Dr. Patricia Plaxton has been practising family medicine in Oakville, Ont., for more than 20 years. But she’s also the mother of two kids, 13 and 16, so she sees doctor’s appointments from both sides. We got her to fess up on some of the more contentious issues facing parents and doctors.
In a walk-in situation you might be seeing a competent doctor, but he or she won’t know your child the way your regular doctor does. Family medicine is about seeing the big picture and developing a rapport with patients. That relationship can really inform the way we manage your child’s healthcare. It’s tricky when we don’t know what happened during a walk-in visit. Patients will ask, “Did you see that note from the clinic? They said they would send it.” And I’ll say, “Nope. Never got it.” That happens all the time.
Unfortunately waits sometimes do happen, no matter how hard we try to stay on track. This is probably the biggest challenge in my day, and I know parents with little ones fi nd it challenging, too. Part of the reason this happens is because patients are often not clear about what they’re coming in for. Some people aren’t comfortable sharing details with the receptionist, but if we know in advance that there’s an issue requiring a little more time, we can plan for a longer appointment. I really care about my patients, so if they’re opening up about an emotional issue or discussing a serious health concern, I’m not going to push them out the moment we go past our standard 15 minutes. If I could give one bit of advice to parents, whether they’re booking appointments for themselves or for their kids, it would be to be very specific about the reason for the visit. It would help so much with wait room backlogs and make everyone happier – doctors and patients both!
Some parents have this misconception that a pediatrician is a better choice than a family physician for their children. This might be the case if there are chronic or serious health issues in the picture, but if your child is basically in good health, there is absolutely no reason for a pediatrician for primary care. A pediatrician is a specialist, and we do have one in our group who is often consulted when the situation requires it. But for primary care, there are a few reasons why a family physician is preferable. For one, we often treat both the parents and the children and it’s useful to know what’s going on with the whole family to understand the big picture. Secondly, when children become too old for a pediatrician, they need to change doctors, whereas my patients stay with me into adulthood. That continuity is a nice plus.
It really depends. First off, a child’s age is a factor. But more than that, it’s about whether they are actually able to describe what’s going on. That’s the key. I have some patients who are quite young who are very capable, and on the other hand, a few older ones who aren’t good at all at relating information. It’s really a matter of knowing your patients. This points to another important reason for having a regular family doctor – we get to know your communication style and you get to know ours. Ideally, though, it’s good to hear from both the parent and the child about symptoms. The more information I have, the better.
This is an area that I see becoming a bigger and bigger problem all the time, especially among the teens in my practice. Kids today have so much more stress to manage than we did, and they’re exposed to dangers online and in society that weren’t part of our reality. If parents see any sign of a mental health problem, they should bring it to our attention right away. It can sometimes lead to serious consequences and shouldn’t be overlooked.
Every family is different in terms of parents being comfortable with that independence, and every kid is different personality-wise, so I can’t say that there is a clear cut-off age for seeing the doctor alone. Sometimes people think of puberty as absolutely the right point to make that break, but I disagree with that thinking. It all depends on the patient’s comfort. That said, I have occasionally asked a parent to leave. For example, I recently had a patient who was upset about a sticky family situation and it was clear he had something to get off his chest. It wasn’t going to happen with the parent there, so I asked permission to see him alone. His mom was fine with that and it was the right call. On the other hand, once a very young kid wanted to see me alone for her check-up; I thought she might be a bit young, but her mom was okay with it so that’s how we did it and it was fine. I was just careful to review everything with her mom afterward.
Oh boy. Don’t get me started on “Dr. Google.” First of all, let’s remember that anyone can post anything online. Yes, there are some healthcare sites that are authoritative and reliable, but so much of what’s out there can’t be trusted. So parents need to be careful in that respect. Secondly, it’s not a good idea to see your doctor with your mind already made up about what your child has and what treatment is needed. That can be limiting and might lead to you not sharing all the key information. We aren’t here to just blindly write out prescriptions or make referrals to specialists; we need to have a consultative role. So, even if you’re confident that you’ve found reliable info online, you should review it with a doctor who has the experience and education to assess that information in context. I can’t tell you how many times I’ve had to re-educate parents who were convinced about a diagnosis that was completely off-base thanks to Dr. Google.
Nancy Fornasiero is a mother of three and frequent contributor to ParentsCanada.
Originally published in ParentsCanada magazine, February/March 2016.