My granddaughter needed a hearing test. My daughter assumed, the way most of us would, that the road to a referral for the test or the specialist runs through the pediatrician.
She booked a visit with a new pediatric practice. Within minutes of the staff learning my granddaughter is unvaccinated, the appointment turned into an intervention. This wasn’t consistent with their practice, they said. No referral, no hearing test, nothing, until she put a vaccination visit on the calendar. So she booked it.
She needed the referral, and of course, she had exactly zero intention of showing up. After that, every call to the office came with a fresh lecture. She told me she had never been so bullied over it in her life.
All of that for a hearing test.
Then I spent a month failing to write it.
I procrastinated. I cogitated and tried to outline something. I played out every angle.
Every road I went down ended in the same place, the same thing I tell women who hire a doula to “protect” their birth plan during a hospital birth: you can’t buy eggs at the hardware store. You can walk in with the best list, the sweetest smile, and the sharpest elbows in town, and they still won’t have eggs. Autonomy and informed consent aren’t on the menu.
I had been asked, and I was desperately trying, to write a guide to buying eggs at the hardware store.
Once you walk into the system and let them know that you need something (a prescription, a form filled out, a referral), the system holds every card. And once they’ve filed you under “those kind of” parents, you get the worst the profession has to offer: condescension, the need to control, weight-throwing.
Medicine has a priesthood problem.
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That parent sees the doctor as a vendor. She’s paying, she wants what she came for, and she’d like it without the attitude, the same way you’d expect a contractor to fix the leak without critiquing your life choices.
Nothing gets under a doctor’s skin faster.
They hate feeling “used” or treated like they have customers instead of serfs. Whatever brought them to medical school, plenty of them seemed to have acquired a taste for being the authority in the room: respected, revered, and, though they’d never say it out loud, obeyed.
There are exceptions. They are RARE, and the rare ones mostly don’t take insurance, which puts them out of reach for most young families on a budget.
But I’d promised my friend scripts. So I made a few attempts:
“Thanks, but I’m not looking for vaccine guidance today. Can we stick to why we came in?”
Or: “If you have something printed, I’m happy to take it home and read it. Maybe we can talk about it next time?”
These buy you one visit, and you pay for it later. Every time you use them, the doctor grows more certain you’re humoring her. Sooner or later you get pushed harder, with threats like the ones my daughter got, or with a letter discharging you from the practice.
Then there’s the version that tries to end the conversation for good.
You: We’ve spent a lot of time with the FDA package inserts for the childhood vaccines. We’re not willing to accept the adverse event risks listed in Section 6.1 in exchange for whatever benefits the public health authorities promise. We’re informed, and we don’t consent.
Doctor: Our policy is that every patient follows the CDC (or if they’re particularly ridiculous, the AAP) schedule. If you won’t, we can’t keep seeing you.
You: Does your practice receive bonus payments from my insurer, or any insurer, tied to the vaccination rate of your patient population? Quality incentives, value-based payments, anything like that?
Doctor: (huff, puff) Well, I never! (clutches pearls)
Deeply satisfying. I’ll confess I had fun writing it. It also probably makes this your last visit. You’ve made an enemy of the person whose signature you need, and the odds they let you back in the door aren’t great.
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If you’ve had a baby in a hospital, you know the pediatrician question comes early and often before, during and after the delivery. Who’s your pediatrician? Have you picked one yet? Can we get a name? At our local hospital, they won’t discharge your newborn until they’ve confirmed an appointment on the books within a couple of days. Tell them to pound sand, and the next call they make is to CPS.
Ask me how I know.
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Look at the calendar the AAP recommends. Your baby is supposed to have about ten well visits before his second birthday: at a few days old, then one month, two, four, six, nine, twelve, fifteen, eighteen, and twenty-four. Now lay the shot schedule over it. Two, four, six, twelve, fifteen, eighteen months. The visits are built around the vaccines. Take the vaccines away, and most of what’s left is a scale, a tape measure, and a clipboard you could fill out at your kitchen table.
So for those of us who have opted way the hell out of the vaccine play, the only reason we ever call or visit the pediatrician is for acute needs. Fever. Rash. Playground injury.
