Western Medicine For Children & Youth (Also known as Bio Medicine or Allopathic Medicine)

By Marie Mulligan MD, © Copyright 2008.

Western Medicine Has Helped Kids With

• Health emergencies
• Acute and chronic illnesses
• Mental health issues
• Birth and developmental challenges
• Comfort care at the end of life

Western Medicine Can Help In The Following Areas

Spirit: Caring for the mind/body in skillful and respectful ways heals the child’s or youth’s spirit.

Body: Western Medicine is designed to cure illness, manage chronic disease and prevent illness.

Mind: Western medicine is rapidly expanding its understanding of the brain and the mind.

Emotions: Western Medicine is involved in treating many mental/emotional/behavioral challenges and illnesses.

Social: The skillful use of Western Medicine supports healthy development and socialization of children and youth.

Brief Description of Western Medicine

• It includes a vast set of practices to treat diseases, injuries and to maintain health.
• It includes specialties of practice addressing every physical and emotional aspect of human beings.
• It is based upon careful observation, scientific methods, a growing body of evidence research, as well as trial and error.
• Practitioners are licensed by state governments and may be certified by professional associations. The federal government grants the ability to prescribe controlled drugs.
• Service is divided into specialties.
• Primary medical care is delivered in offices, clinics, local community hospitals, by: Pediatricians; Pediatric Nurse Practitioners; Pediatric Physician Assistants; Family Physicians; Family Nurse Practitioners; and Family Physician Assistants. These practitioners refer people with complicated challenges to specialists, such as Speciality Pediatric Physicians.
• Specialty Pediatric Physicians deliver their services in offices, clinics, local community hospitals, specialist hospitals, and regional centers. Specialists are usually available in larger cities and are less available in smaller cities and towns.
• Non-Surgical Specialties:
• Allergy (for allergies); Cardiology (for heart); Dermatology (for skin); Developmental (neurological and behavioral development); Emergency; Endocrinology (for glands and hormones); Gastroenterology (for stomach and intestines); Genetics; Hematology (for blood); Infectious Disease; Neurology (for brains and nerves); Nephrology (for kidneys); Oncology (for cancer ); Physical Medicine (rehabilitation); Psychiatry (for mental health, learning and behavior); Pulmonology (for lungs); Radiology (for diagnostic imaging and interventional radiology; for options to surgery procedures); Rehabilitation; Rheumatology (for arthritis and autoimmune conditions); Sports Medicine
• Surgical Specialties:
• Cardiothoracic (for heart and chest); Dental; General (non-specialist surgeons); Neurosurgery (for brain and nerves); Obstetrics and Gynecology (for female reproductive organs); Ophthalmology (for eyes); Oral and Maxillofacial (for teeth, mouth and face); Orthopedics (for bones); Plastic or Reconstructive surgery; Otolaryngology (for head and neck); Transplant; Trauma; Urology (for kidney and bladders); Vascular (for veins and arteries)
• Allied Medical Fields:
• Audiology (for hearing); Chiropractic; Dentistry; Dietetics (about nutrition); Epidemiology (health and illness research about large groups of people); Health Education; Medical Social Work; Nursing; Optometry; Pharmacy; Physical Therapy; Psychiatry; Psychology; Podiatry (for feet); Public Health and Preventive Medicine; Respiratory Therapy (for breathing); Speech and Language Therapy

Success With Western Medicine

• Ask your primary care provider. Each one has countless stories.

Western Medicine Is Appropriate For Ages

• All ages

Children & Youth’s Reactions To Western Medicine

• This depends upon emotions and expectations of the parents/caretakers/children when they come for help.
• This depends on the nature of the practitioner, diagnosis and treatment methods. Some of the machines and procedures can be scary.
• Parent/caretaker/and medical staff staying calm, relaxed and friendly and patient with the child or youth can help.
• Most children & youth appreciate being helped, especially when frightening parts are over.

Extra Care Is Needed

• Care is needed when children & youth have been terribly frightened by past medical procedures.
• Care is needed when the child or youth and family are very frightened in general.
• When the child or youth do not have medical insurance, families need help in finding foundations, state and federal programs to cover the cost of medical care and procedures.
• Some medical practitioners make medical decisions based upon influences.
• Studies showing that something does not work or might be dangerous may not get published. As a result, health providers are forced to make decisions based upon incomplete information. There is some movement to correct this problem.

