No child should ever go without adequate medical care in America. The key word here is "adequate," which is not to say that all parents can have whatever health services they wish for their children, whenever they wish, and from whomever they wish. It is this misconception of "adequacy" that undermines our ability to solve or even make a major dent in the cost of pediatric health care in the Medicaid population.
Dr. Stuart Yoffe
Almost every physician I know or have ever known in a 40-plus year career wants children to receive a high level of health care. Furthermore, most of us realize that it is not the child’s fault that the parents are poor. We don’t care. Most pediatricians and family physicians can and will provide adequate care for the children, according to their health care needs. Where I believe we have failed goes back to our role of physicians as being leaders and teachers who are not afraid to provide these services both to parents and to society, even when society may not wish to hear the truth.
Emergency departments are for emergency care. They are not for individuals who cannot pay their health services bills. They are not for those who find it easier to come to the hospital as an after-hours clinic. They are not for those parents who have failed to distinguish between a true medical emergency and a convenience for themselves and their children.
Parents simply do not know what is and what is not a pediatric medical emergency. The solution to this first problem can be summed up in three words: Education! Education! Education!
Somewhere in the recent past, medical school and residency training programs have misplaced the contract that occurs when a patient and physician agree to a health care relationship. The doctor has a responsibility to provide supervision, instruction, and education, while the patient – or in this case, the parent – has the requirement to follow those leads. When one party does not uphold his or her end of the bargain, he or she must be taken to task. I don’t believe a statement, "The doctor has no more open appointments today, so go to the emergency room at the local hospital," fulfills our end of the contract." We have to do better, and that may mean extended hours, shared call schedules, or other creative approaches to providing care to those infants, children, and adolescents who are sick.
An alternative, but really supplemental, strategy is to teach parents the difference between true emergencies and minor health problems their children will repeatedly encounter so that they are able to choose not to use emergency departments (EDs) for routine care.
What we need is good, solid, easily understandable, and easily usable information for parents so that they are not left with the three alternatives that the State of Texas recently provided in one of its latest parental handouts: call 911; go to the ED; or call your physician. A much better alternative to these three is for parents to become more knowledgeable and more efficient in caring for their own children through an educational program that works. We must not only request that parents become better educated, we must demand that they at least try. If they are not capable, then we must provide the leadership in offering them whatever assistance they need.
As physicians and leaders, we have to provide the right kind of information for parents. Single-page handouts don’t work. They are left in our examination rooms, waiting rooms, and in the parking lot. Furthermore, even the well crafted one-page tools are routinely kept only as long as the current illness is present; then they are misplaced or discarded.
The educational material we do distribute to our new parents must be the right physical size. If you watch the parents in your practice’s check-in area, you often will see a mom with one child in a stroller, a second child in hand, and perhaps a third child repeatedly being requested not to run around the table. Mothers do not bring anything into the clinic or to any doctor’s office that does not fit into "the bag." Most men, and even women without children, have no concept of "the bag." But, if an article, be it a new type of bottle or clothing apparel, does not fit into "the bag," it is not brought to the physician. And parents likely won’t take home any material that won’t fit in there either.