In previous posts I have talked in detail about the decision to try medication for my son. I first wrote about our experience with Risperdal, and then followed up with how my son’s doctor added Celexa to the Risperdal. This medication combination has been extremely effective for my son. His attention span has increased, he is far less impulsive, and his aggressive outbursts are no more. The best change I have seen so far is that he appears happy and is able to enjoy his day.
Please note that what works for one child may not work for another. If you are considering medication for your child, discuss the pros and cons with your child’s doctor. Despite the success of this new medication treatment plan, I reluctantly made the decision that we had to change doctors. Switching doctors when you have a child with special needs can be a difficult decision.
In this post, I wanted to talk about my personal experience in changing doctors. In addition, I want to give you a list of questions you might want to ask yourself if you are a parent considering seeking a new doctor for your child.
The most important thing to consider when seeking any sort of medical treatment for your child is that your child comes first. You don’t have to accept poor service because it is convenient, or because the doctor is highly rated, or because you don’t want to hurt the doctor’s feelings. It is also easy to get into a rut of not getting quality service because you think that this is as good as you can get. Of course everyone has their own subjective standards as to what qualifies as "good" health care, but there are some standards which we should expect and especially for our kids.
In our situation our doctor was actually not the problem. It was more the hospital system we had to go through in order to receive services from the doctor. My son’s pediatric neurologist’s talents were obscured by a hospital which could be best described as a prescription mill. We had to wait over six months to have my son seen by a doctor. The time span between appointments was often equally as long. When my son turned 14 we were seeing some drastic changes in his behavior for the worse. His Prozac was no longer effective and we needed help. Despite the fact that we were in crisis, I was unable to schedule an appointment any sooner. I was told I would have to call every day to see if someone cancelled. When you have a child who needs help this situation is intolerable.
When we were finally seen, the doctor prescribed Clonidine for my son. It was a complete disaster for us. All it seemed to do was cause him to nap during the day and then when he woke up he was irritable and unhappy. We saw an increase in meltdowns and aggressive outbursts while he was on this medication. Again I want to stress that every individual will have a different reaction to medication. Clonidine definitely did not work for my son. But for other children, it may be an entirely different story. The primary concern during this time was that we could not reach the doctor to discuss options. We were stuck in limbo for four months as we waited for our next appointment.
It took two more visits, months apart, before my son’s medication combination was the "right one." During this time I had many concerns about side effects and appropriate dosage. I would write up a huge list of questions for the doctor to ask during my son’s appointment because I knew once we left her office we would not receive any information or support. When you have a child who is taking heavy duty medication (such as Risperdal), you want to be able to know that when you call with a question that someone will respond.
One day when I called with a question about my son’s medication I was put on hold only to wait to talk to an answering machine. The voice on the machine said that someone would respond within 48 hours. When I finally got hold of a nurse I was told to wait for our next appointment to speak with the doctor. In my mind I kept thinking, "This is unacceptable." In fact, the situation had been unacceptable for years but we kept putting up with it, thinking that this is just the way it is.
During our last appointment I brought up my concerns again with the doctor. I wanted to know why it was impossible to schedule an appointment sooner than four to six months. I wanted to know why it was impossible to talk to a human being if I had questions about my son’s medication or treatment. The doctor apologized some but told me that they could not possibly have enough people to answer phone calls. I asked what we were to do if my son had a bad reaction to any of the medication, and I was told to go to the emergency room. It became clear that there was no support in between visits and we were basically on our own to deal with whatever would happen. This finally became a deal breaker.
What kept us going back up until that point was that we felt the doctor was good. We liked her and she worked well with my son when we were able to get in to see her. We were also told that there was a shortage of such specialists and that we would have a difficult time finding anyone else. I kept thinking that it would be a huge hassle to find another doctor. In the end it was not a hassle at all. A friend recommended a pediatric neurologist located within five minutes of our home The other center was a 45 minute drive. The new doctor has live people to answer the phone. And he will personally call you back if you have questions. When I scheduled the initial visit with the new doctor we had to wait only a couple of weeks as opposed to six months. Needless to say, I am pleased as punch with this new arrangement. I had no idea that such good service existed. I wondered why I didn’t make the switch sooner.
If you are thinking about changing your child’s doctor, here are some questions you might ask yourself to make the process a little easier.
"¢ Can you make an appointment with the doctor within a reasonable time period?
"¢ Does the doctor have a good rapport with you and your child?
"¢ Does the doctor make time to answer your questions?
"¢ Is it possible to reach the doctor, nurse, or physician assistant in between appointments?
"¢ Does the doctor discuss the possible side effects, interactions, or withdrawal symptoms of any medication she or he prescribes for your child?
"¢ If medication is prescribed, does the doctor have a back-up plan if the current medication does not work out?
"¢ Is the doctor respectful of your choices with regard to treatment and/or medication?
"¢ Does this doctor have experience treating other children with your child’s diagnosis?
If you answered no to the majority of these questions it may be time to re-assess whether or not your child’s current doctor is the right one. It never hurts to look around for a new doctor if you are dissatisfied with the medical care your child is receiving.
We would love to hear your opinion on this topic. Have you ever had to switch doctors for your child? Was it a difficult process? What was the deal breaker for you in making the choice to switch? What qualities do you look for in a medical specialist for your child?