History

• The roots of Western Medicine go back to ancient Greece when they moved away from believing that gods do the healing, to physicians relying upon observation and logic.
• Modern Western Medicine is about 500 years old.
• In the late 1800’s Canadian Sir William Osler founded the first modern medical residency program, emphasizing bedside history taking and physical examination skills, combined with studying medical records and texts.
• Western Medicine replaced native and traditional healing practices. There is now much interest in researching these ancient practices and making use of what is effective.
• In the last century there has been an explosion in medical knowledge and technology: e.g., the research and development of drugs by the pharmaceutical industry; and the development of new surgical techniques.
• Evidence-based or scientific medicine is a new trend. Doctors make decisions about diagnosis and treatment based on the best research possible. Good research is costly. Research often does not address the real life choices a provider must make when a patient has several problems and requires multiple treatments. A person’s conditions and their medications can become very complicated. For these reasons there are limits to its usefulness in taking care of individual, unique persons.
• The cost of modern medicine in the U.S. has become extremely expensive, pricing it beyond many families–even those with health plans.

Basic Concepts And Components Of Western Medicine

• Continue rapid improvement of practices through research.
• Extensive training gives detailed knowledge of the human body, how it works and about what can go wrong.
• Conduct and apply scientific research.
• Be dedicated to not causing harm.
• Keep accurate records.
• License who gets to practice medicine and medical procedures.
• Continuing medical education is a requirement for licensing.
• There is a responsibility to protect patient confidentiality.
• There is a responsibility to give clear information about procedures – known risks, benefits and alternatives for medical interventions.
• There is a responsibility to get consent from patients or family before doing any medical procedure.

Description Of A Typical Session

• Method of payment for service will be reviewed by office staff, determining the level of care to be given. (See Cost Of Service below.)
• Licensed medical personnel get to know the child or youth by being friendly and taking a history of the current situation, past illnesses and conditions, family history and social circumstances. They will talk with parents and the child or youth.
• Ideally, a review is made of all past medical records.
• A physical examination will be made by medical provider–possibly by a doctor, nurse practitioner or physician’s assistant.
• Tests and further examinations will be ordered and given and possibly medical imaging of the body will be made.
• Repeat appointments may be necessary.
• Many other tests and diagnostic procedures could be required: medical imaging: x rays, CT scan, MRI, ultrasound, etc.
• A treatment plan will be made based on the existing information and availability of service and medications.
• May recommend self-care, the use of over-the-counter medications or prescriptions for medications.
• Further observation, changes in lifestyle, referrals to allied health professionals, and referrals to specialists, surgeries or other procedures may also be recommended.

Major Differences Of Opinion Between Practitioners

• Pharmacological studies are producing many new medications. There is criticism that negative studies are not published. This hampers provider’s ability to make fully informed decisions.
• It is important to get second and third opinions from different doctors about major conditions and treatment plans – if financially possible.
• Computers and the Internet have made home research possible. It is now possible to check out a variety of sources of information.
• Check out information from governments (USA and others); university medical information sites; patient advocacy groups; and independent reviews.
• Caution is needed when checking medically related websites. Many websites have information that is biased toward selling products. Seek sources that are as independent from financial gain as possible.
• Much research is now funded by large medical/pharmaceutical manufacturing companies.
• There is a growing debate about the influence of pharmaceutical companies on what physicians prescribe.

