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Pediatrician vs family doctor
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<blockquote data-quote="Marguerite" data-source="post: 187631" data-attributes="member: 1991"><p>Sara PA - you said exactly what I was going to say.</p><p></p><p>With ANY doctor, you need to see the person who suits you best and who is a "best fit" for the help you need. </p><p></p><p>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.</p><p></p><p>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. </p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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:</p><p></p><p>1) You're willing to try.</p><p></p><p>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.</p><p></p><p>You need continuity with medical history. But you also need competence.</p><p></p><p>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.</p><p></p><p>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. </p><p></p><p>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.</p><p></p><p>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). </p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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. </p><p></p><p>Marg</p></blockquote><p></p>
[QUOTE="Marguerite, post: 187631, member: 1991"] 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 [/QUOTE]
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