How Do You Know When to Ignore a Referral?

Health & Wellness on 04.13.11
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Photo: cogdogblog/Creative Commons

Since my son, Stefen, was born 13 months ago, he has seen:

the pediatrician roughly a dozen times
the neurologist six times
the geneticist one time
the opthamologist one time
the hearing specialists four times
the general surgeon one time

So far, except for his hypotonia — for which he sees a physical therapist once a week, though we’re trying for twice that — he’s healthy. Perfectly healthy.

I am a pretty laid-back mother. When the cats sit uncomfortably close to Stefen’s face, instead of screaming with panic, I take pictures. All of these appointments feel like overkill, but as relaxed as I am, I’m having a hard time figuring out when enough’s enough. When do you say no to a referral when the referral is for your child?

Why So Many Doctors?
If your baby is in daycare, he will get sick. A lot. Before I had Stefen, I had no idea what that meant. How much work my husband and I would miss. How agonizing it is to listen to the baby cough violently and watch snot shoot out of his face all winter long. That explains the numerous, endless pediatrician visits. None of his illnesses have been out of the ordinary.

My husband had seizures as an infant. Stefen never did, but the year of follow-ups and two EEGs with the neurologist were to track his inactivity. The neurologist wanted us to see the geneticist just in case there was something to worry about. (There wasn’t.) He also wanted us to see the opthamologist because it appeared Stefen’s eye was wandering . (It wasn’t.)

Stefen failed his newborn hearing screenings, so we were sent to the New York Eye and Ear Infirmary when he was 7 weeks old. He passed. He then failed the follow-up because he was too young for that particular test, and he failed two more because he was recovering from ear infections. We’ve been sent to an ENT, though we have to continue screenings at the Infirmary until he passes. I believe his hearing is fine.

The surgeon was for a possible revise of Stefen’s circumcision, which he does not need. (Fun fact: This particular surgery is common. It’s one of those things nobody talks about, and then when you ask one person if they’ve heard of this procedure, everybody comes out of the penis closet.)

Appointment Exhaustion
When these appointments don’t amount to anything, I measure them against the other stresses in my life and get irritated. Last week, I actually walked out of a doctor’s office after being given two referrals, stopped on the sidewalk, and cried. Time is so stretched as it is; the thought of adding another doctor just to be told Stefen is fine, on top of everything that surrounds being a working mother, is more than I can handle. I certainly wonder how all of these visits are affecting him.

I don’t want the other stresses in my life to influence whether or not I take my child to the doctor. He’s counting on me. (I find myself canceling or not scheduling my own doctor appointments because there just isn’t time. That’s for another post.) Stefen’s doctors have reasons for sending us to specialists and I’m certainly glad they’re cautious, but at some point, if it looks like a duck and quacks like a duck (even if it quacks a bit later than other ducks because this duck has hypotonia), just let it waddle into the pond already.

Saying No to Saying No
We almost ignored the referral to the geneticist because none of us (including the geneticist) had any idea what the visit was for. I was going to ignore a relative’s well-meaning but heart-attack-inducing suggestion that we look into Stefen possibly having Spinal Muscular Atrophy, the leading genetic killer of infants and toddlers. But I keep landing in the same spot: I’d rather waste everybody’s time and be told nothing is wrong than brush things off and find out later we missed a diagnosis. I’m not confident enough to say no. I’m terrified of being an irresponsible mother.

It’s easy to be skeptical when your child is healthy. I’m lucky to spend umpteen hours and copays being told nothing is wrong with my kid. But the skeptic in me does sometimes feel like my family is a drain on the system or that we’re being, I don’t know, used to fill some kind of insurance quota or something. Should I be questioning our medical team more passionately?

Here’s the thing:

I trust our doctors. Our often over-cautious doctors. I think that’s the key: If your child is in good care and you feel you’re being pointed in the right (forward-facing) direction, no matter how high-maintenance, then something worth pursuing is there, even if only to rule it out. If you’re running in circles, then you question it. I mean, as a parent, you always question, but that’s when you question them.

I wish there were an answer: “Once you reach point D, ignore your doctors and enjoy your morning. Have pancakes.” But just like anything else, it’s about instinct. It’s about not letting all of those doctors’ business cards piling up in your wallet cost you a good night’s sleep. And hopefully you never have to use them again.


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