Fees/Costs In 2007

• Costs of all medical procedures vary from area to area, health plan to health plan.
• United States has amazing health care if you are very wealthy or if you have very good health insurance.
• The present system in the US is a minefield for ordinary families and it is constantly changing.
• Often insurance plans appear worthwhile until the fine print of the contract is studied carefully.
• You have some complicated things to deal with if you are not very wealthy or do not have very good insurance.
• State and Federal health care rules change every month…or quicker.
• The medical system in the United States is set up as follows:
• Fee For Service paid by medical insurance companies
• HMO (Health Maintenance Organization)
• PPO (Preferred Provider Organization)
• The federal government in cooperation with state governments provides health insurance for low income women and children. Families have to apply. Programs differ by state.
• Many people are not poor enough to qualify for the programs for people in poverty, but are not rich enough to pay adequate insurance or high co-pays and high deductibles, which lower the cost of insurance.
• Check your municipal and state government for any assistance programs.
• Often programs are funded, but are not well advertised.
• Some nonprofit corporations and some states help provide service for some families in this group.
• County Public Health departments and community and free clinics may have this information.
• Fee For Service
• People can pay directly or can pay an insurance company to pay most of your medical costs.
• You pay more of your medical costs when you have a less expensive policy.
• You get to choose your health care provider.
• The insurance company may have limits on how much they will cover and for what conditions they will pay.
• You have to keep your own records of your medical expenses. This is complicated if your child or youth needs a lot of medical attention.
• If your doctor charges more than the fees paid by the insurance companies, you will be expected to pay the difference. Check this out before you have anything done. If you can, shop around for a better price.
• Check out the size of the deductible - the amount that you have to pay before the insurance company starts to pay. The size of the deductible often relates to the cost of insurance.
• Check the upper limits (or cap) of your coverage for procedures, hospitalization, medicines, etc. These caps can be by month, year, lifetime, or condition.
• Check the size of the co-pays and for what services they are needed.
• Check to see if certain conditions are excluded from coverage.
• Check if your plan pays for chronic conditions your child or youth had before getting the policy.
• If a referral for a medical procedure, medication, hospitalization is made by a practitioner, make sure that the insurance company will pay before you get the procedure done. The health practitioner’s office can often check with the insurance company for you.
• HMO (Health Maintenance Organization)
• For a monthly fee, you get to use only the health practitioners and facilities designated by the HMO.
• You may get to choose the doctor of your choice within that organization.
• Check out fees called co-pays which may be charged for office visits, medicines, tests etc.
• Some medicines and some procedures may not be available or covered.
• Check out the size of the deductible - the amount you have to pay before the HMO starts to cover.
• Check out the upper limits (or cap) of your coverage for medicines, procedures, hospital stays, etc. Caps can be made by month, year, lifetime or condition.
• PPO (Preferred Provider Organization) - a combination of Fee for Service and HMO
• Check to make sure your health care provider is listed in your health insurance company’s list of network providers. If they are not, the co-pay will be higher. You will likely have to pay much more than you would if you used a provider listed by your health insurance company.
• Check how much the insurer will pay if your provider is not associated with the PPO.
• Check out the size of the deductible - the amount that you have to pay before the insurance company starts to pay. The size of the deductible often relates to the cost of insurance.
• Check the upper limits (or cap) of your coverage for procedures, hospitalization, medicines, etc. These caps can be by month, by year, by lifetime, by condition.
• Check the size of the co-pays and for what services they are needed.
• Check to see if certain conditions are excluded from coverage.
• Check out if your plan pays for chronic conditions your child or youth had before getting the policy.
• If a referral for a medical procedure, medication, hospitalization is made, make sure that the insurance company will pay before you get the procedure done. The health practitioner’s office can often check with the insurance company.
• Information to check out for all types of coverage
• Check to see if your insurance plan adequately covers what you want for your child or youth. For example, different plans pay different amounts for: psychotherapy, occupational therapy, nutritional consultation, preventative health care, or chemical addiction programs. Some plans do not cover these services at all.
• The network of help for uninsured people or underinsured people varies from community to community.
• Some services are offered for children/teens but not for older teens.
• In order to have better health care and to reduce medical bills, families need to find a primary health care provider. Avoid using the Emergency Room as a substitute for having a primary care/health care provider.
• Your health care provider, free clinic or county clinic staff may have suggestions for you on your search for resources for your child or youth.
• Some religious organizations can help you through the medical payment minefields.
• County public health departments and local churches may be useful in connecting you and your child or youth with health care.
• Expect frustrating waits, and questions you may find intrusive. Keep your focus on your child or youth’s needs.
• Do not give up. Keep looking for resources.
• If you do not have funds remember to locate city, county, and federally funded health centers.
• To help navigation through the health care system, find a primary health care provider for your child or youth.
• Check out the website: www.nlm.nih.gov/medlineplus. It has many links, including JAMA Patient Page, Health Care Insurance; The Basics.

Average Time Per Session

• This depends upon the problem being addressed.
• New visits are usually 30 to 60 minutes – longer under special circumstances.
• A basic medical visit typically averages 10 to 15 minutes.
• Wait times vary depending upon the provider.

Estimated Length Of Time Before Improvements Can Be Expected

• Results can be almost instantaneous or can take many months or even years, depending upon the problem.

Suggestions To Make Western Medicine More Effective

• If possible, get second or third opinions for major surgeries and procedures in order to build confidence.
• Choose medical providers: who you feel good about; who treat you with respect; who answer your questions; who work with you to make decisions; and who can help you stay calm.
• Communicate clearly with medical professionals.
• Write down questions and observations before consultations.
• During important appointments - which could be frightening or confusing, make sure to take a friend or family member with you.
• Make sure you and the practitioner agree on a treatment plan for your child or youth.
• Follow recommendations carefully and thoroughly. If the plan is not working for you or your child or youth, notify the practitioner immediately. Make another plan.
• Pay attention and report unexpected changes quickly.
• Learn how to use the Internet and get information from government and university medical information websites. Be cautious with websites sponsored by private companies wanting your medical business.

