Our pediatrician fired us recently and it wasn't easy to tell the children. He notified us by certified letter:
"I consider a good parent-physician relationship vital to the type of comprehensive medical care I render to your children. For the past six years, I have found that on more than a few occasions, there has been a conflict between your philosophy and my view of good pediatric care. Consequently, I feel that it is to our mutual interest that your children be transferred to another physician's care."
I told the three children as soon as I'd finished the letter and told them it had nothing to do with them; their doctor was objecting to us, the parents. The oldest started to cry, "Let us keep going to him," she said. "What have you done to him?" asked the second child.
In trying to answer his question, I spoke to myself as well. I had always thought the pediatrician an excellent doctor and one who cared about the children. I had (obviously incorrectly) thought myself a good parent. Yet when I thought back over the six years we had known our pediatrician, and considered the last six months more carefully, I realized I had been behaving in a way he thought unacceptable: I had asked "Why?" too many times.
Our youngest child, as are the other two, is an asthmatic. He had recently been hospitalized for his inability to respond to adrenalin and, to prevent further breathing difficulties, had been put on slo-phyllin (a bronchiodilator) when he wheezed. He had also been given a prescription called hycodan-alupent-dimetane to control minor coughs and runny noses.
As a parent, I wanted two things for my children that are sometimes difficult to have together. I wanted the ashtma attacks to decrease in severity. At the same time, I wanted to know the effects of the slo-phyllin and to see if there were alternative methods of treating asthma. Therefore, while I was quite grateful to the slo-phyllin, I had, on occasion, asked our pediatrician about its side effects.
I had also noticed the orange label on the hycodan-alupent-dimetane medication and the statement that it was a "controlled substance." I called our pediatrician a few months ago to ask whether our son's medication had narcotics in it. He said he did not know and recommended I call my pharmacist. ("Yes," said the pharmacist, "you could call it a narcotic.")
I am not saying that I point-blank refuse to give our son a medication with a "controlled substance" (in this case codeine) in it; I am saying that I believe I have a right to know that codeine is in his medicine.
The final "conflict" occurred shortly before we received the letter. Concerned about the large percentage of time our son had to be on slo-phyllin, we decided to look into ortho-molecular medicine.
"Ortho-molecular" is a term coined by Linus Pauling meaning "right-molecules in the right concentration." Ortho-molecular physicians believe that Vitamin C and other substances for some people might help prevent disease. The emphasis is on preventative nutrition; most ortho-molecular physicians would agree that a child beginning an asthma attack needs medication.
Such an approach to decreasing our son's asthma attacks may well be a waster of time and money. There may well be negative side effects. I asked our pediatrician for his reaction, thinking he needed to know we were considering taking our son to an ortho-molecular specialist, in addition to taking him to the allergist for desensitization.
His response was quite emotional. He yelled: "They are a bunch of quacks and are just interested in your money."
As I see it, our "conflict" is one between parents who want to know what the benefits and risks are in a treatment for asthma and a pediatrician who sees his role as the giver of The Treatment and who feels uncomfortable with ambiguity.
When our second child was the most seriously asthmatic, I took him to the clinic of a large hospital for allergy shots. The resident-allergist told me that our son should be given theophyllin "all the time." When I objected, saying our pediatrician had advised that he stop medication 24 hours after the wheezing had stopped, she still insisted I keep him on theophyllin. She assured me there would be "no effect."
Perhaps this resident is correct and there are no negative effects from long-term use of theophyllin medications. Perhaps the side effects only apply to some people who have received an overdose. Perhaps, however, as I have seen from reading the "Physician's Desk Reference," there are many possible effects.
"Slo-phyllin 80 syrup (theophylline, anhydrous): theophyllin may cause gastric irritation, nausea, vomiting and abdominal discomfort, headache . . . fall in blood pressure, central nervous system stimulation . . ."
Since I am a "difficult" parent to read such publications and to ask a good number of "Whys?" I did not put my son on theophyllin "all the time."
I would guess, however, that there are many parents who too often accept without question what the doctor says.
In my weeks of looking for a pediatrician who was both a good doctor and an individual who could be questioned, I learned that there are a number of resource available for parents who want to find a compatible physician.
The established, professional organizations -- medical-school faculties, medical societies, teaching hospitals -- are safe sources for lists of doctors with good medical experience who are board-certified. Consumer directories have been published in many cities listing physicians, areas of specialization, educational background and fees.
The professional organizations cannot, however, give you information about doctor-patient relationships. While that kind of information may be more difficult to obtain, there are intelligent ways to proceed.
I found the best way was to use informal networks of friends. One mother in my neighborhood told me about her pediatrician who was "conservative" in prescribing medication. A friend of hers, using the same doctor, told me she had been able to work with him in deciding which medication to use for her toddler's recurring ear infections. I went to see this pediatrician, explained why we needed a doctor and asked him the questions I particularly wanted answered.
If you are new or living where most people have grown children, consider tracking down a self-help group. But just as you would choose friends who have similar values, choose a group whose values you accept.
Whatever the resource you choose, you should be able to get a list of possible physicians and find one best able to meet your child's medical needs . . . and enable you to establish a satisfying doctor-patient relationship, one that will not end when you ask your doctor "Why?"