← The Pediatrician Next Door - Simple Advice on Parenting and Family Health
The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 137: Are Well Visits Worth It? Should I See the Doctor if I Don’t Need Vaccines?
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The kind of questions you'd ask if you had a pediatrician friend living next door. That's me. I take the science, the stories from my practice, and even my own parenting mistakes. And I put them all together so you can understand why kids do what they do and what you can do about it. And today, I'm going to start with a confession. I am three months overdue for my own well visit. Yeah, I'm a doctor. I give medical advice all day long about keeping kids on schedule, and I can't even get myself to book a routine checkup. I'd like to say it's because I'm too busy saving lives, but honestly, I just don't want to go to the doctor. But here's what that made me think about. If I don't need any vaccines and I'm feeling healthy, is that appointment really worth my time? I know a lot of parents ask the same question. If my child doesn't need shots, do we really need to come in? So today, that's our are well visits and sports physicals for that matter, truly necessary when nothing seems wrong? I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kid's health. I mix the science of medicine with the reality of parenting. Picture yourself sitting in the exam room for your child's routine checkup. The time it took 25 minutes to get out of the car. That visit, when your child was climbing on the chairs, wiggling on the table, your phone was blowing up with calls and texts and you were probably thinking, my child is healthy and doing fine. Why are we Even here, that's the feeling I usually have at my very own well visited. I'm mostly there because if I need something in a few months, I can then message my doctor and get it without seeing her. To be honest, I should be there because I want my doctor's advice on how to stay healthy. And also I know that my own mother in law found out she had an autoimmune liver disease by her routine labs that were done at her physical and she ended up going on a medication that protected her liver and then she never had a problem. So it's also on my mind that I wonder, what if my quick physical exam, the one I always want to skip, turns out to be that moment something important was caught early. So that's how I convince myself to go in every year. It's mostly out of anxiety, so I'm probably being crazy. Anyway, what I really want to know is how often, if you skip your annual well visit is an important diagnosis missed. Although maybe my question is moot. Because if a condition is caught only just one single time in a thousand people, if it's serious enough, it probably is worth it no matter what to do. Visits with everyone. But what about kids? When kids come in for checkups, most of the time they look completely fine. They're bouncing around the room, smiling, maybe fighting with their sibling, which is also very normal. Nothing about them screams medical problem. But here's the thing. Sometimes the only clue that something's off is something like their growth chart, something we only measure at their, well, visit. I've had kids where everything looked totally normal when you just like look at them. But when I plotted their height, for example, the line had flattened out. That little dip on the graph was the first sign of, say, a hormone deficiency. And with treatment, the kid then grew. Normally without that visit, we might have brushed it off as, you know, just a short kid until years later. I also came across a case when I was looking into this issue about an 8 year old boy who went to his doctor, or maybe it was a school check, and he mentioned or they noted blurred vision and no one really thought like that's an emergency. But they checked his blood pressure too, and it was sky high. And that's when they started digging deeper and it turned out he had something called coarctation of the aorta. It had been missed since he was an infant. And it's a serious congenital heart defect where the big artery to your heart is too narrow and that narrowing makes the heart work way harder. And you can have a lot of problems for that. Anyway, thanks to that visit because someone listened and checked his vital signs, that boy had surgery within days. His blood pressure was almost immediately normal and well, he could keep being a kid. But if that hadn't been found at that checkup, he might have ended up in the intensive care unit or worse. A few months ago I saw a 12 year old boy and honestly, it is still haunting me. He hadn't had a well visit in about five years and I could hear a heart murmur on him as I was putting my stethoscope on his chest. I didn't even touch his chest with it yet. I asked the father if he had ever been diagnosed with a heart problem and he said maybe when the kid was five, he thinks maybe a doctor told him to see a specialist but. But they didn't have time to go. So I told the dad, you absolutely have to go now. But the dad said they were leaving the next day for Africa for three months on a mission and then they would be back. And I am so devastated. I keep checking his chart and he just missed the cardiology appointment he had scheduled for after his return from Africa. I've been thinking about him a lot. There's just no way. There's nothing wrong. I've had colleagues catch kidney problems in kids just based on their blood pressure and all kinds of stories of thank God the child came to the doctor. And a few stories where we've seen a kid came to see one of my partners and had something very, very wrong. And that's when we realized they had missed several years of well visits. These are thankfully very rare occurrences, but they happen. Of course, the more common things we catch are things like a kid needing glasses. But. But we also do see a fair amount of what we call precocious puberty. That's kids entering puberty too early and that can cause long term issues. Most of the time they just need to see an endocrinologist and they can pause puberty with their magic endocrine medications. But I did have a partner see a girl who had started developing really early. She was only six. Her parents thought she was just