I’m at home today as my little guy was sent home from daycare before he was there long enough to wash his hands before breakfast. He is just not himself. He walked down the two steps from our garage to the ground instead of taking a HUMONGOUS JUMP from the last step over the puddle which is a tenth of an inch deep and eight inches wide. He always leaps when he is feeling good. He also has a fever of 101.3 F.
The daycare will require that we’ll bring in a doctor’s note before my son can go back. No big deal, I’m calling the pediatrician after I finish my coffee. I know the Nurse Practitioner will diagnose him with a daycare crud viral infection. She’ll recommend lollipops, lots of liquids, ibuprofen for pain and fever control, and lots of sleep.
From a system point of view, the pediatrician visit is most likely a wasteful visit. I know that, the day care knows that, the scheduler knows that, and the NP knows that (that is why she is getting the day care crud cases as she is the cheapest person who can see and prescribe common antibiotics, asthma medication and tests). However, from a cost perspective, this is probably waste, that at this time, is not high on anyone’s priority list to reduce. No one would complain if every kid saw the pediatrician one less time over the course of a long winter solely because they got a little bug and need a note to return to normal activity.
On a cost savings basis, one PCP visit per kid per year is peanuts. It might be $100 per kid per year. That is not nothing, but compared to emergency room overuse, or over-prescription of brand maintenance drugs instead of generics, or the refusal of Congress to allow Medicare to truly throw its weight around as the biggest buyer of medical services in the world, or heroic and counterproductive last stands, reducing pediatric utilization by a visit per kid per year is a drop in the bucket.
Face
Is this SOP for most daycares? We use in-home and it’s an honor system (kid needs to be 24+ hours post-fever). And what’s a doc supposed to do for the viral cases? Just write “viral, kid’ll be normal in a day” on some letterhead? Clearly no meds can help.
I’m really glad we dont have to see a doc every time the spawn spawns a mild fever and stuffy nose. Otherwise, we’d be seeing him every 2 months or so.
A
I don’t know how widespread this is, but our daycare is on the honor system unless the kid has been sent home. So if I don’t bring him in, it’s an honor system, but if he’s sent home he needs a doctor’s note to be let back in.
Tommy
I don’t have any children, but my friends that do say the pediatrician visit is a horror show. Basically, “hey this is a great way to get the rest of our kids sick.” Heck one of my clients sells a telehealth/telemedicine service and this is actually one of the primary benefits he promotes. Parents seem to get the benefit of this service within seconds. Seems like almost a universal problem.
Aardvark Cheeselog
I used to think my wife was driving up medical costs for everybody with her practice of getting a pediatrician visit for every cold, but after I thought it through I came to this same conclusion.
Keith G
Peanuts to the system, but to a number of individual families such a required visit may be quite a disruptive event.
WaterGirl
I had forgotten about HUMONGOUS. Thanks for that!
Tommy
@Face: I can only speak for my niece, but yes it is SOP where she went to daycare/pre-kindergarten. I guess it is a good thing, but frankly I am stunned about how anal they are about everything. There seem to be so many rules and regulations I feel my brother and his wife spend way too much time trying to figure them all out.
Nicole
Maybe it offers some legal protection to the daycare/school facility? If a kid is sick with something serious and also contagious, better to hand the judgment call off to a doctor about when the kid can come back.
But yeah, a hassle. I was so grateful that when my son developed pinkeye, it showed up on a Friday evening, so we were able to call the pediatrician’s after hours number, they called in a prescription to the drugstore for us, and he had all weekend to be treated so no school was missed. Would that infections were always so considerate to working families!
Mnemosyne (iPad Mini)
It’s usually just daycare crud, but there was also the time my best friend brought her kindergartener in and it turned out to be walking pneumonia. She felt like the world’s worst mother that day.
(The whole family had been sick, including my BF, and her daughter has always been very stoic and didn’t complain. Still, she felt like a jerk for missing the signs.)
someguy
@Mnemosyne (iPad Mini): Yeah, but the system can’t really be expected to pay for all the extra doctor’s visits. Can’t have one set of rules for the special snowflake then another set of rules for everybody else. Either you control costs or you don’t. Pick one.
Liam Yore
Sadly, I see parents bring their kids into our ER far too often for this same complaint. Some docs/PAs/NPs who are anxious about “missing something” in a kid, particularly those who are not super experienced or are not parents themselves, will go ahead and order chest x-rays and blood and urine tests in an otherwise perfectly healthy child. Drives me nuts, and from my perspective is probably the most easily identifiable (if not the most easily remedied) example of overuse of resources.
Tommy
@someguy: But the “system” needs to pick up the costs. My brother and his wife both have really good jobs. I am willing to bet they are more lucky than most. But a $100 here or there is still an expense they have not budgeted for. That is “real” money. I am willing to bet for many who are not as blessed as my brother find it very hard to find $100 just “laying around.”
Mnemosyne
@someguy:
How expensive is it for a kid to see a PA or NP? I would like to know that before we decide it’s okay for kids to die of undiagnosed pneumonia so we can save a few bucks. As I pointed out above, not every parent is qualified to say that their child just has “daycare crud.”
