A Medical Home?

Way back in August, I was looking at our calendar and noticed an appointment missing. Nolan's two year old well-child visit had never been set up by our pediatrician's office, and I didn't realize this until I flipped the calendar over and realized there was no appointment scheduled for the little guy's two-year old well child visit.

I called the pediatrician's office, and they told me that if I wanted to see our regular pediatrician, we would have to wait until November for an appointment. Because Nolan has so many issues, I really wanted to see our regular pediatrician- it was worth the wait. We last saw the pediatrician for a well-child in March, which means that Nolan's posterior urethral valves, gastric motility issues, and severe gastro-esophageal reflux disease (GERD) were all additions to his medical file since that visit.

I walked into the pediatrician's office today, and in walks... a random nurse practitioner. Not our regular pediatrician, as I had requested. This meant I had to go through Nolan's general history with her, including his hearing loss, urology work-ups, failure-to-thrive, and GERD. She didn't have a "feel" for his history, so she spent a lot of time worrying about his language development (this isn't our primary concern at the moment, which our regular pediatrician would have known).

All of this underscores the importance of a child's "medical home." For children who have multiple medical specialists, the medical home is a central location for all of the various medical records, and a physician who is aware of the entire scope of medical and developmental issues at play. In our case, we have an audiologist, an ENT, a GI specialist, and a urologist who all submit records to our medical home (the pediatrician's office).

When you don't have the same physician on a routine basis, however, the medical home becomes useless. Perhaps for children who have no underlying issues, a random "doctor of the day" is fine. For us, it is a rather big waste of time, since all of the appointment time is spent doing "catch up" work rather than discussing current concerns and growth. Frankly, I feel like we are medically homeless.

At any rate, the nurse practitioner listened to Nolan's heart, weighed him, measured him, and ordered a Hepatitis A shot and a flu shot. The H1N1 vaccination is still not available in our area, so we were out of luck in that department.

The current stats are (at almost 27 months of age):

Weight: 23 pounds, 12 ounces. A slight decrease from his weight at the GI doctor's office in August (he was 24 pounds then). This is right at the 3rd%.

Height: 34 1/2 inches. This is just above the 25th%. His growth rate in height has actually decreased (he used to be in the 50th%), but he's on the charts in a healthy region, so there is no real concern. We'll keep an eye on it, but it shouldn't become a problem.

Head Circumference: 50cm. This is in the 75th%. No matter what, the boy has a lot of brains!

The nurse practitioner wanted to see him in six months, because they typically do a check-up at 2 1/2 years. I collected my howling children (Nolan, indignant because of the shots, and Matthew, indignant that he didn't get his choice of sticker) and headed for the front office.

There, I was informed that our insurance wouldn't cover a check-up in six months. So we'll see them again in a year. I wanted an August appointment, so that we'd be closer to Nolan's actual birthday. I was then informed that insurance mandates that the well-child visits be one year and one day apart. So even though we were almost three months late in getting to see the pediatrician, we can't set the appointment closer to his actual birthday. This is going to cause a problem for school immunization requirements when the time rolls around- he won't be allowed to have his immunizations until after school starts, all because of insurance company bureaucracy.

I'm not too worried, because we'll just use his specialists as his "medical home" if need be. Because in some strange philosophy of being "penny wise and pound foolish," the insurance company allows us to see the specialists whenever we want. Go figure.