By: Anne Russell BSN, RN
Time is at a premium when you visit a doctor—yours and the doctor’s as well as other members of a multidisciplinary team, such as nurse educators, dieticians, and social workers. It is reasonable to expect patient-centered care from any medical office. It is supposed to be about your child’s health needs (or your own) and your concerns, but to the doctor and other members of the health care team, it’s a business as well as a calling and you are paying for the services received.
With the clock ticking, getting the most out of that precious office visit is frequently a matter of your own preparation! You don’t want to leave the clinic with a prescription in hand and more questions than you had when you went in.
How can you prepare to make the most out of an office appointment?
• Write down prioritized questions and/or informational updates ahead of time and bring them to the office. This can help to organize your thoughts and serve as discussion points.
• Bring a current list of any medications and/or vitamin supplements and their dosages, which your child consumes. Note any prescription refills you may need. Also, list any homeopathic or naturopathic therapies—they contain chemicals that may conflict with pharmaceuticals, even if they don’t help medically.
• Consider having your spouse or other caregivers join you so another adult is present to hear any medical recommendations. This is especially helpful if you are feeling anxious or overwhelmed and may not be at your best to absorb all that is being said.
• If possible, leave siblings at home or in the waiting room so focused attention can be given to one child with fewer distractions.
• Bring toys or books along so a small child can busy himself with them while you speak with professionals after completion of a physical exam. Snacks are not an acceptable distraction – many pediatric and allergy offices no longer allow food in the exam rooms to help minimize exposure risks for patients with food allergies.
A Common Example
A frequent scenario in the pediatric office is that of a baby or toddler with eczema. This finding may be a “red-flag” that the child is allergy prone – meaning they are genetically hard-wired to develop allergies during their lifetime. Typically, eczema presents as persistent red, dry, itchy patches over cheeks, wrists, elbows, knees and/or ankles. Eczema is considered the “itch that rashes” and left untreated, can become infected. Eczema, or atopic dermatitis, in an infant or toddler is an indicator that the child has a high probability of developing nasal allergies, food allergies, asthma and/or other allergic conditions. Management consists of routine skin care and moisturizing to calm inflammation. If needed, prescription medications are also available. So, what are examples of questions and/or observations which are beneficial to share with the health care team?
• Ask for a definition of eczema – its causes and what you should expect. Be sure you understand the goals of treatment.
• It is helpful if you bring a symptom ‘diary’ outlining any pattern involving the timing or worsening of the eczema. Bringing photos of your child’s eczema patches may be helpful – especially if on the day of the exam their skin looks clear!
• Bring a list of all medications you have been using to relieve itching, including over-the-counter drugs, prescription drugs and “alternative”
treatments such as primrose oil.
• Ask about common triggers of eczema (e.g. sweat, cold, wool, stress, detergents, foods, etc.) that may prompt you to recall potential causes of eczema in your child.
• Ask for an eczema action plan that delineates any necessary daily skin care measures (e.g. tepid water baths, bleach baths, recommended moisturizers, cotton clothes, clipped nails) and includes what to do during periods of flares.
• If any antihistamines and/or topical medications are prescribed, be sure you ask about any risks, benefits, and expected results. You should leave the office knowing how and when to apply the medication.
• Ask about when or if your child may outgrow the eczema. Does eczema change over time?
• Ask about signs that indicate the eczema is infected and what you should do if that occurs.
• Be sure to talk to the health care team about any sleep disturbances the eczema is causing. Uncontrolled eczema can mean nights full of itching and related irritability. Sleep deprivation is not good for the child or family.
• Be sure your health care team discusses the potential for food allergies. While any food protein has the potential of causing an allergic reaction, what are the top food allergens? Does it make a difference if you delay introducing potent allergens like peanut? What signs of allergic reactions should you look for? Should your baby be on a special formula?
• You always have the right to request a referral to an allergist, or to self-refer. Often, prompt and timely co-management by an allergist can minimize weeks, months or even years of less than optimal care. Definitive diagnosis of a food allergy should be made by a board-certified allergist through diagnostic testing after careful history and physical exam. Even if your toddler ‘just’ has eczema and most especially if it is difficult to manage, you may greatly benefit from seeing an allergist. The specialist can also provide further anticipatory guidance related to the development of food allergies, asthma or other allergic conditions.
• Ask for any patient education handouts and/or medically valid internet resources.
• Don’t leave the office without knowing when you should return for a routine follow-up visit and/or what parameters should prompt you to call and make an appointment.
• Many offices also employ nurse educators, dieticians, and social workers as part of the multi-disciplinary team. However, they may only be available on a part-time or consultant basis. Be sure to ask your provider about these services and how to procure them.
So, come prepared! You will leave the office visit better informed and equipped to face a challenging, chronic medical condition. And you will put the entire health care team on notice that you are going to be an active collaborator in securing the best medical treatment for your child.
Anne Russell BSN, RN has had a clinical and educational focus in food allergy for over 15 years. She has served as a food allergy program coordinator in a university allergy department. She has also presided as Executive Director of a statewide nonprofit organization that provided food allergy and anaphylaxis education to families and professionals in health care, schools, daycare centers and places of worship. As a School Health Director for a private school (preschool-12th grade), she coordinated efforts for individualized health plans for multiple students with allergies and asthma. Currently, she provides food allergy and asthma education to patients/families in a pediatric practice and is adjunct faculty in Nursing at a private university in the Midwest.