Letters from Maine

Filling in the Blankety Blanks


 

The good, the bad, and the ugly—to everything there is a season. I would put school and camp forms among the ugly, and their seasons are approaching.

For college and summer camp forms it's May and June. In July and August, it's time for fall sports and kindergarten entry. September brings only a brief hiatus, though, because with each new sports season, would-be athletes will discover crumpled, candy bar-stained permission forms in the bottoms of their backpacks a few hours or days before their first practices.

It's not the volume of these seasonal paper inundations that I find so troubling. After all, I am happy to learn that so many of my patients have been successful enough to be admitted to a college or have chosen to leave their televisions and video games for a few hours to participate in athletics.

The problem is that the cursed forms that must accompany my patients on these academic and recreational adventures ask questions whose answers have little or no bearing on what these children will be doing. Furthermore, I suspect that no one ever reads even a third of the information that I've taken the time to provide.

Does a summer camp really need to know the height, weight, and blood pressure of my patient? Are they planning on using the measurements I have provided to order t-shirts for the campers? Are they considering putting some campers on a low-salt diet? Is an Ivy League college going to use my patient's urine specific gravity for their budget calculation for water usage?

From time to time, I see the occasional antique camp form that still asks, “Nits?” I am tempted to reply, “Yes!” to see if Camp Nurse Ratched calls me to ask what I've done about the lice. One highly respected and selective eastern university demands cholesterol levels on its form. Are they planning on restricting my patient to the salad bar? It's more likely that someone in their medical school is collecting data for a research project.

I can understand why international study programs and organizations that offer unusual physical challenges might want detailed information. I suspect that they have been burned in the past when participants have arrived unfit for rigorous activity or too mentally fragile to thrive away from their usual support systems.

But the vast majority of schools and camps don't need to know even a tenth of the information that they ask for. Even when I encounter the rare question that deserves an answer, I'm faced with a space barely big enough to scribble my initials.

The staff and provider time required to complete these camp and school forms is staggering. It is certainly an unnecessary distraction from the real business of helping our patients get and remain healthy.

I know that some practitioners charge for completing forms, but I can't bring myself to take this step. There is a better solution. Some colleges have already begun to produce forms that don't insult my intelligence, and now it's time for the other colleges, schools, and camps to follow suit. A standard form should simply state, “We have already asked your patient/parents a whole bunch of questions. Is there anything we here at Camp Intelligent should know about him/her so that we can provide him/her with a safe and successful educational/camp experience? Here are 20 comfortably spaced lines for your reply. Please write legibly and include a copy of his/her immunizations.”

Now here's the rub. If we physicians are to be given credit for the intelligence to respond to these broad and open-ended questions, then we must come up with honest and complete answers about our patients' health, particularly their mental health.

For our patients with chronic diseases such as asthma, this also means providing an accurate, up-to-date, and unambiguous action or management plan. Freed from the shackles of answering dumb questions about the 85% of our patients who are healthy, this should be a piece of cake.

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