In other words – you want someone to call late at night to run some symptoms by and get the watch-at-home, bring-in-tomorrow or go-to-the-ER answer. What you don’t need is a fight-or-flight-inducing confrontation every time you need something from a practice that is trying to hold your child’s care hostage to an injection schedule.
Here’s where my benefits-consultant brain kicks in. Most health plans are graded on something called HEDIS, a set of quality scores run by the National Committee for Quality Assurance. One of those measures is Childhood Immunization Status, the share of kids fully vaccinated by their second birthday. Plans get scored on it, and plenty of them pass the pressure down to practices through quality bonuses and “value-based” payments.
- Sick care. Ear infections, strep, the rash that won’t quit, the cough that sounds like an angry seal. If you’re uncomfortable with homeopathic or other holistic approaches, urgent care and telehealth handle nearly all of these episodes, and there’s an urgent care clinic in roughly every strip mall between here and the Pacific.
- The occasional physical form. Daycares, schools, camps, and sports leagues want a signature. Many urgent care and retail clinics do school and sports physicals for a flat fee.
- A referral now and then. Here’s the kicker to my daughter’s story: plenty of insurance plans, PPOs especially, don’t require a referral to see a specialist at all. Call your plan before you book anything. She probably endured all that bullying for a piece of paper she never needed.
If firing your pediatrician makes your stomach drop, I understand. Most of us were raised to believe a good mother has a pediatrician the way a good Catholic has a parish. If you need someone with an MD to tell you it’s okay, let me introduce you to Dr. Larry Palevsky.
I’ve learned a tremendous amount from Larry over the years at the Weston A. Price conference. He’s a New York pediatrician who has spent years questioning the white-coat orthodoxy from the inside, and he does it with all the Norman Rockwell family doctor kindness you’re longing for but somehow never seem to find in those totalitarian practices anymore. He only sees patients locally, so unless you live near him on Long Island, you can’t book an appointment. But his website is the next best thing. It gives you all the credentialed permission you need to fire your own pediatrician.
Dr. Larry taught me that you need way less urgent care than you think.
A child who can mount a good fever is a healthy child. That heat is the immune system at work, and most of the time it needs nothing from you except room to finish the job. When we reach for the Tylenol at the first degree, we interrupt that work, and our kids pay for it over the long haul. Even the (kid-transing, school-closing, Kennedy-hating) American Academy of Pediatrics says fever is protective and that fever reducers are for comfort, with no need to chase a normal reading on the thermometer.
What a sick kid needs is wonderfully old-fashioned: a dark, quiet room, a mommy rubbing his back, and a steady supply of broth.
In our house, the other thing that comes out when someone gets sick is the homeopathic kit.
Acute illness is where I’ve seen homeopathy help most in my own family: the high fever that comes on suddenly in the middle of the night, the clingy, inconsolable teething baby, the earache that shows up at bedtime. A well-chosen remedy is gentle and cheap, and it doesn’t suppress symptoms so much as help the body move through them to homeostasis faster and more gently. If you’re curious, a basic acute kit and a good home-prescribing guide are a fine place to start. Many professional homeopaths (myself included) will happily take your call or text and do the remedy-selection for you. Some even offer full-family memberships so that they’re always on call.
The white coats do get one thing right: a tiny baby under three months with a fever of 100.4 or higher needs to be seen today. So does a child of any age who is limp or hard to wake, has a stiff neck, stops making wet diapers, is working hard to breathe, or has a rash that doesn’t fade when you press on it. Those are the times you pick up the phone.
AI can tell you this, by the way.
Long before I woke up to my own health journey and the failures of Team White-Coat, I was the career mom who brushed off my kids’ illnesses, suppressed symptoms with Sudafed, Advil, cortisone cream and sent them to school anyway. Suck it up, I told them, because that’s what I did. I went to work sick, I expected them to go to school sick, and I called it grit. I wish I knew then what I know now. I recently apologized to my 20-something year old son for how I treated him when he was sick growing up.
I also like MyCatholicDoctor.com, which offers freedom-respecting urgent care or ongoing pediatric care virtually, and even better, they take most insurance plans. In both cases, you get an ongoing relationship with a pediatrician, minus the inquisition. Yes, it’s telehealth only. That’s the first objection I hear, and my answer is: so what?
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Via https://www.katytalento.com/p/what-if-your-kid-doesnt-need-a-pediatrician
(Photo credit: Israel Hayom)