Other Methods That Are Similar To Western Medicine

• Western Medicine is comprehensive and has a unique perspective on the body, illness, and healing. Traditional Chinese Medicine and Ayurveda are comprehensive also and have unique perspectives on the body, illness and healing.

Other Methods That Complement Western Medicine

• Most methods work well with Western Medicine.

Special Training Needed To Work With Children & Youth

• This is different for each medical specialty. (See above.)

Certification/Licenses Held By Practitioners

• This varies depending upon nature of training. For example, doctors have more training than Nurse Practitioners who have more training than nurses.
• Specialists have much more training.
• Board Certified Physicians have basic training of four years of college, four more years of medical school, three to seven years of post-graduate residency and/or fellowship training.

Professional Associations To Contact For Names Of Local Practitioners

• There are different associations for each medical specialty and subspecialty. (See above.)
• Check out recommendations from family members, friends, and other people you trust.
• Interview the medical practitioner. They work for you.
• Check out your state’s medical board Internet site to see if the practitioner is being investigated for unprofessional conduct, negligence or if they have outstanding ongoing medical liability law suits.
• Check out state medical board Internet sites to see that the practitioner has passed competency examinations that are required every six or seven years.
• Although it may take a lot of time, check out the financial terms of both your health insurance company and medical provider.

What To Look For When Choosing The Best Practitioner

• Make sure the practitioner communicates clearly. Look for someone who answers your questions so you can understand and who checks with you to see that you understand.
• Look for a practitioner who has good listening skills.
• Choose a practitioner who is willing to consider your values and lifestyle.
• Find a practitioner who uses what is called a ‘Shared Decision Making Process’ with you, so that what you know and feel is taken seriously.
• Check for availability, including after-hours care.
• Check for approachability.

Resources, Research Papers, Books, DVD’s, Websites

• Many reputable medical schools and health care institutions have reliable sources of information. To name a few: www.aap.org; www.familydoctor.org; www.mayoclinic.com; www.health.harvard.edu; www.healthletter.tufts.edu; and many others.
• Check out the website: www.nlm.nih.gov/medlineplus.
• Check out “medicine” in the Wikipedia website: www.wikipedia.org.
• Wolinski, Howard and Judi. Healthcare Online For Dummies. New York: Hungry Minds, Inc., 2001.
• An excellent source for evidence-based Complementary and Alternative Medicine: http://denison.uchsc.edu/education/cam2/database.html
• More General western medicine info sources:
• Harvard Health Publications:http://www.health.harvard.edu
• www.familydoc.org
• Dr. Mulligan’s Published Works:
• Contributor, Natural Medicines Comprehensive Database, Publishers of Pharmacist’s Letter, Stockton, CA, 2007. See: http://www.naturaldatabase.com.
• Farley M, JM Golding, G Young, M Mulligan, JR Minkoff. “Trauma history and relapse probability among patients seeking substance abuse treatment.” Journal of Substance Abuse Treatment 27, no. 2 (2004): 161-167.

Biography of Marie Mulligan, Author

• Marie has been practicing for over 23 years. Currently she sees between 20 to 30 infants, children and youth per week.

To Contact Marie Mulligan, Who Contributed This Chapter

E-mail:mariemulligan@GrowingUpEasier.org

Marie Mulligan’s Comment About Western Medicine: It is a privilege being a family physician, being able to provide health care to people at all stages of their lives. I find patient centered care particularly rewarding where what is happening in each patient encounter has more to do with the needs of the patient and their family than with my own agenda.

Rick Geggie’s Comment About Western Medicine: Western Medicine has saved my life many times. It has saved my son’s life as well. I have found Western Medicine to be very dependable in emergencies. My experience with Western Medicine’s solutions to long term chronic problems has been mixed. The high cost of Western Medicine is understandable because so much technical development and research is involved. The cost factor has lead to cost-cutting practices which have shortened the amount of time doctors and medical staff can give to patients.

As a Canadian American I am a proponent of universal health coverage. I see grave danger in having so many families, children and youth without access to health care. Solutions to these problems are on the way.

As with any other practice I am concerned when practitioners are not curious about the value of other practices – which may be less costly and more efficient in making a child or youth’s growing, living and learning much easier.