Pediatrician Gripe: Mentioning Complicated Medical Issues at the End of a Routine Physical

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The Offending Statement

“By the way, my child is getting headaches/stomachaches every day.”

There is perhaps no greater headache for a pediatrician at the end of a routine visit than a headache question. The “Oh, by the way ...” question that may point to a serious diagnosis is at the top of almost every doctor’s most dreaded list.

Why We Don’t Want to Hear It

Why is waiting until the final moments of your child’s physical to mention a chronic or serious issue so dreadful to your pediatrician? In a word: time.

By my standards, a pediatric physical takes approximately 30 minutes to perform completely. A complete “sick” visit—addressing a specific issue and taking into account all possible causes—may take longer, depending on the particular problem. Now take into account that I have strategically arranged my schedule to review your child’s health with you and accommodate the rest of my patients. If I hear that your child has “hardly any” issues to review at this particular visit, then I plan my day accordingly. If a serious issue arises at the end of an appointment, well, it backs up the appointment behind you, and the one behind that, and the one behind that, and so on. Everyone knows what it’s like to be stuck sitting around a waiting room—especially with small children: It does not make for happy patients.

What You Should Say

Know that there is a difference between a standard physical question like “How does my child’s growth look to you?” and an appointment stopper, such as, “My child has been having daily headaches for four months, what’s wrong?” One involves a well issue and one is a different matter entirely.

So what can you say? Call your doctor’s office before the appointment and tell the nurse that there is a specific issue you would like to discuss with the doctor at your child’s scheduled visit. This lets the office adjust schedules accordingly. Some offices may have you talk with a triage nurse to help you start dealing with the problem in advance.

If you forget to call, then bring it up at the start of your visit. If you’re being really forgetful, and addressing the problem doesn’t come to mind until the final moments of your child’s physical, try, “I’d like to discuss his headache issues with you. Do you think we have time today or should I schedule another appointment when we’ll have more time?” Sometimes, when asked this question, I will opt to tackle the issue right then and there, but if I know the problem is complex and time will be tight, I have the option to devote as much time as I need at a later date. Sometimes I’ll give the parent the first two steps to get started with and see them back for a shorter visit to tie up the loose ends during a follow-up appointment.

Helping Parents Deal

I don’t think parents particularly plan to drop a bomb on their doctors. In fact, I think many parents feel that they are being efficient by waiting until the physical is out of the way to discuss problems. They have their doctor’s attention, this was a scheduled visit, and they are prepped and ready to ask all the questions they have saved up during the interval.

Sometimes, a parent's concern about a health issue may manifest itself in an apprehension to bring it up, or in mentioning it casually. No parents want to think that their child could have a serious health problem, but delaying discussing it won’t help.

Other patients just don’t give a hoot about the full waiting room. They feel that they have waited their extra 15 or 30 minutes and they want their money’s worth, too. Just remember: If all patients practiced proper doctor’s office etiquette, the wait would get shorter and shorter, so do your part to make the waiting room a happy place!