The Great Pediatrician Debate

Ok, ok, so sue me. I stole the subject of this post from AnyMommy's blog entry but the content is completely different. Last week was Kiernan's 18 month well baby checkup so it was a subject that was fresh on my mind anyway.

Last year Kiernan's pediatrician retired and in her place a new, younger one was hired along with a nurse practitioner. I liked Kiernan's doctor so I figured I would give the new one a chance before jumping ship and running to a new office - let's just say I don't like the other two doctors at that practice and leave well enough alone.

The first appointment we had after Kiernan's old pediatrician retired was his 12 month checkup. I was only able to get in with the nurse practitioner. I was amazed when I found that I liked her. Well, as much as one can like doctors anyway. She didn't talk down to me as if I was a mom that worries too much.

Yes, Kiernan's development is right on track. His ears do look a bit inflamed, but since he has no fever and they don't seem to bother him, nothing to worry about. Here's a prescription just in case so you don't have to bring him back in if it turns into something nasty.

Good news for me - no additional insurance copay. Things did turn worse a couple of days later, so good thing for that prescription.

The second appointment was with the new doctor for the 15 month checkup. Kiernan had been fighting off a cough and been congested, but seemed to feel fine, had no fevers and was sleeping through the night. The cough had cleared a few days earlier. When the new doc examined him she told me he had bulging ear drums and instantly wanted to know how many ear infections he had had. I mentioned 4 or 5 and she says that we need to keep an eye on that and have him back in a month to check his ears again.

Great, here we go again with the rechecks and the concern about nothing. Didn't we go through this earlier with weight right after he was born? So he's had a few ear infections, doesn't every kid? They aren't chronic, and if they had been he wouldn't be able to say and understand the words he does now. While my mind is reeling with all of these thoughts I sit quietly and squirm.

Well, since he has not been running a fever and he seems to be feeling ok, we can go ahead with his shots. He's due for 4 this time.

She rattles off the first three that I don't recall the names of, and varicella (aka chickenpox). Beosig and I discussed that one and decided we'd like to hold off on it. Every kid our age suffered through them, no big deal. Before I go on, I have to say I'm not one of those parents that refuses to vaccinate their kid. I have a kid in daycare and germs of all kinds spread like wildfire there, so I will take the necessary precautions to keep my kid healthy. This is the one and ONLY vaccine I want to skip all together. I want to expose him to the virus the way both of us were exposed and hope he gets it so he develops a natural immunity. It is not a life threatening disease. We both lived through it and have the scars to prove it.

I tell her we'd like to opt out of that one for now. She asks me point-blank why. I know she's looking for me to say the usual right of passage excuse. I don't give her that satisfaction. This has turned into a me vs. her debate. Instead I just mention that I've heard kids that get the vaccine get shingles instead which we know is painful and that it's generally understood to be a disease that affects older people.

She retaliates with no it isn't and she sees kids with shingles all the time who have not had the vaccine. I wonder quietly how much of this she is making up to scare me. I don't back down. She says she has some article from some medical journal du jour about kids who died from complications of chickenpox, would I be interested in reading it. I humor her and say "sure".

A few minutes later she returns with a graphic article that includes full color photos of kids who have died from chickenpox just as she said. I look at the images briefly and say these people had to have known there were complications, it can't have happened overnight. Oh, no, she says, it came on quite suddenly and they had no warning. I'm thinking, that's total crap and you know it. I say nothing and continue to look over the article. She leaves the room for a reason I can't remember which was probably just some made up excuse so that I can sit there and wallow in the fault of my decision while looking at these photos.

I feel terrible for the parents of these children, but come on, how could they not have known there was a problem? One of them depicts a child with a huge cavernous opening that was filled with pus and infection from a pox prior to their death. I think I could have fit two fists in that opening easily. There is no way in hell that parent didn't know ahead of time. And if they really didn't, well then they certainly weren't very observant. Not to be totally cruel but seriously...what kind of idiot does this woman think I am? Her guilt trip and scare tactics won't work on me.

She returns and I tell her I have not changed my mind. We proceed with the other vaccinations and get the hell out of there.

A month later we return for the aforementioned recheck on Kiernan's ears. This time they look better but "a little dull" indicating some fluid might be behind the eardrums. No real reason for concern as it will probably clear on its own. Good news. Let's put this thing to rest. I am given the ultimatum. If he gets another ear infection in the next 2 months that we will get a prescription for antibiotics. If it doesn't clear up he'll get a shot of antibiotics and a referral to an Ear Nose and Throat (ENT) specialist. Pretty much guarantees tubes.

Nice. No parent wants to have their kid put under for surgery. Even less so when it is not necessary. I had tubes 5 (yes 5!) times as a kid. I know what it was like. I also know I was misdiagnosed and had they removed my tonsils instead of putting tubes in I would have been fine since I had chronic tonsilitis which also caused my eustachian tubes to swell up and not allow drainage. I have permanent holes in my eardrums from all the "tubes". I can't dive and I can't get water in my ears without suffering from a ear infection later. Yes, I can hear just fine, thank you. The only up side is that I can fly in a plane and have none of the issues others get with plugged ears. I do not want my kid to go through that unless it is absolutely necessary, so you bet I'm going to fight this tooth and nail all the way, which brings me to my next point.

What is it about doctors referring kids to ENT specialists on a whim if they get X number of ear infections? That number varies from doctor to doctor. It's like they have some kind of quota to fulfill for a given time period. "Eight more referrals to go until I get my bonus!" Kids get colds. Colds lead to occasional ear infections. It's a fact of life, especially with the smaller kids since their eustachian tubes are not fully developed yet to allow proper drainage. It's basic anatomy! Infants have eustachian tubes that are horizontal which aid in bacteria growth when fluid builds up and is unable to drain from behind the eardrum due to this fact. As the infants grow the eustachian tubes stretch to become more and more vertical which aids in drainage.

Don't get me wrong. If I thought for a moment that Kiernan was suffering from chronic infections or losing hearing from ear infections (none of his ear infections have been very serious I might add) I would be the first one knocking on the ENT's door for help. They do have their place in the doctor food chain. I just don't think there is a need to force it on people.

Fast forward to the 18 month well child checkup. I request to meet with the nurse practitioner instead of the doctor now. I prefer not to repeat that last visit, thank you very much. Everything checks out, he's right on schedule for development, no worries. He's due for his dtap vaccine and varicella. I mention I'd like to wait on that one until he's older. She says ok, no fight, no scare tactics and moves on. That's the way it should be. I deserve to have my decisions respected. That's all I'm asking. Question my reasons if you want, suggest alternatives, give me the facts I am missing, but please don't try to bully me into doing it your way.