A question for the Docs...

[NavyDude]

This isn't a student or school related topic, so for that I aplologize in advance, but I have a question for the Docs.

I am taking my son to our Primary Care Facility tomorrow for some chronic problems we believe are related to prolonged mold exposure and I would like to get a referal to an allergist or another physician that specializes in this area.

My quesiton is: If I request a referal, does our Primary Care Manager have to provide it, or do they have the option of denying one to us?

I would just like to know before I go in and they try to feed my a load of BS like has happened so many times before. Thanks for your help, it is greatly appriciated.

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[colbgw02]

i believe that they are not obligated to refer you. if it were, then i would kind of consider that like a patient forcing me to prescribe a certain medication.

that said, doctors, even military ones, know that patients will get what they want, often at the doctor's expense, so we typically give in unless the request is completely unwarranted.

 

[IgD]

Is your house infested with mold or something?

 

[J-Rad]

This is actually something of a complex question:
No PCM is obligated to make a referral for you. What if you came in demanding a referral to neurosurgery for your kid's classic sx of migraines? I'd say no...but a Pediatrician or FP worth their salt who can spare a few minutes (and in-the-field guys/gals don't always have a few with 15min appt.'s and being heavily burdened by AHLTA) will take the time to explain why certain referrals don't make sense, and how it will not only waste the subspecialist's time but also waste the family's and patient's time and cause frustration. They may make recommendations for other referrals that make more sense, they may recommend treatment before referral, and sometimes they'll make what they know is a weak referral (but to an appropriate subspecialist) to placate anxious parents (the most common probably being the referral to cards for the obvious innocent murmur).
Parents don't often realize a few things:
1. Common things are common. Kid holds on to colds for a month and a half every winter, gets worse at night, some wheezing (to make up an example)? It's most likely asthma not the toxic black-mold-of-death. I can make up lots of other scenarios that are commonly heard including one that might fit your child to a tee-not because I have some special ability, but because, again, the common things are common.
2. Sometimes tests aren't actually that useful. A good example is allergy testing. It's most useful when it's used for targeted purposes. But if a PCM thinks a kid has allergies, step #1 is not a referral to Allergy. It's performing some adequate trials on the right medicine(s). If the symptoms are alleviated, who cares what the child is allergic to? And for those of us with environmental allergies the allergy testing is probably going to show that we're allergic to the things many people are commonly allergic to (dust mites, pollen, etc...) that you can't do much about other than sealing yourself in a bubble (though you can do some things to mitigate dust mite allergies).

Parents worried that their child is allergic to mold that's in their [base] housing are common visitors to the office (again, I'm relating a common complaint, not necessarily yours which you have not expounded upon). Sometimes the description of sx truly does raise some suspicion especially if there is documented mold in the domicile (and don't make a big deal about the toxic black mold; there is a paucity of evidence that it's more dangerous than any other mold) and a lack of a better explanation. But that kid who starts having worse allergic rhinitis sx at night when he's snuggled up to his dust mite-infested pillow and teddy bear...again, its most likely not the mold.

Ultimately this situation is about setting up a good lines of communication with parents and giving good explanations as to why sometimes the answer to a request for referral is "no"

 

[colbgw02]

Parents don't often realize a few things:

the understatement of the century. and yes, i'm sure everyone is replete with stories that start with, "well, this one time my child had (enter random slightly-less-than-routine disease) and the doctor missed it."

i'd like to make an audio recording to play for parents in the ED; it would go something like this...

"your son/daughter has a viral syndrome. he/she will get better on his/her own, and no, antiobiotics will not help. use tylenol and/or motrin for fever and pain as needed. ensure that he/she stays adequately hydrated. follow-up with your primary-care doctor in (enter random number) of days. return to the ED for fever greater than (enter random number), yada, yada, yada..."

that alone would probably free up 2 hours of time on every 12 hours shift, but this is a mil. med. forum and i digress...

 

[NavyFP]

the understatement of the century. and yes, i'm sure everyone is replete with stories that start with, "well, this one time my child had (enter random slightly-less-than-routine disease) and the doctor missed it."

i'd like to make an audio recording to play for parents in the ED; it would go something like this...

"your son/daughter has a viral syndrome. he/she will get better on his/her own, and no, antiobiotics will not help. use tylenol and/or motrin for fever and pain as needed. ensure that he/she stays adequately hydrated. follow-up with your primary-care doctor in (enter random number) of days. return to the ED for fever greater than (enter random number), yada, yada, yada..."

that alone would probably free up 2 hours of time on every 12 hours shift, but this is a mil. med. forum and i digress...

Concur, but I would rather see 100 "healthy" kids than miss the bad one. It takes me 2 minutes to see the OK kid, (and 10 minutes of documenting in AHLTA), but I'm OK with that.

 

[colbgw02]

it only takes you 10 minutes to write an AHLTA note? my hat is off to you...

"worst medical software ever" - simpsons comic book guy

 

[NavyDude]

I appriciate your responses. I apologize if the question may have come off a little strong, I was not intending try and bully a referal out of the physician or anything. I just wanted to the Doc to take me seriously and I wanted to know my options. I know they see parents and kids all the time for stuff that may be some what ridiculous and are then expected to jump through hoops over it.

My concern is that fact that we do have a mold infestation in our apartment. It was not so much of a concern at first, but the problem keeps reoccuring and management is doing the very minimum to fix it. So we know he was exposed to mold, we tested the mold and it is not the toxic mold, however, there is a LOT of it. The test also showed three different types. Also, my wife and myself show the same symptons as my son and they really started around the same time we discovered the mold in his closet. At any rate, we are getting out of our apartment but I am still concered about any damage that may have been done already.

Anyway, thats my story. The Doc was great (I was amazed) and she did put in a referal and also prescribed Claritin for him. I didn't even have to ask for the referal, she beat me to it. Well, thanks again for all the great information. You guys rock!