Friday, June 19, 2009

Practice Today: What will it be like next month?

So, after my presentation this week, I became a primary care pediatrician again, seeing kids for camp and kindergarten, poison ivy and swine flu and the ever present behavioral health problem.  Summer is actually the time in which I usually see the few behavioral health issues, I think;  stress decreases as the schools are close, the kids can run around outside or visit their grandparents and many families seem t have a bit more room to cope with life.  Many of the kids who don't have behavioral or mental health issues come in for their annual physicals, and I get to see a lot of high school graduates who are on their way to college.  Still, this year, this annual unwinding of practice tension has been complicated by the swine flu outbreak and the loss of practice supports as a consequence of the state budget crisis.  We are still seeing flu still, which is decidedly odd this time of year and it is keeping us busy, and our DPH-funded care coordinator will have her last day with us on June 30, 2009 (truly unfortunate- we've had a care coordinator since 1996 and it has allowed us to be more proactive in our support of families).  As the CSAs ramp up, the rest of us are ramping down.  As I have said, this will be an interesting transition.
In the midst of this, I have had several youths who worry me:
1)  A young man previously diagnosed with ADHD who took himself off of medication this year, barely passed the 7th grade and had a PSC score of 46 at his annual physical.  I think that he has agreed to talk to his therapist again, and consider reevaluation- I think that bipolar may be a better description for him than ADHD.  PSC screened positive- now he needs to get into the system.  Sadly, he has private insurance, so the wraparound won't help him.
2)  Another youth in his senior year with a therapist, a psychiatrist,  a history of a failed suicide attempt this year and a PSC of 26 or so.  His affect was worrisome, but he assured me that the therapist had it all covered.  Still, he was actually better than last year;  I hope he graduates and that things get better for him.  
3)  A young lady with ADHD, who seemed to be doing OK on her meds, but whose attitude toward school took a nose-dive in the last semester.  She does not want to talk to a therapist, so we will continue to monitor her status with concern.  MassHealth at least, so if she gets worse, I have some place to send her.
The screening continues, the workload piles up; will we be able to get these kids into the system?  After three days in the office, I see that we still have a lot of work to do to make this system work.

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