Pediatrician vs family doctor

[Kjs]

When we were at ER that ER doctor called difficult child's pediatrician. told me to call pediatricians office he wants to see him early next week.

Ok - difficult child's pediatrician that knew him inside out for 13 years retired in spring. His replacement is who I am speaking to now. I called for an appointment. Was told he needed to return my call.

This doctor does not know difficult child at all. He asks me if he might have some anxiety problems. yes he does.
Doctor tells me I need to find a psychologist and that will fix his headaches. I inform the doctor that he has seen psychologists, psychiatrists and counselors for the past 10 years. He says oh...for what...so I explain everything (now I am at work during this call)

Dr. says he must see someone to talk to. I AGAIN tell him that difficult child has never ever talked to a therapist or counselor. He refuses to open his mouth. Literally.

Then doctor tells me I need to take difficult child to childrens hospital for specialized testing. (30 miles away). He said I should stay there a few days and go through all this testing.

I asked if he could first run some blood tests. oh, no - must go have all these other tests done. After several minutes I simply told him no, cannot afford it and I work. We need to start with the simple tests. Dr. went on to tell me I should take sick leave or vacation to do this and it is sad that it comes down to money.

I asked many times about blood work, tests suggested here such as lyme, and thyroid. Doctor tells me he needs to call all the specialists to see what he can order.

I asked again about certain tests, he says he needs to speak to specialists. Talks about pediatric neurologist. I informed him his previous doctor who HE replaced is the one that referred us to the pediatric neurologist. The neurologist is the one who ordered the MRI, MRA and EEG.

I ask the doctor about fioricet. That is what I take for my headaches, my older son takes that, my sister takes that. This doctor reminds me he is a pediatrician and does NOT prescribe that kind of medication.

I ask about several other medications I have tried or heard about and he gave me the same answer. he is a pediatrician he doesn't prescribe those kinds of medications. And at an earlier visit he told me that he is a pediatrician and his patients should not even KNOW about narcotics or marijuana / drinking. I reminded him difficult child is in HIGH SCHOOL and he does see this and hear of it.

I asked him what ages he treats. He tells me infants through age 17.
After several more questions with the same answer I told him straight out, that I need to bring difficult child to a doctor who will treat him. If HE cannot do this then we need to find a doctor that can.

His response was he will call all the specialists and get back to me NEXT week. We can then discuss what kind of tests he will do.

I reminded him that school will be started and the sooner we can do some blood work the better it will be. difficult child cannot miss school. Not in high school, not with 90 minute classes. He just cannot miss.

I am now wondering at what age do you leave a pediatrician?

 

[tiredmommy]

Now. Today. Start calling your friends and family... find out who they see. Talk to any nurses you know and look for suggestions. Your son can't keep having such debilitating pain. {{{Hugs}}}

 

[crazymama30]

I agree with tiredmommy. That man is worthless to you. I left a "pediatrician" clinic when difficult child was just over a year old, easy child was 2 1/2. They never saw the same doctor twice when they were sick, I would get conflicting info from different docs, it was crazy.


Your son is in high school, go to a good family doctor. Get some names from nurses, or other people you trust. Good luck.


His patients probably know more about marijuana and narcotics than he apparently does!!

 

[timer lady]

I agree with TM; it's time to start looking for another doctor. At 13, I'd look for an adolescent pediatrician (we have seen that specialty pop up here in the Twin Cities big time in the last few years ~ knowing that teens are a different monster from children & from adults).

Beyond that, difficult child's pain needs to be addressed ~ the physical needs to be ruled out before counselling can be suggested. And good luck getting a 13 y/o to talk ~ the best I've seen is a group that kt has been in for the last 2 years at day treatment. That has done more good for her than any counsellor.

Prayers & good thoughts that your difficult child has a relief in pain this weekend; that you find some answers.

 

[SRL]

I have a great deal of respect for our pediatrician and he is quick to draw the lines at medications also.

Kids typically move on in their late teens but I know parents who've made the switch earlier. All really depends on the needs of the patient and the family. If you think your son would be better served with a GP, then make the switch.

 

[smallworld]

Like SRL, I have a great working relationship with our pediatrician, who serves as my kids' case manager, so to speak, and is also quick to refer to specialists when the situation (like migraines) and medications prescribed are beyond his expertise. When my son was experiencing debilitating migraines likes yours, our pediatrician referred us to an excellent pediatric neurologist, who took my son's pain seriously and ordered diagnostic tests and then got him on a medication regime that solved the problem.

So . . . I agree with everyone that you first need to find a pediatrician who treats adolescents and will work with you to find the right specialist to help your son. I have to believe your son needs to see a competent pediatric neurologist. And I say pediatric neuro because the medications used for adults are not always used for kids (like Fiorecet).

