, quite sophisticated, study used high-tech brain scanning techniques to examine teenagers’ brains when exposed to a variety of simulated situations. The authors concluded this: “Adolescent males are relatively insensitive to punishment or losses, but hypersensitive to large gains.” From this they also speculated why punishment or threat of punishment alone is often not the best way to discipline an adolescent male.
So science may be demonstrating what parents have known for generations. Still, an interesting read.
Don’t ever give your child codeine cough syrup. Ever.
We’ve known for some time that codeine, often in the form of prescription cough syrup, can be bad for children. The side effects can be severe, especially in children under the age of two, but it can do bad things in older children as well. The main problem is that the effect on a given child is quite unpredictable. What’s more, these syrups don’t even work at suppressing cough. A recent study reports the discouraging news that physicians haven’t gotten the message; the number of prescriptions written for codeine cough syrup for children has barely changed in the last several years; it is still a very large number. Parents can help. If a doctor wants to write such a prescription for your child, say you don’t want it. You might also remind the doctor that medical experts are unanimous in their condemnation of these products. Also, codeine as a pain killer doesn’t work well for children. So don’t use it for that, either.
I’ve written before about using e-mail to communicate with your doctor. My own personal physician does this for all of his patients who wish to participate, and it allows me to do things like ask him simple questions or get refills on my prescriptions. It works well for those kinds of things and saves both of us time and the frustration of playing telephone-tag. Of course he knows me already and I know him, and he sees me in the flesh at least once each year. Many pediatricians now have websites for their office practices and use them to distribute information to the parents of their patients as well as for e-mail.
Is there any way this kind of virtual medicine could work if there were no pre-existing relationship between doctor and patient? Could a doctor dispense useful advice without ever having seen the patient? The answer would depend upon the problem, of course — I would be leery of diagnosing and treating, say, pneumonia over the internet. But what about other things? Could an online exchange between a patient and a doctor be used to, for example, schedule an x-ray of a swollen, painful arm? The patient would still need to see the non-virtual doctor, but could this kind of practice save time and streamline the process? And what if the exchange was not by e-mail, but in real time?
A new company is trying to establish just such a system. Called American Well, it aims to offer not e-mail exchanges, but real-time conversations between patient and physician. I have no idea if this will work out, but I could see a system in which a pediatric practice with several pediatricians would assign one of them to spend chunks of time interacting with parents of children in their practice, using either instant messaging between doctor and patient or perhaps even a sort of internet chat room for general discussion with several patients. If this were linked to the scheduling system of the practice, tests could be arranged and follow-up appointments easily made. As a pediatric intensivist I can’t see my practice being changed by this brave new virtual medical world, at least for now. But who knows what’s coming.
Sachin on 