A brief (and thankfully resolved) medical emergency with my son last week has reminded me how very important it is for all parents to have a strong working relationship with their child’s doctor. It also reminded me of how difficult it can be for adoptive parents to find a doctor who is not only a good match for their family but also someone with knowledge of the unique medical needs sometimes presented by children who have spent time in less than optimal care. Here are some things to consider when looking for and working with your child’s doctor.
1) Work on having a real relationship with your child’s physician. This is key and yet so hard to find, establish and maintain. Medical practices are often set up in ways that make building a real relationship difficult. For example, if you use a large physician’s group you probably don’t always see your own doctor. It’s true that being able to see anyone in your doctor’s group makes scheduling an appointment convenient, but it also means that you aren’t fostering that individual relationship. Research tells us that a strong relationship with your physician is key to early diagnosis and effective treatment, not to mention it just plain leaves everyone feeling better about their experience!
Here’s a quote and link to an article referencing just such findings:
“A systematic review of studies published over the past four decades has confirmed that good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes” ScienceDaily (Apr. 10, 2007)
My family is fortunate to have found an excellent pediatrician who has really tried to get to know us personally. When my son began to complain of severe stomach pains last week I was relieved to call and learn that she was available for urgent care that day. I took my son in and she agreed with me that it wasn’t typical stomach pain. She suspected appendicitis and since our oldest daughter had suffered a burst appendix several years prior I was more than a little anxious about that possibility. Still an xray was inconclusive and since our son was not running a fever, vomiting, or showing other overt signs she sent us home with strict orders to go directly to the local children’s hospital ER if anything got worse.
Later that night she called to check on our son as she was driving home from her office. ( I was pleasantly surprised. ) The next morning she called us again. (This time I was grateful and relieved.) Upon hearing that our son was no better she brought us back in for another look. The receptionist waved us in as we walked through the door. “Have a seat in the waiting room.” When I indicated that we needed to pay our copay she shook her head and explained that the doctor had specifically told her not to charge for this appointment since it was at her request that she was seeing our son again. (Again I was pleasantly surprised.) When we saw the doctor she chatted with us and decided it was better to go in to the hospital to have things checked out.
Long story short, we went to the hospital and after a CT scan it was determined that our son had a stomach virus and swollen abdominal lymph nodes that were causing his pain, not appendicitis. We were relieved. Even more than relieved we were impressed when our doctor again called that evening to see what had transpired at the hospital. She was leaving on a trip the next day and gave us her cell phone number “just in case” our son got worse and we needed to talk. (At this point I am truly amazed at her level of commitment and concern.)
So was this doctor’s behavior above and beyond the call of duty? Absolutely, and yet I believe it is the relationship thing. This doctor had worked with us for years. Whenever possible we had requested our children’s appointments be with her. She had gotten to know us and was vested in our son’s care beyond her own personal responsibility. This was the result of us forming that relationship with her over the past six years.
2) Look for a physician who has experience working with adoptive families: I’ll never forget when my husband and I brought home our oldest daughter. She was 6 years old at the time and had spent all 6 of those years in a Russian orphanage. She had never been outside of the orphanage except for some scary experiences at a hospital when she had surgery on her foot and another time when she had required treatment for pneumonia. Just the adoption exit physicals in Moscow upset her and I was immediately aware that we had a problem. She needed immediate medical attention when we arrived home not only because she had a severe case of scabies but also for various other unknowns. Even so, after the exhausting flight home and the onset of jet lag the last thing I wanted to do was drag her to a traumatizing doctor’s appointment.
At the time we lived in a different city than we do now. We were lucky that our family doctor at that time had recently adopted internationally himself. This was simply a lucky coincidence but it really turned out to be so important. I called his office and explained the situation. Shortly after, the doctor called me back personally and we devised a plan. He was so attuned to what my daughter’s needs were, having just done this himself, that he had us come to the back door of the practice. He asked his nurse to take off her white coat and he did the same. They met us at the back door looking incredibly normal and non threatening and he actually sat on the floor and played ball with my daughter for 15 or more minutes before he did an exam. He also used the playtime to assess other concerns with me.