If diagnostic tests are run to rule out all physical causes beyond migraine, the thing you have to remember is that there are two types of medications to treat migraines. One is the type that treats the pain once the migraines has started. The second is the type that PREVENTS the migraine from even starting. Given the frequency and level of pain your difficult child is experiencing, I strongly believe he needs a medication to PREVENT migraines. These include blood pressure medications like Propranolol, tricyclic antidepressants like Nortriptyline and anticonvulsants like Depakote and Neurontin.

Hang in there.

 

[BusynMember]

My son had debilitating migraines that even rose his blood pressure. However, we DID have all the tests done to make sure he didn't have something worse than migraines. He just had migraines. We treated the pain right away. That doctor sounds useless in the HERE and NOW although he had good suggestions for later on.
When my kids became teens, we saw both pediatricians AND family practitioners. There are good and bad ones in both specialties. A few of my kids rebelled against "pediatrician" when they were in their teens and we found a GOOD family doctor who took care of everything for all of us. And a few of my kids were fine with the pediatrician (as in my kids who are still living at home).
Good heavens, you didn't need that!

 

[Andy]

OMG - Does this doctor not want to do his job or what? I usually have to fight to get anything beyond simple tests and he is refusing to do those.

I wish the specialist was in your budget right now. Once you get there they would be astonished that the basics were not done before referring on.

Anyway, as others have said, you need to find another doctor.

I found out that there is a children's walk in clinic one hour away from us that is open Saturdays and Sundays. The web site said not but they really are. They tap into the nearby Children's hospital.

Can you look for a Children's Hospital nearby and tap into the doctors offices connected to it?

Keep fighting - you can not settle for anxiety as the cause until every other stone has been left unturned.

 

[Sara PA]

Time to leave that pediatrician is now. The problem isn't with the pedicatric specialty but with that particular person practicing that specialty. You need a doctor you can work with. That matters more than whether he's a family practioner or pediatrician.

 

[TerryJ2]

Arg.
I don't think it has anything to do with-his being a pediatrician. He just can't or won't do his job.
Funny, our just retired and the new one is really on the ball, so much better than the old one. It's the luck of the draw.
I agree with-everyone here, look for someone else, regardless whether it's a pedicatrician or family dr.
So sorry.

 

[Marguerite]

Sara PA - you said exactly what I was going to say.

With ANY doctor, you need to see the person who suits you best and who is a "best fit" for the help you need.

The previous pediatrician could have been the perfect fit - but that is no guarantee that whoever bought his practice even thinks the same way, or is interested in the same direction. I made the mistake of thinking that staying with the same gynaecology practice for my 4th child would give me the best chance of the same level of care - I was sadly wrong. I should have made the decision to move on, as soon as I felt uncomfortable.

It is different with GPs - it is worth working with aGP who has bought the practice with your files, because GPs are by definition generalists. Plus, there is all that history.

But where there is no history, or the history has already been copied to a GP in the form of letters (as should be the case with difficult child) then it's a lot easier to move on to find the best fit.

Kjs, you're right. You need to get help NOW while it's more convenient. The trouble is, it generally takes time to get in to see a specialist. I think you're not going to get the answers difficult child needs in the time you're hoping for. But you can do better than this bloke, by the sounds of it.

You need someone who will HEAR you when you say, "We've tried that," or "It doesn't work." You shouldn't have to waste time reinventing the wheel.

Mind you, if the doctor says, "I want you to try X," and you feel it's unlikely to work even though you haven't tried it before - you do need to at least give it an honest try. Because then the doctor sees several things:

1) You're willing to try.

2) X has now been honestly tried and for various reasons can now be ruled out. This means the range of options has now been reduced, which should help narrow down the possibilities still further, until it's easier to get the right answer.

You need continuity with medical history. But you also need competence.

At the hospital, twhat the doctors there observed and tried needs to be communicated to someone outside the hospital system, because this boy is going to need further help with this. The hospital were not able to do more than help deal with the worst of the crisis. The problem goes beyond the crisis. As a result, they need to pass the baton on to the next person in the relay team. They ask you, "Does he have a doctor? A pediatrician?" then write the letters for these people. If you'd said you didn't currently have a pediatrician, they may have said, "get one," or they may have just shrugged and not written a letter for one.

A letter from the hospital should make it a little easier to find a pediatrician prepared to take difficult child on as a new patient, and to speed up the waiting time.

Sometimes you might find that although you got on well with a specialist in the beginning, sometimes the relationship can change for all sorts of reasons. If you are in the process of changing specialists when some other doctor tells you to go see your '---ologist', then you go see the new one. After all, if you were changing over anyway, then you may as well change now rather than have to switch over later on, half-way through the investigative process.

Kjs, I'm concerned that whatever is wrong with difficult child, it could take you months or longer to find out. I suspect stress could be a factor, which will make it even more difficult to pin down any physical cause. There can be many factors which can make it worse, including diet (as has already been suggested).