maturing quickly and no big deal. They didn't even bring it up until the pediatrician did her little private parts check. You know what I mean? Our quick little peek. In this case, it was a huge deal. This turned out to be the first sign of a brain tumor. It's rare, but you only find it if someone is paying attention at a well visit. And that's the thing about well visits. Sometimes they uncover dramatic life changing diagnoses and sometimes it's just quieter things like a vision problem or a learning delay even. Either way, you don't know what you're going to miss until you skip the visit. I was looking into this and I found a statistic that I thought was really interesting. Which visits do you think families skip the most often? Which ages? I would guess parents go to the newborn, the two month, the four month, six month, probably the 12 month most consistently and probably the kindergarten visit too. And I'm right, the most skipped visits are 15 month, 18 month and 4 years. Which is weird to me because those are the visits when we do the most important developmental screenings. Those are the visits when we screen for autism and physical delays, speech delays. If you miss those, you might miss the chance to catch a speech delay or learning issue at a time when early intervention makes all the difference. So yes, sometimes these routine visits are the exact ones that uncover something important things parents would never notice at home, especially if they don't have other kids to compare to. But of course, not every checkup ends with a big diagnosis. A lot of the time what we're really doing is just talking or giving advice and guidance. The kind of stuff that can sound like nagging more than medicine. We're going to get back to that in a moment, but first let's take a quick break. The holidays have arrived at the Home Depot and we're here to help bring the excitement with decor for every part of your home. Check out our wide assortment of easy to assemble pre lit trees so you can spend less time setting up and more time celebrating. And bring your holiday spirit outdoors with unique decor like one of our Santa inflatables. Whatever your style, find the right pieces at the right prices this holiday season at the Home Depot. Your teen adjective used to describe an individual whose spirit is unyielding, unconstrained. One who navigates life on their own terms, effortlessly. They do not always show up on time, but when they arrive you notice an individual confident in their contradictions. They know the rules but behave as if they do not exist. The new fragrance by Miu Miu defined by you. Imagine fast hydration combined with balanced energy. Perfectly flavored with Sweet Zero artificial sweeteners. Introducing Liquid Ivy's new energy multiplier. Sugar free. Unlike other energy drinks, you know the ones that make you feel like you're glitching. It's made with natural caffeine and electrolytes so you get the boost without the burnout. Liquid IV's new energy multiplier Sugar Free Hydrating energy Tap the banner to learn more how many times can I tell a teenager to wear a helmet or limit their video game time before they start tuning me out? It's a trick question. The answer is zero times. I don't know if my words are ever going in, but does that mean it's not worth saying? Or does that steady drumbeat of mine actually make a difference in the long run? Which brings me to my next do we really need prevention advice? Does it actually change anything? I know prevention advice can sound boring. I mean, I bore myself most of the time. Wear your helmet. Get enough sleep. Eat your veggies. I know I sound like a broken record, but prevention isn't just nagging. It can be life saving. I once had a teenager come in for a sports physical. He was totally healthy. No complaints. He was ready to start football. But I asked a few routine questions, like we always do. Any chest pain? Any family history of sudden death? And that's when his mom casually mentioned that his uncle had died in his 20s, and that one detail changed everything. We sent him for a cardiology evaluation before he ever stepped back on the field. And without that conversation, he might have been cleared with a signature and a pat on the back. And then there are the smaller things. Like when I talk to kids about vaping. I know they sometimes ignore their parents, and maybe their parents don't even talk about this. But I've had teens tell me later, at another visit, you know, I didn't want to admit to it, but I actually was vaping and I quit because of what you said. So maybe my nagging does work. Once in a while. Pause. Ask yourself when was the last time you had 30 minutes to talk about your child's safety and health without rushing, without a crisis? That's what a well visit gives you. Although sometimes it's only 20 minutes. That's a whole other thing. We've talked about uncovering hidden problems, and we've talked about prevention. But health isn't just about growth charts and helmets. It's also about kids having a voice. Because here's the truth. Parents don't always get the whole story. You know this, and it's not your fault. Sometimes kids just need another adult to talk to. So here's my next question. Do kids get everything they need from the adults in their lives? Or does it help to have a relationship with someone else, like a doctor or even a coach who knows them well? I can tell you from experience, kids don't tell their Parents, everything. And sometimes, thank goodness, they do tell me. I remember a 14 year old girl who. She looked totally put together on the outside. Great student, super polite, so smart, smiling, really happy. But when I asked her in private about stress, she didn't answer. She just burst into tears. She'd been having anxiety attacks at school and she hadn't told anyone. And my well visit opened the door for her to get help. Here's the problem. Even when teens do come in for their visits, fewer than one third of them actually talk with their doctor about anxiety, depression, sexual health, anything. And only about half of them ever get time alone with their provider, which is the moment when they're most likely to open up, obviously. So a lot of kids aren't necessarily getting the full benefit of their well visits. Here's something else