I realize that not everyone is going to get that level of empathy from their family physician or pediatrician and yet everyone should be looking for someone who is willing to look at their child’s individual needs. A physician who has worked with international adoptees before is going to have a better understanding of what your child’s needs might be. If you cannot locate a physician with this particular background you will need to be more cognizant of advocating for the needs your child has that go beyond that of the typical child visiting a doctor’s office.
3) Look for a physician who understands variance in developmental age due to experience. If you’ve ever accompanied a child to a “well child” pediatrics appointment you know that this is where charts and comparisons abound. Your child will be weighed, measured, and evaluated based on “the norms” in our country. This has it’s downfalls even for kids born healthy into a nurturing family, but for kids who began life in an orphanage or other less than optimal care comparing them directly to the norm group is not only disconcerting, it is misleading and can be counterproductive.
When our oldest daughter came home at 6 she fit on the growth chart like a 3 year old and her communication ability (even in Russian) was more on target with a three year old as well. This is actually typical of children who spend time in less than optimal care. At Heart of the Matter we call it “real age vs chronological age.” What we are referring to is that institutional care does not typically offer the experiences necessary for expected growth and development. We tell parents that for every 3 months their child spends in less than optimal care they can expect about 1 month of delay in social, emotional, cognitive and physical development. This doesn’t mean that the child won’t continue to develop “normally” it just means that their experiences have only brought them so far down the path of development at this time.
Physicians who don’t understand this often unduly alarm parents by suggesting there are concerns that the child is not reaching milestones when in fact the child simply hasn’t had enough experiences to match the development of the norm groups in our country. Our daughter was a perfect example of this. She was physically and developmentally like a 3 year old when she arrived home because she had received so little in terms of nutrition and experience. Placed in our nurturing home she thrived and quickly closed the gap in some areas of development. In other areas she required more time. This is also common. We were lucky that our pediatrician was experiencing this first hand with his own son because he was able to process our daughter’s development with us in a much more informed manner.
4) Look for a physician who accepts new research and medical information from the family and partners with them to understand how that research or medical information applies to their child. Although now sensory integration is more commonly understood in the adoptive and medical communities when we brought our oldest daughter home 16 years ago that was not the case. At that time very few people had heard of sensory integration issues or therapy. After attending a conference on post institutionalized children I went to my doctor armed with information and research about sensory integration and sensory concern. I was reasonably convinced that my daughter exhibited signs of struggle in this area and I needed his assistance in seeking appropriate diagnosis and treatment for her.
Our doctor admitted he knew virtually nothing about the condition but agreed that it sounded like our daughter. Because he was an adoptive parent himself he kept an open mind and he even told me that he saw some of the same symptoms in his son. He agreed to look over the information I had brought him. Later that week he called me with a referral for our daughter to see an occupational therapist at our local children’s hospital and he even thanked me for the information because he and his wife had decided to have his son evaluated as well. That was my first experience where I really felt like a partner in my child’s healthcare and not just an overly interested bystander.
5) Look for a physician who offers medical advice as opposed to dictating parenting expectations. It is true that doctors, particularly pediatricians, know a lot about child development. That in itself makes them a good resource on some parenting topics. That being said, it does not necessarily make them parenting experts. Your child’s pediatrician should be your chief resource on your child’s medical health, growth, and physical development but he or she should only be a possible resource when it comes to parenting. The Parent’s Guild blog site did a great job of explaining this in a recent post. Check it out here.
This one is probably even more important for adoptive parents to remember. Why? Because typical or traditional parenting techniques often do not work (for good reason) with our kiddos. In fact often times these types of parenting can intensify some behaviors related to adoption issues like attachment. And our children often require allowed regression to hit missed stages of development and to encourage bonding and attachment. Meeting up with the doctor who encourages all parents to get their child off a bottle by 18 months or insists something is wrong if your child isn’t potty trained by three years of age can result in adverse consequences for kids and parents alike.
Although it is tempting to think that it is impossible to find all of these qualities in a physician remember that I myself have found it twice. Don’t just consult the insurance book to choose your child’s physician. Talk to other adoptive parents and ask about their experiences with the physicians on your list. Consult your local adoption support groups for referrals to adoption friendly physicians. Most importantly, interview several doctors to get a feel for their ability to communicate with you and their style of practice. When you think that you have the right candidate remember that establishing this kind of working relationship with a physician takes time and effort not only on the physicians part but on your part as well.
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