Last updated 1 year ago
In the last couple of weeks, the American Academy of Pediatrics, the AAP, came out with two important new guidelines. One had to do with attention deficit hyperactivity disorder, ADHD, and the other with television viewing amongst toddlers. I think they are related.
For over 50 years, the diagnosis of ADHD was limited to children ages 5-12. The key feature of the new guidelines is an expansion of the affected age range. ADHD can now be diagnosed in children as young as 3, or as old as 18. (18 year olds must have onset of symptoms at a much earlier age).
Television viewing by toddlers has been shown to cause learning problems. The AAP now recommends no screen time for children 2 years of age and under.
I think the 2 problems are related. What do we teach children under 3 years of age? We teach them basic social skills. We teach them how to be polite and take turns and listen when someone speaks to them. They learn how to play with others. They learn appropriate ways to interact with adults. If they are having problems learning these skills, it could lead to the same problems that we see in ADHD.
I think the 2 problems are related. Do you keep the television on in the background? If so, you should know how it affects your children. They will shift their gaze to the television 3 times per minute during play. Most likely, they do so even more often if you are speaking to them or disciplining them.
I think the 2 problems are related. The first line of therapy for preschoolers with ADHD is behavioral, not medicine. In fact, 1/3 will have resolution of their ADHD symptoms with parental training.
These are my thoughts. They are opinions. However, they are the opinions of a member of the AAP with nearly 20 years experience in the field of Pediatrics. I cared for many children with ADHD, and observed many parenting styles. What is your opinion? Will this article affect how often the television is on in your home?
Last updated 1 year ago
They're Your Medical Records-Why Can't You Have Them?
This past week, I got a reminder that I am always a consumer of healthcare, and only sometimes a physician. I needed a copy of my immunization records. That sounds easy enough. As a provider, I know that this is the simplest part of the record to copy and forward. I also knew that I would have to jump through the same hoops as anyone else.
I called and was directed to the website to download the correct form. I did that. Fifteen minutes later, I was calling back, because I couldn't find the number to fax back the signed form. During that call, I pointed out that some of my immunization information might be in my employee file in Occupational Health, rather than my patient file. They assured me that they would check both. In less than 30 minutes, I was receiving my records back by fax.
I will admit that this is where it differs from most people. I only got my records by fax, because I was in a physician's office. A clinic or hospital will not fax records to an individual. Some will not fax them to a school. Some will fax them to an employer, others will only do so under special circumstances. Everyone else has to wait for snail mail. Okay, you say. That should only take 7-10 business days. Right. It should. Usually, though, it takes 2 months. It doesn't matter if you are having records sent across the country or 2 blocks down the street. It still takes 2 months. If you are asking for your complete medical record, it can take much longer.
What if I didn't have a fax machine, or a personal computer? Then, I would have to find the time to drive in to the office and fill out the release form. If you have moved out of the area, they can mail you the form. That is a 7-10 day delay each direction. This is very frustrating, especially if you are dealing with a deadline. People have asked me if this is an intentional stall technique designed to keep people from asking for their medical records. I don't think so. If it is, it isn't very effective.
As a pediatrician, most of my dealings with forwarding records are quite simple. Parents want immunization records, school physical forms and camp forms. Most of the time these are handed to the family at the child's well visit. Sometimes, however, forms get lost after that. Some parents have to have 3 physical forms completed for each child, each year. Yes, they lose them. Other times, I have seen schools or daycares lose forms for an entire class. It happens. We deal with it. However, there is no denying that such things put stress on the physicians and office staff involved.
I asked a few other people about difficulties getting medical records. I was overwhelmed with the horror stories that were forwarded to me. Stories of people whose records were delayed because of concerns about litigation. Stories of prolonged waits to get records transferred after a move. Stories of physicians not knowing where to look in the charts for outside records(http://chilmarkresearch.com/2011/03/04/a-tale-of-two-medical-records/). Stories of charts being "wrecked," or someone tampering with them, to hide information (http://www.usatoday.com/news/health/2008-04-29-medical-records_N.htm#). Exhorbitant fees charged by the page for copying and forwarding of records.
You have a right to your medical records. Hospitals and clinics have the right to charge a fee to offset the costs of copying and forwarding these records, but there is currently no industry standard for those fees. Hospitals can delay giving you the records under a few select circumstances. However, they should make every effort to get the records to you as quickly as possible. Especially, if it involves the transfer of care of a patient.
Shouldn't electronic medical records (EMRs) be making this easier? I've been using EMRs for almost 10 years. They have done some wonderful things. If a clinic has multiple locations, the same chart is available in all of those locations on the same day. Providers can now type (or use voice-to-text) a note into the chart and have it available the same day the patient is seen. Allergy information is available from the moment a client checks in until they fill their prescription at the pharmacy. Prescriptions are sent digitally, with no misinterpretation due to handwriting.
So, why ca
n't you get your records? Well, a lot of people are working on this. The first part is to make sure the chart is up to date. You may have heard of a government initiative called Meaningful Use. One part of Meaningful Use wants to see providers complete patient notes within 72 hours of a visit. (I work with physicians who complete most of their notes the same day). The second part is accessibility. Some places allow the client (read patient) to access their EMR through a secure portal and view their information. However, most of these are "read only." At Personal Medicine, the patient owns the record and can access it at any time and print or download whatever they need, through their secure portal. Other places are looking at CCRs, Continuity of Care Records or CCDs, Continuity of Care Documents. These can be used to download your entire record to a SIM card or a MicroSD drive.
Talk to your healthcare provider. Let him or her know that you want more. You want accessibility and portability. You want a portal where you can view your records at any time. Better yet, you want to be able to print your records through that portal. Talk loud and talk often. Your voice can and will make a difference.
Oh, yeah. My immunization records are missing several pieces of information that should be there. Like my last 2 doses of influenza, and proof that I had measles, mumps, rubeola and varicella as a child.
I have emailed my Primary Care Physician and asked for a CCD. I'm still waiting to hear back. Next, I'll try visiting him in person.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for
your child in
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Last updated 1 year ago
Do you read food labels? Are they sometimes difficult to read or difficult to understand? The Institute of Medicine is proposing a new labeling system. It will be on the front of packaging and simplified. Do you like this idea? http://sbne.ws/r/9h87
