What do you think about celebrities selling pictures of their newborns?
July 29, 2008
Ok, I’m not the Pediatrician to the celebrities. But if I was their doc (Hmm, flying in to the south of France to take care of the Jolie-Pitt twins might not be so bad!) I have a few tidbits of advice….
2. Pacifiers are ok, but keep them at home and save them for naptime and bedtime. So Gwen, leave Kingston’s at home.
3. Parents need to teach portion control to avoid future obese children. Snacks are ok but kids don’t need to eat the whole bag.
July 24, 2008
Five years ago, I gave birth to a different kind of baby, my own medical practice. The difference between the labor and delivery of this child compared to my human children is that the pushing and contractions are ongoing. While a formal MBA would teach me a great deal, this process has been a business boot camp for someone with little business education but lots of gut instincts. With a shoestring budget and staff, I opened the door to see pediatric patients and their parents in 2003. The learning curve has been a roller-coaster ride of information and emotions, and I feel responsible now for not only my patients but my staff’s wellbeing, too.
Why would the mother of two young children want to take on the growth and development of something so large? There were all of the typical reasons: autonomy, desire to have my own patient base, and control of my income and future. But mostly I wanted movement. I joined my previous practice five years prior to this decision, and it was a practice that had been through better times. There was little interest in upgrading the dilapidated exam rooms and any new ideas were beaten to death by committee. At the time I left it felt stagnant. The divorce between myself and these other partners wasn’t pretty (I was escorted to my car with a box on the last day). The rift has healed, but the scar between our two practices will always be there.
My own practice feels very different. We’ve done well. I say we, because I cannot take sole credit for the double digit success of the practice. My husband is my administrator, billing person, in-house IT fixer, and handy man. I’m sure he wears even more hats than that. I’ve had a loyal front office scheduler who has been with me from the first day. I have a terrific partner who joined me two years ago when I was working in less than 1400 square feet. My nursing staff has grown from one RN to four full-time clinical staff. And in four years time, I closed my patient panel to new patients because I was busy.
Through two pediatric collaboratives, I have been able to implement new ideas in pediatric healthcare. Continuing the momentum that started the practice is a constant challenge, but I feel that I owe my patients the best of what’s out there. That momentum has caught the eye of two large and competing healthcare systems in our area, and we are being wooed to join forces with one of them.
I have very mixed feelings about giving up this baby. I have nurtured this collection of patients and parents and staff with heart and soul. When we moved into a larger office a year ago the practice grew into its kindergarten body quickly. Yet our youth means that we don’t have the financial foundation to do everything I would like to. For instance, our sign on the front of the building is still a banner because we haven’t anteed up the $5K for the sign. The $20K CBC machine will have to wait until winter and we are out of our lean summer season.
Part of the wooing means that we would have the bells and whistles of a well-backed, financially sound healthcare partner. EMR would no longer be just a bunch of letters. The phone system would get its much needed upgrade. We might even get the services of a decorator to go beyond wall color. All we have to do is sign on the dotted line to begin the process.
But I have a lot of questions. How will my patients receive this merger and acquisition? Will I be required to only use the physicians in my network? Will I be instructed to only use a certain lab and radiology departments? What if they aren’t as good as what I use now? Is this healthcare system really financially healthy? Will they be able to provide me with prn help when someone calls in sick? Will my staff be taken care of in terms of benefits and salary by their new boss? Will I have to give up giving out samples? Can they help us with call coverage? How will other physicians react? How long do I have to make the decision?
My biggest question is about how proactive these big guys are willing to be. Will they support the wellness, as well as, the sickness of my patients? Do they see the value of patient education? Will they be as eager to embrace new concepts as I am? Can they help me merge the old-fashioned physician-patient relationship with the best of technology (as technical as you can be in a pediatric practice)?
I feel like the parent watching her child go off to the brave new world of school for the first time and wondering if I should home school. Do I let this baby go?
July 23, 2008
Here are some random thoughts about how doctor’s offices can have less impact on the environment. I’ve written previously about greening the office on KevinMD. Promoting breastfeeding is a good way to get started. There is no packaging involved, and the benefits are bountiful. Consider that it takes 95,000 tons of tin plate to manufacture 550 million cans of formula. And speaking of formula is there a better way to package powdered formula? Could there be some sort of reusable container?
Local produce is another suggestion I have giving parents lately. The quality is better than the produce shipped in from across the country. Tomatoes and cantaloupe taste better when they are allowed to ripen on the vine. Local produce can be less costly, too, when shipping isn’t figured into the price, and supporting local farmers is good for the local economy. Organic is great when it’s local, but I’m a little wary of organic pineapples and bananas shipped in from far-flung locations. Since we peel these fruits anyways, I’d rather stick to the nonorganic variety or local fruits like the berries and peaches we have available in the southeast at this time of year.
Organic doesn’t always mean safer, either. Consider the anaphylaxis from bee stings or peanuts in susceptible people. With the recent outbreaks of E.coli in tomatoes, it bears repeating that all produce should be washed before consumption. Care also needs to be taken with certain foods for babies. For example, the eyes in potatoes can be poisonous to babies.
Toy choices can be green, too. Wooden toys such as blocks have long life spans in the toy box. Watch the country of origin to make sure the paints used on wooden toys meet US standards and don’t contain lead. Toys can be recycled through consignment stores, eBay, Craig’s list, and yard sales. Nothing pleases an older baby than being able to shred paper or play peek-a-boo with a box lid. Older children enjoy creating toys from household scraps like newspaper, boxes, bottles, milk cartons, and some crayons or paint. Some of the best swords come from the tubing from wrapping paper or paper towels.
I’m sure there are lots more ideas about promoting healthy and green lifestyles in the pediatric office. I’m looking inward, too, to see what new processes I can put in place to reduce my carbon footprint in the office. I’m trying to print fewer articles from the computer and just read them (it’s hard – there’s something about having information in hand to be able to show and share with others). I’m also considering a couple different types of e-prescribing to decrease paper use and improve efficiency. Like all things in pediatrics, it takes baby steps.
July 21, 2008
Just got a new book in the mail from Amazon. Do Vaccines Cause That?! by Martin G. Myers, MD and Diego Pineda looks like an excellent evidence based approach to vaccinations. Also looking forward to the next book by vaccine guru Paul Offitt, MD.
Have you ever watched home video shows on TV? Most people have, and they are a Pediatrician’s nightmare – unsupervised kids on trampolines, babies skating all over the house in walkers, bikers with no helmets. Glad to know that our safety advice is getting through loud and clear. Do I sound cranky?
Maybe it is because I had to admit an infant to the hospital last night with a body temp of 102 and pH of 6.9 after a near drowning incident in a hottub. Who puts a baby in a hot tub?
Conversation with young mother of 4 who is ovarian cancer survivor: waited for 3-4 months to have herself checked out because she “needed” to take children to their own appointments, birthdays, etc. Note to self: keep check-up appointments. Taking care of self models behavior for own children.