SOAP (Organization of a Doctor Visit)

I recently had a college student observe me in the office because she wants to be a pediatrician.  I spent a few minutes explaining to her how a visit is organized so I thought I would also share that information with you.  One of the first things a medical student learns about seeing patients and charting is "SOAP"  This stands for Subjective, Objective, Assessment, and Plan.  This is the order in which the visit and the charting is done.

Subjective means the information that we get from the patient. This includes history of the present illness, past medical history, family history, medications, allergies, etc.  Some of this we ask every visit and some of it we review in the chart before coming into the room. It is very helpful if you voice all of your concerns and problems at this point in the visit.

Next is the objective part of the visit.  This means the physical exam as well as vitals signs such as weight, temperature, blood pressure, etc.

For the next step, assessment, the doctor takes the information that she gathered in the first two steps to come up with a differential or list of what things the patient might have. Sometimes this is very easy, for example a bulging red ear drum means you have an ear infection or sometimes there are several possibilities of what you might have.  I sometimes don't say a lot when I am examining a patient because I want to collect all the information and then I think while I am washing my hands before I sit down to talk with you.

The last step is the plan. Together the doctor and patient discuss treatment recommendations.

Since September the assessment and plan for all of your child's visits are available for you to view online (securely of course).  The front desk has the directions on how to access this information for you.

Frost the Cupcake (Sunscreen)

I know that sunscreen is not a very popular topic in the winter time but sunscreen is important year round.  I recently attended a continuing education conference where I heard a dermatologist (Dr. Wagner) speak on this subject so I thought I would share some of it with you.

I'm sure I don't need to tell you about why sun protection is important.  Skin cancer, wrinkles... who wants them?  (By the way teens don't care about skin cancer so they are more likely to protect their skin if they think that the sun will make them ugly!)

It is best to get in the habit of applying sunscreen every morning.  Make it part of your morning routine such as brushing your teeth.  Then if you are going to be in the sun such as going to the pool or park reapply the sunscreen 20-30 minutes beforehand and every two hours after that.  Dr. Wagner related applying sunscreen to "frosting a cupcake."  You want to apply a lot and to not miss any part of the cupcake, er, skin.  It is safe to use sunscreen on babies less than 6 months of age.

So, what sunscreen to buy?  Dr. Wagner recommends a sunscreen with the SPF of 30.  There is little benefit to the higher SPF sunscreens and as the SPF increases there are increased chemicals in the product. You also want to pick a sunscreen that is waterproof and protects agains UVA and UVB (aka broad spectrum). Some of the best ingredients include mexoryl and zinc oxide.  Also if possible get a sunscreen that is perfume free.

Let's not wait until summer. Let's start frosting the cupcake now!

What ER Do I Take My Child To?

You think your child broke their arm or that they might have appendicitis so what do you do?  First of all, give our office a call.  Sometimes we can help avoid an ER visit.  Then if you need an ER we recommend a children's hospital such as Phoenix Children's Hospital or Cardon Children's Medical Center.

So, why a children's hospital.  I know that there is probably another hospital closer to your house or one that advertises shorter wait times but we strongly urge you to go to a children's hospital.  At a children's hospital you will get a doctor and staff that specializes in pediatrics.  Children are not just small adults and they have different problems and different needs.  I commonly see my patients receive unnecessary tests or medications from "adult" ERs.

Another reason to go to a children's hospital is for the specialists.  For example, if your child might have appendicitis the results of tests such as ultasound or CT can be dependent on the tech or radiologist's experience with children.  Then if your child needs surgery they will have to be transferred to a children's hospital for the surgery and admission.

Lastly, I would go to a children's hospital for the Child Life specialists.  These therapists help make your child's stay less stressful and painful.