The Specialty Clinic Visit – 101

I have a child with a considerable amount of medical challenges. From about 3 months old, Savanna was seeing specialists. This required many specialty clinic visits. These clinic visits are unlike the occasional visit to the pediatrician for a wellness check.  The waiting room calibrates your view of your situation. Often these visits are intimidating and confusing. Despite the length of the overall visit, your time with the doctor is usually very brief.

I have learned they usually have three basic components common no matter what type of clinic you attending. I wish someone would have shared this with me in the beginning. From all of my visits to specialty clinics, I have learned seeing ‘the doctor’ in a specialty clinic is a process.

The teaching/screening phase.

If you are attending a teaching clinic (usually affiliated with a university), you encounter medical students of varying degrees of progress through their schooling. You may be asked redundant questions. You may find yourself  frustrated. Sometimes, you may even interview with a resident; more rarely you might speak with a Fellow. I used to get so annoyed with this part of the process.

There are a few ways you could respond or behave during this phase.

You could act like you don’t respect their opinion because they aren’t “the doctor” and clearly haven’t read your child’s novel-length, multidisciplinary case file. You could practice your delivery of questions and concerns with respect and in a dignified manner. You could be as polite as possible answering all the questions of the medical student/resident while also expressing your concerns.

Accept this fact: “The doctor” you are so desperately wanting to see was once a medical student.

If you get the luxury of seeing a Fellow, a doctor specializing in this particular field of study, consider this a blessing. They have a more vigorous interest in the specifics as this is what they want to do for the rest of their career as a doctor. It is another set of trained eyes on your situation. And, if you need after hours support, this is probably one of the people you will speak to, not ‘the doctor’.  Approach this situation with same courtesy as you would with ‘the doctor’ – for sure.

If you attend a clinic that is not affiliated with a teaching facility, you will most likely see a RN or maybe an APRN (Advanced Practice Registered Nurse).  This person is like the doctor’s right hand person. Their goal is to screen the visit looking for changes, collect questions; all less the practice of the information gathering itself.

The fact presentation phase.

This is where ‘the doctor’ is present and that person presents facts and their opinions. This is where the doctor talks and you listen. Generally, the doctors will not let this phase derail with mushy conversation. They will try to keep it on the straight and narrow.

Maybe this appointment was just a follow-up and their was nothing to present in terms of new news or results. If so, this phase is over before it starts.

If you have a notebook, it is a great time to take notes if new material presented. I highly recommend asking for the clinic output note (all the records really). Sometimes they will provide that on the same day, sometimes not. This will have everything outlined that the doctor spoke about or to during the visit. Sometimes it will notate some of the discussion included in the next and third section.

The mushy conversation phase, sometimes called ‘discussion’.

This is where the doctor is trying to get out of the room as quickly as they can if new material was presented along with a new or modified action plan; and hoping you just don’t have any more questions. They are reimbursed flatly by the visit and services provided regardless of how long it takes. Don’t get me wrong, the money isn’t specifically on their mind. Its, the entire case load and schedule they need to get through during this day.

This is your time to ask specific questions you had at the start of the fact phase.

If you are still in the hunt for a diagnosis, maybe your list of questions looks different after what the doctor just presented. Perhaps the doctor answered questions. Maybe questions were answered with more questions, in which case your mind may run in a direction didn’t anticipate.

I think it is important to remember, the doctor didn’t do this to your child. It isn’t their fault, and their response to the situation may or may not have an impact. Some situations don’t have curative resolution. In these situations, the doctor is treating the family as much as the patient. I found personally, once I came to grips with this fact that the situation is not their fault, the relationship was more fruitful.

Usually, you will need some time to process either the technical details, the emotions, or both. If you are seeing a specialist like an ortho about your kids compound fracture, the ultimate outcome of your child related to the broken bone is highly documented, and typically straight and narrow. But if you are discussing a more invisible bastard of a problem, like epilepsy, there are no crystal balls. You will be tempted to ask such questions, but this is where things get really mushy.

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