Thursday, July 22, 2010

The Sad Part of Pediatrics

I'm never sure where the line in the sand is between appropriate blogging and toeing HIPAA, but what I was taught in med school was follow the letter of HIPAA and this situation has been eating at me and needs to get blogged.

One of the things that I love about being a pediatrician and having my own clinic is the continuity of care. I am these people's pediatricians. I had my fourth visit with a four-week old today and it was the most awesome thing ever. Next week, I have a visit with one of my babies from the nursery, the younger brother of one of my patients and a well visit with one of my personal patients. That's also totally awesome. (The best thing about the newborn nursery is when I ask patients who they want their pediatrician to be and they say "can I come see you?")

Things that are less totally awesome: having continuity of care means I'm the one who knows when the ball gets dropped. So one of my babies is still in the "neonatal" period (first month of life) and has missed twice as many visits than it is weeks old. They've come to a whopping one visit. While at that one visit, I felt like the parent was really disengaged and they even left the room while I was examining the baby. They didn't schedule another visit, so I called the family and reminded them how important it was to be seen. They agreed, I gave them the benefit of the doubt and overbooked my schedule in order to see them at a convenient time for the family.

I think this story is going somewhere obvious, but I was still really sad when they didn't show up. So, luckily, I have good social work resources. So we did some exploring. And there are...other issues (the kid isn't really getting fed) and we've warned the family that this is likely going to become a DHS case (our version of CPS). But it makes me really sad. I feel guilty for my role in getting authorities involved, even though I know that it is absolutely the best for this kid. I want to believe that every parent is trying to make things work and is doing their best for their kid. But in a lot of ways, that's a naivete born out of primarily doing inpatient peds, where parents cared enough to at least bring their kid to medical attention when things were bad. I really hope things turn out OK for this kid, but also for this family and that having authorities involved will be a needed wake up call.

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