Tuesday, May 05, 2015

Being the Medical Advocate for your Teen

I firmly believe that each of us has to be an active participant in our own health care and the care of our families. It is not enough that we turn our health care over to professionals without being active in the decision making process too. After all, we have to live with the consequences and/or the benefits of whatever happens.

I've had plenty of bad past experiences to learn this lesson, but it was reiterated to me last week when my 17-year-old son fractured his clavicle.

My son Noah is 6 feet tall and around 155 pounds wearing size 10 shoes.  For all intents and purposes, he is adult sized.  My other son, the paramedic, told me that if he saw Noah in some kind of traumatic accident, he would treat him as an adult because of his size.

However our local Children's Hospital emergency room sees all patients under the age of 18.  Since Noah is 11 months away from that, he was required to be given pediatric care with referral to a pediatric orthopedic surgeon.

The care in the ER was puzzling.  Although he clearly had a fracture or some type of painful orthopedic problem, a playful baby with a rash was seen first while Noah sat uncomfortably in the waiting room.  And while he did get in pretty fast after that, he was not given anything for pain or even offered an ice pack until I suggested it. I only suggested it because at this point in my life and years of motherhood, I know what to do for musculoskeletal injuries to relieve pain!  Then they told me they didn't carry narcotic pain medication, until they asked around and found out that he could take a Norco pill before they discharged him. Was this because they don't see a lot of teens with this injury? I'm not sure. But I thought it was odd not to have pain meds in the emergency room. This experience renewed in my mind the need to speak out for the care you need, because if you don't no one else is going to do if for you!

But the next lesson came with trying to get an appointment with an orthopedic surgeon. The surgeon we were referred to didn't have an opening until June - a six week wait which was sort of amazing to me.

Back in the early 1980s, I worked for an orthopedic surgeon's office. Every time he was on call, or for the first snowy day, or the first nice day in the spring, we would be swamped with patients! And we got all of them in even if we had to triple book them. It actually had a kind of rhythm, where they came in and the x-ray tech x-rayed them while I filled up the exam rooms. These were all people with acute injuries who had their initial treatment in the emergency room.

I'm not sure what good it does to see an orthopedic surgeon six weeks after the injury? Be that as it may, I asked to see someone else sooner and the receptionist told me that the policy of their office was to wait 10 to 14 days post injury to be seen, so that they could check on the healing progress.  That might work for a small child, or even for a hairline fracture, but not a complete break in an older teen who is also an athlete.

So I decided to look for a doctor who emphasized the ORTHOPEDIC aspect of this injury as opposed to the PEDIATRIC, and got an appointment at an orthopedic center. I contacted our regular sports medicine doc for the referral. We were seen in two days and two days later, Noah had open reduction and internal fixation.

His recovery five days later has been remarkable. He rarely needs a pain pill and he has much more mobility in his arm. He has even been able to play the piano. His wound looks good and we see the doctor on Friday to see if he will need any physical therapy and how long it will be before he can start running again.

The surgery he had is basically here.

If I had just gone along with what I had been told, he would still have a displaced fracture, very limited mobility and more pain. We were also told that the fracture would not have healed correctly on its  own and that he would have needed the open reduction eventually anyway.

Here is what I would like to share:

  • Ask for help with pain. If they don't ask about it, make sure you do.
  • Don't assume that the referrals you get are the only choice. 
  • Do research. These days with computer access, it's easy to find medical information. Use it to your advantage. 
  • Be pro-active!  In our case we would have been the ones to deal with a prolonged recovery and delayed surgery - no one else. So it behooved us to find someone to help us earlier than the recommendations. 
  • Medical care is expensive, so think of yourself as a health care consumer or customer, not as simply a patient or the parent of a patient. That makes decision making a lot more cut and dry. 
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1 comment:

RAnn said...

Hope Noah is better soon. It is amazing that the ped ortho wouldn't even see him for a week--or at least send him for x-rays. I'm sure it has been their experience that many if not most kids ortho injuries that don't come from the ER with specific instructions do respond well to time, but to not even look???

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