Not to mention that it’s cheaper for a kid to see a PA or NP for asthma maintenance on a regular basis than it is for them to have to be rushed to the ER after an attack. Preventative medicine works especially well with kids, even if there appears to be a higher up-front cost because those ER visits never have to materialize.
Another solution, of course, would be to have free or very low cost medical clinics in or near schools to take care of the basic stuff so parents wouldn’t have to take off work for preventative care. But, of course, we can’t have that, because some high school girls might learn that contraception exists.
MobiusKlein
@Keith G: Exactly – parents pay a co-pay, have to take time off work, arrange a last minute doctor’s appt, and get it all done in 24 hours.
My kids’ preschool asked for a Dr. note if the absence was three days or more.
FlyingToaster
It isn’t SOP at my daughter’s preschool, nor at grade school.
Both have the same policy: 24-hours fever-free w/o fever-reducing meds. Or 24-hours post-contagious with a more serious illness.
If you did take your kid to the doctor, and it’s something contagious, please call the school so that they can give other parents a heads-up that {disease} is going around. So pinkeye, lice, and last year’s norovirus all got e-mails warning us to look out for them, with a symptom sheet linked.
I’m a little surprised that daycares and preschools are requiring doctor’s notes, but this is probably a liability issue (don’t sue us if your kid comes home with an illness) than wanting to be wankers about everything.
Tommy
@FlyingToaster: I am all for rules and regulations when they have a cause and serve a specific purpose. I guess I am getting old and might start to yell “get off my lawn” but a doctor’s note. That just seems over-the-top to me. I am sure as a kid I went to school many times with a cold, fever, you name it. The end of the world didn’t happen. Nobody sued the school. Pretty sure we are all alive and well.
Keith G
@MobiusKlein: Add to that the plain fact the the poorer the patient, the more likely that patient is going to be interacting with the least efficient medical processes. If one is paying into a gold plan or a pricier silver plan, I bet a morning phone call can get an afternoon appointment with little effort.
Many of the urban workers that I know whose income is in the “20s” to lower “30s” utilize community-based nonprofit clinics to stretch their medical care dollars. I walked into one of those waiting rooms last years on other business.
Yikes, just fucking yikes.
I bet that their non appointment non-urgent triage was hours of waiting.
Yep, a full day away from a time-clock job and a co pay.
low-tech cyclist
Richard – hope your little guy feels better soon! Yeah, not feeling up to jumping over the puddle is a pretty big tipoff, isn’t it? Although with my little guy, it would have been not enthusiastically jumping IN the puddle to see how big a splash he could make.
@FlyingToaster:
Same with my son’s day care and elementary school.
PurpleGirl
@Tommy: I’ve seen commercials for a telemedicine service and, yes, among the touted benefits is common colds and pediatric colds being diagnosed without office visits. I think this is a good use of the internet. If the cold lasts longer than a few days, you can then always make an office visit.
Keith G
@Mnemosyne:
Common sense?
From the American Academy of Pediatrics (this is a more detailed set of guides, but still nearly the same as what I learned in the 1980s)
Tommy
@PurpleGirl: The service my client offers is pretty darn amazing. I have a ton of stats come across my desk. I always take them with a grain of salt, because clearly they are trying to sell their product.
But one of the more amazing stats I’ve seen is about 70% of all doctor visits don’t actually require you to go to said doctor. It can be done online. And of course as technology advances this will only increase.
I am wearing an UP Jawbone fitness bracelet. It only monitors a handful of things now, but in the not so distant future it will monitor a whole lot of things about my health. I’ll call a number, sync my data with a doctor, and off we go.
Luthe
Every kid that goes to a PCP or NP for a daycare note (or antibiotics or whatever) is one less kid whose parents could have taken Lil’ Bit to the ER for that same note (or antibiotics). So viva la extra PCP visit! It’s way cheaper than what could have been (and pisses off ED docs less).
richard mayhew
@Luthe: That logic only works when the option space is Office Visit or ER visit when the real option space is stay home with lots of fluids and Nick Jr to Office Visit to Urgent Care Visit to ER Visit. If this is only daycare crud, the optimal choice is stay home with lots of fluids and Nick Jr.
Mnemosyne (iPhone)
@Keith G:
Of all of those symptoms, the only one her daughter showed was the persistent fever, which is why she brought her to the doctor. But, hey, I guess her common sense should have told her that a kid with only one of those symptoms had walking pneumonia.
Marci Kiser
A seldom-mentioned cost of the “note” system is the overtreatment of children once they are at the pediatrician. Case in point: over 2/3 of pink eye is viral, meaning antibiotics will not help. However, 100% of children with pink eye will receive antibiotics from their pediatrician because day cares require a child with pink eye to be on antibiotics before they return. These sorts of policies are arguably the primary driver behind pediatric antibiotic overuse in our country.
Richard Mayhew
@Marci Kiser: not sure if “primary” is the right word. I will readily concede “significant” driver
Ilya
So this is the fault of doctors how? Your kid’s school has a dumb rule. As a doc who saw at least 10 of these “crud viral infections” each day in the ED, trust me, we really don’t want you coming in either, we have people who desperately need their lortabs refilled.