I get headaches, bad ones, under a range of different circumstances. I've found that a number of different factors have to work together to cause a severe headache, with me. Glare is a big factor - I remember a severe headache putting me in hospital, the evening after I spent half an hour looking at a light box at the orthodontist's rooms after the girls' first consult. His light box was actually in the coffee table, making it more relaxed when having X-rays explained, but the period of time I was looking at the pictures was enough, added to the fatigue (another factor) from a busy day taking kids to appointments. A virus or other infection can also increase the risk, for me.

A young friend of mine has found that some foods will trigger severe headaches in her. Her mother gets bad headaches with MSG, and also with changes in barometric pressure.

We had a world-class neurologist in Sydney (now retired) who specialised in migraines - James Lance. He trained a lot of students and now a number of top neurologists in Sydney are also expert in helping patients with migraine.

When to transfer a child from a pediatrician to more specific specialists - it depends on the child and on the specialty, but for something like this, the child should be referred to an expert in identifying and treating headaches (usually a neurologist) but a good first start is the child's main treating doctor, to handle the referrals and communication between specialists. If the child has been seeing a pediatrician, then you involve them too.

easy child saw a pediatrician when she was born - she was very tiny. As a result she had to see the same pediatrician for a check-up when she was 6 weeks old. He noticed a deformity in her eye and referred her to an ophthalmic surgeon. The pediatrician asked me who my eye doctor was and referred easy child to him as well. We were not required to go back to that pediatrician because the problem that had involved him to begin with was now resolved. The new problem - that was handled without the need for us to return. easy child was seen by my eye surgeon who examined her eye, checked her vision (there was a possibility of cataract which thankfully was unfounded) and then he wrote back to that pediatrician. The pediatrician then wrote to our GP, enclosing copies of letters from the eye surgeon. The child had been seen, checked out, problems ruled out and now all info was stored on her file with the GP. Any future problems - the GP could decide which specialist (if any) to bring in.

difficult child 1 has now been told that although he needs ongoing medical care indefinitely and a prescribing doctor for his medications (which up until now have been prescribed by our pediatrician) he is now too old and needs to be referred to a psychiatrist for his medications in future.(it's a facet of how ADHD medications are managed in Australia). In other words, difficult child 1 will be too old for the pediatrician when he turns 25.

I suspect your difficult child's headaches could have a complex cause. You're going to need a good GP who is going to remain supportive and be a good "spider in the centre of the web" for you.

If the headaches are not especially connected to difficult child being an adolescent, then unless the pediatrician you choose happens to have expertise in childhood/adolescence headaches, there are going to be limits on how much the pediatrician can actually be involved.

Kjs, talk to the GP. If he feels a pediatrician needs to be involved then ask for a recommendation, preferably someone who is known to be experienced with adolescents (especially difficult ones). Otherwise - just get referrals to whichever specialist the GP thinks difficult child should see.

Marg

 

[tonime]

I agree with everyone else--time for a new doctor. Does your difficult child still see any counselors? -- only because they may give you a good recommendation for a new doctor.
I never heard of a doctor refusing simple blood tests. I wouldn't entrust my health with him.
Good luck and keep us posted. The worst part is that your poor difficult child still has to suffer with these headaches in the meantime.

 

[nvts]

"Hi! My child is spiking a 104 degree fever - I need to come in right away"

"I can see him next Thursday"

Time for a new doctor! He's in it for the easy stuff, innoculations, the croup, cute and cuddly - not "real life" stuff with kids that he doesn't value.

"I need to find out from the specialists what blood tests and that'll take a week".

What a tool! Not for nothing, there are pretty standard tests out there to run that all you need is the blood to run the panel. OOOOOHHHH! What if he has to have another blood draw for add'l testing by the specialists? OOOOOOHHH! God forbid you have a baseline or some of the things that you can already rule out!

Run, don't walk, to someone who's actually interested in helping you guys. Honestly, if he does have a psychiatrist, I'd call him to see if he can recommend a developmental pediatrician for him. A lot of those guys are really up on the quirkiness of our kids!

I've got you guys in my prayers and heart!

Beth

 

[Marguerite]

Beth, you raised an important point about blood tests with a difficult child - it is really important for a doctor to have a good idea, before he orders the tests, of any other tests he might need to run. That way he can arrange for a bit extra blood to be taken (in the appropriate tube) so you don't have to keep getting difficult child in to the pathologist for yet another blood draw.

We have a huge ordeal with blood draws for difficult child 3, even though he tries to cooperate. It's just that his anxiety is so extreme, his body won't cooperate, his veins close right up from the adrenalin and panic.

Kjs, I hope you have better luck today (Monday) with making contact with someone who will try to help.

Marg