How can I make the most of a visit to the pediatrician?

As parents, we’ve all had questions when taking a child to the doctor: what information should I bring? How do I get copies of past lab reports and X-rays? How do I keep track of my child’s immunizations and medications?

We shared these common concerns with Dr. Jean Hanley, a board-certified physician with more than 20 years of experience in pediatrics and allergy, asthma, and immunological diseases. Hanley is also the founder of PLANning Health, a non-profit patient-advocacy service that helps people with health problems receive better care in all aspects of their health, such as understanding their symptoms, diagnosis, procedures, treatments, and insurance coverage.

Kathy Sena: When my child is sick, and I’m worried, it’s easy to forget to bring the right things to the doctor’s appointment. What should I remember to bring to make it an effective appointment?

Dr. Jean Hanley: It’s helpful to create a medical history for your child and to update it as needed. This can be done on paper, on a computer document or spreadsheet, or with one of the convenient health-tracking apps for your computer or mobile device. List immunizations, past diagnoses, treatments, lab results, medications taken daily (asthma inhalers, recent antibiotics, etc.), and intermittently (acetaminophen, ibuprofen, etc.).

I highly suggest trying one of the free or inexpensive medical-tracking apps that can be easily downloaded to your phone or computer:

• My Medical Records (online and mobile app: www.freehealthtrack.com)

• My Medical (online and mobile app: www.mymedicalapp.com)

• Hermes (mobile app)

• MyHealth (mobile app)

These databases allow you to record medications, procedures, tests, allergies, surgical procedures, diagnoses, injuries, photos, insurance info, and more. Having easily available medical information can lead to a more-efficient and productive doctor’s visit.

If you don’t have all of this information available, it’s important to bring at least the actual medications that your child has been taking recently.

Write down your child’s symptoms: cold, cough, ear pain, etc. When did the symptoms start? If there was an injury, what happened? Where does it hurt? How have the symptoms progressed? Are they getting better, worse, or staying the same? (If the illness or injury happens suddenly, and you have to rush to a doctor’s appointment, try to write down this info while in the waiting room.)

KS: How do I get copies of medical records, tests, X-rays, etc. from other doctors to bring for my appointment, if necessary?

JH: Requesting records from hospitals and clinics takes time, and each office has its own procedure for requesting records. Most facilities require that you fill out a special form. Healthcare providers are required by law to share information regarding your child. The requested items can be sent to you by mail, fax, or e-mail, or you can pick them up in person. Procedures such as lab tests, X-rays, etc. will need to be requested from the doctor who ordered them. Most labs do not provide information directly to the patient or guardian.

The smartest step a parent can take is to obtain the records at the time of the visit, so that they have as much information as possible at their fingertips and they don’t have to go through the hassle of requesting records.

KS: Should I bring another adult along for the visit if I’m bringing a young child? How does this help?

JH: I always advocate bringing another adult with you to doctor visits, whether it’s for your child or for yourself. A spouse, friend, or other family member often serves as an objective observer and provides what I call the “witness effect.” Although I’m a doctor, I get sick, too! As a patient, I often went to appointments by myself. When my spouse would occasionally accompany me, I noticed that more time and attention was being given to me. Although I felt that my care was very good, the “phenomenon” of even more information being disseminated when I had another adult with me was an eye opener. An objective friend or family member also may be able to ask questions that you may forget, or to ask for important details or clarification.

KS: What about communicating with my child’s doctor by e-mail? How do I suggest this? Is it common these days?

JH: There has been a very slow, but steady, increase in electronic communications between doctors and patients, but only about five percent of doctors do this currently. One issue is privacy. The Federal Health Insurance Portability and Accountability Act must be complied with in all e-mails, ensuring that any health information sent is secure and truly private. For this reason, many doctors won’t use e-mail.

Doctors who do use e-mail will ask their patients to sign forms agreeing to communicate electronically regarding health issues. Some only exchange lab or procedure results or non-urgent follow-up information. For other medical situations, you’ll likely be asked to call the doctor’s office. I believe that e-mail communications and texting will continue to increase over time. The only way to know if your doctor is actively e-mailing patients is to ask. Many medical groups, such as the American Academy of Pediatrics, are trying to establish guidelines as to how to incorporate and better serve patients through electronic communications.

It’s important to remember that no amount of electronic communication can take the place of a thorough history, a physical exam, and an in-person conversation with your child’s doctor.

KS: I’d like to do online research on my child’s condition or symptoms before the doctor’s visit. How do I share this information with the doctor?

JH: In our information age, many parents want to have a shared decision-making relationship with their child’s doctor. The parents may have already researched the illness and may have a fairly good idea of what diagnosis or treatment plans are available. Some parents feel more comfortable accepting the doctor’s information as-is. Either way is acceptable, as long as you’re comfortable with the relationship: one-way vs. shared.

A note of caution: With medical information at our internet fingertips, it’s easy to become overwhelmed and confused with the details of a diagnosis, treatment, or the potential side effects of a medication. Medical misinformation from the internet often leads to perplexing concerns about medical conditions. For this reason, it’s imperative that parents ask for clarification and confirmation of online information and that the doctor’s office provides written instructions regarding your child’s diagnosis and treatment.

KS: What should I do if I don’t understand my child’s diagnosis or the treatment plan the doctor is suggesting?

JH: Contact the doctor’s office right away to get answers to your remaining questions. Often, a nurse will help you understand what you need to know. If you find that you frequently are not given sufficient information about your child’s health, then you may want to either prepare and research conditions prior to the doctor’s visit or consider finding a new doctor who may be more thorough during the visit.

KS: What should I do if my child is diagnosed with a major illness, and I need help navigating the healthcare system, researching treatment options, dealing with insurance issues, etc?

JH: There are many resources for most childhood illnesses that should be available from your doctor’s office. But depending on the severity of the illness, the family may need help in navigating the healthcare system.

Sometimes a diagnosis cannot be established. Other times, a diagnosis has been given, but insurance issues delay proper evaluation or treatment. Several treatment options may be presented and the parents may not understand the differences or the risk and benefits for each. There are numerous areas that may need to be addressed, and this is when a patient advocate can step in and help the parents sort out the issues.

For example, a child for whom I advocated had a rare, potentially fatal rheumatological (arthritic) condition for which the doctor prescribed a lengthy treatment with medications that had serious possible side effects. After researching the illness, doctor, and medications, I was able to provide reassurance to the family that they were receiving excellent care and that the benefits of the life-saving medication well outweighed the risks.

Patient advocacy is a growing field, and some hospitals and clinics are beginning to hire their own advocates. If your doctor or hospital cannot suggest a patient advocate, you can find one independently. The Professional Patient Advocate Institute (www.patientadvocatetraining.com) and Health Care Navigators (www.health-care-navigators.com) are two of several organizations that can help you find an advocate. Advocates can be doctors, nurses, other medical personnel, or social workers.

My organization, PLANning Health (www.planninghealth.org), is a non-profit and does not charge for services, although donations, from those who can afford it, are what keep us afloat. Most for-profit patient advocates charge $50 to $200 per hour for services.

Patient-advocacy services may include making home visits, developing medication and treatment plans, providing questions for doctor’s visits, accompanying patients to the doctor’s visit, researching illnesses on reliable medical websites, dealing with insurance issues, and more. The needs of the family may be satisfied by one phone call or they may require more-extensive services.

Kathy Sena has been writing about children’s health since her son was born in 1995. She is now learning more than she ever wanted to know about the college-search process. Visit her website at www.kathysena.com.