There may be "hand on the door" questions in any field. That is, the things that patients or parents bring up just as we are wrapping up the visit. Or we have already concluded the visit and have just come back in to the room to give that school note or health form. Then "the big reveal" as they say on reality TV.
Sometimes these patient/parent questions can be answered and addressed fully, yet quickly. Some can be partially addressed with a scheduled follow up. However, there are those that loom much larger, the weightier ones. These questions may require more probing, and sometimes a re-framing of the entire afternoon schedule must occur. Sometimes he feels like his heart is racing and then he passes out...
Or, I'm not sure if she's been touched by someone...
And we remind ourselves and recognize that there are skillful ways to elicit concerns earlier in the visit so as best to meet the families' needs. Like asking them what are they concerned about! But doing so without
looking at the laptop or pager. While seated
not standing. In a way that they know you want
to hear them. Without your hand on the door.
As a primary care provider, I welcome essentially all questions about the health and well being of the child. I'd be hard pressed to find one that isn't "okay" for patients/parents to ask me. Many topics come up in the context of anticipatory guidance
. Or, they ask me and we discuss. Assorted questions about growth, sleep, school, teeth, puberty, fever, bullying, sex, rashes, food, bed-wetting, guns and safety? Yes. And more. This is the stuff of primary care outpatient pediatrics. To help the infant, child, and teen be healthy, to grow to his or her full potential and to maximize the chances that this will happen, in the context of their families and communities.
The AAP says that pediatric primary health care encompasses...
- health supervision and anticipatory guidance;
- monitoring physical and psychosocial growth and development;
- age-appropriate screening;
- diagnosis and treatment of acute and chronic disorders;
- management of serious and life threatening illness;
- when appropriate, referral of more complex conditions;
- provision of first contact care;
- coordinated management of health problems requiring multiple professional services