Letters from Maine

What's Your Recipe?



Practicing pediatrics is a lot like baking brownies.

I've been to enough picnics and to enough potluck suppers to know that everyone likes brownies.

And it is clear that every parent wants quality health care for their children.

The problem is that there are lots of ways to make a brownie. Do you like yours more like cake or more like fudge? From scratch or a mix? Nuts? On top or mixed in? Is store-bought in a cellophane bag good enough?

Likewise, everyone seems to have his or her own definition of quality health care. Of course you want your child's condition accurately diagnosed and treated with the most appropriate remedy. Just as chocolate, flour, and sugar are to a brownie, those are the essential ingredients of quality health care. But the ratios between the ingredients and the special additions to the recipe are what make one provider's approach to health care delivery more or less appealing to the appetite of the patients and their families.

In our group of four pediatricians, each of us has his or her particular style of delivering quality health care. We talk frequently among ourselves and see each other's charts many times during a typical day. We use the same rationale for choosing antibiotics and asthma medications. And, although we try to speak with one voice, we each have our own distinct accent that can put a different spin on the same message.

As the senior member of the group, I tend to rely on my age and an aura of experience to convince the patient's family that I have chosen the diagnosis and treatment wisely. Instead of ordering much lab work or x-rays, I use the unstated “because-I-said-so” rationale. While it's a defense that may not stand up in court, it works more often than not with most families who have chosen me as their primary care provider. I'm sure I don't spend as much time as my partners do explaining anatomy and physiology in great detail … but I do draw a lot of pictures.

But, there are some families for whom lab work and x-rays are part of their definition of quality health care. Just as there are some parents who prefer their medical care with a liberal dose of worry sprinkled on top. They will tend to choose one of my partners who shares their preference for looking at worst-case scenarios.

Please don't hear this as a judgmental observation. I completely understand why some people are comforted by hearing about all the ugly and unlikely possibilities that have been ruled out. It's just not the way I like to bake my brownies.

My usual health care delivery style is the pop-in-the-microwave-ready-to-serve version. I contend that in a blindfolded taste test the consumer couldn't tell the difference between mine and the baked-from-scratch version. It's got the essential ingredients of the correct diagnosis and treatment. And, surprisingly, many working parents with busy lives and overscheduled children like the quick turnaround time in the office. But, not surprisingly, other parents feel more comfortable when they know a diagnosis and treatment plan has baked in the oven for 15 or 20 minutes.

With four pediatricians in our group, the families who choose us can select a primary care provider whose style best fits their preferences.

But occasionally families will ask to see someone other than their primary care provider because on a particular day or with a particular complaint, they feel that a different style would be a better fit for their schedule or their emotional needs.

The challenge for physicians comes when we are on call and the only package on the shelf. Obviously, if there is time, I would like all families to receive the style of care they are most comfortable with. I can still bake them from scratch, add nuts, or make them sweet and fudgy, and I will. The challenge is figuring out just how each family likes its brownies.

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