I discovered. It's not just about that one conversation. It's definitely about building a relationship over time. That's what comes out when I reviewed the journals on this issue. When your pediatrician knows your child well, their personality, their quirks, if something big comes up later, you're not starting from ground zero. There's already some relationship, some trust, and that can make all the difference. Think about it. Do you want your child to have another trusted adult in their corner? This all sounds great in theory, right? I mean, I am totally convinced now that I should go to my annual physical and I should make sure that my kids go to theirs. But in real life, here's what I'm thinking. It is hard enough to juggle school, work, sports. How do I actually get everyone, including myself, to the doctor's office? And that brings up my next question. It's so hard to get a convenient appointment. When I logged into my portal, I had to schedule three months from now. And I'm not totally sure I'm going to make that if my schedule changes. So I was sort of wondering, are there alternatives that are just as good? Or do I really have to see my doctor at my office? And I am not paying extra for a concierge doctor. I just can't do that. When I logged into my own portal to schedule my overdue physical, one of the options was a virtual physical, which I think is crazy. My initial reaction was absolutely not. You cannot listen to my heart or notice a thyroid lump on a zoom call. I mean, telehealth is amazing for a lot of things, but there is no way it's a replacement for a physical exam. That said, there are some creative alternatives that I read about when I looked into this. And one is group visits. My friend who's a nurse midwife at Kaiser has been experimenting with these. So what about doing them for families with lots of kids? That could be great. I mean, I've had parents bring in three kids at once. We check their growth and update vaccines and then sit together and talk about all the things. The problem is there is always chaos in the room. So if we could just do the visits with only the parents, parents could learn from each other. I mean, maybe older siblings could come and give their perspective. And then the whole family leaves with a great plan for the whole family's health. It's efficient and could be fun. I know some practices are trying this, and I am curious what they've found. I have another friend with a concierge practice, and he goes to the family's house and does the well visit there. And that could be another option. Some of these creative ideas, group visits, concierge doctors, they sound great. In theory, they might make checkups easier or maybe more enjoyable. But the truth is no one has that kind of choice. The biggest issue I found when I was reviewing the studies done on this issue of well visits is that across the entire United States, only about half of teenagers even have access to what we call a medical home. That's a place where care is coordinated and consistent. That means half of teens don't have reliable access to preventative care at all. So before we talk about alternatives, we have to acknowledge that access itself is a problem. A lot of people don't live close to a clinic, or for people who do, they can't get an appointment. And if they can, it's in the middle of the school day. When I worked in the emergency room, I actually did research to look at why kids without an emergency came to the er. A lot of kids do use the ER for routine things like eczema or allergies or even, honestly, to get a refill on their ADHD medication. What I found when I asked patients about all the different issues in their life, it was really surprising. What do you think was the most common reason parents gave for why they came to the ER for their child's routine health care needs? It was lack of transportation. They told me they had to wait to borrow a neighbor's car or their own primary care clinic took too long to get to on the bus, or the family only had one car and they had to wait until it was available. The other thing I found was that families who used the ER were more likely to live close to the hospital, so it was convenient how do we fix this? I don't know. We bring our healthcare to people rather than making them come to us is one thought. I really don't know. And that's the bigger challenge. Sometimes it's not about whether families want care, it's about whether they can actually get it. Convenience, transportation. Those barriers are real and I definitely do not have the answers. So let's bring it back to my original if you don't need any vaccines, can you skip your well visit? After looking at all of this, I think you know the answer. Well, visits aren't about vaccines. They're about catching hidden conditions, giving life changing prevention advice, building relationships, and making sure families don't get missed or fall through the cracks. Skipping a visit is like saying, well, the smoke detector hasn't gone off, so maybe we don't need fire insurance. So here's where I land. Yes, well, visits matter. Even when nothing seems wrong. They matter because kids need a place outside of their own home where someone is asking questions and listening closely. It also sets aside time for you to really review everything that's going on in your child's life. Thank you for being here with me today. If this episode made you think differently about well visits, talk about it with your friends. Ask them what they've done, how do they keep track of visits, and please, if you would, leave a review on Apple Podcasts for me and tell me what you think. If you aren't currently subscribed, follow the show and join me next time to explore the questions we all want answers to. For more from the Pediatrician next door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to hellopediatriciannextdoorpodcast.com for a chance to hear your voice on the show. I'm Dr. Wendy Hunter. And I'm the pediatrician next door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more Limu Emu and Doug. Here we have the Limu Emu in its natural habitat, helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural ally, Doug. Uh, limu is that guy with the binoculars watching us. 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