Mi Casa Es Su Casa

Let me ask you a question. Your receptionist receives a call from the mother of a 7-month-old who has been feverish and irritable for 3 days. She is visiting from out of state and staying with a family whose three children have been your patients for 13 years. The mother is “pretty sure” that her insurance will cover an out-of-network visit.

Would your receptionist: (a) schedule an appointment, (b) ask you if it is okay to book the appointment and then warn the mother that she will have to pay at the time of the visit, or (c) suggest that the family take the child to the emergency department?

What would your answer be if the scenario included that this child from out of town also was the niece of one of your nurses?

I ask this question because the issue of how one manages visiting families comes up almost weekly in our office. Because our license plates here in Maine include the slogan “Vacationland” and because Brunswick sits on the shores of scenic Casco Bay, we have lots of visitors.

Our policy has always been to find an appointment slot for someone who tells us they are visiting from out of town regardless of whether they have been referred by a family that we know. I hope that the bulk of our motivation is just old-fashioned New England hospitality. But, a lot of it is just habit. In the not-so-good old days before there were such things as emergency department physicians, we were going to end up seeing the patients from out of town anyway. And it was usually more convenient for us to have them come to our office.

Even when staffed with well-trained physicians, an emergency department is usually not the optimal diagnostic or therapeutic setting for a moderately ill young child or infant. And most families who are accustomed to good office care at a medical home know this.

Although it's hard for me to imagine why anyone who lives in Vacationland would want to travel out of state, from time to time it does happen. And, when our patients' families return we occasionally hear horror stories of their attempts to find pediatric care. I recently had a mother tell me that a referral from a current patient and an offer to pay cash failed to unlock the tightly guarded pediatric office in the suburban community where she was visiting her parents.

I am sure that there are some communities with large transient populations in which our visitor-friendly office policy might be committing economic suicide. And, I suspect that many larger communities have emergency departments that can offer nonurgent pediatric care that would pass my “Is it good enough for my granddaughter?” test.

However, it troubles me to hear how shabbily some of our families are treated when they venture far from their children's medical home.

When we became fellows, the American Academy of Pediatrics didn't ask us to promise that we would see any patient who has a medical home supervised by one of our brother or sister pediatricians. Nor do any of us have written contracts with the families in our practices stating that we will agree to see any child who comes to visit them. But, if you have found yourself in a strange town with a sick child as I have, you know what you should do when a distraught mother visiting from out of town calls your office.

Let me ask you a question. Your receptionist receives a call from the mother of a 7-month-old who has been feverish and irritable for 3 days. She is visiting from out of state and staying with a family whose three children have been your patients for 13 years. The mother is “pretty sure” that her insurance will cover an out-of-network visit.

Would your receptionist: (a) schedule an appointment, (b) ask you if it is okay to book the appointment and then warn the mother that she will have to pay at the time of the visit, or (c) suggest that the family take the child to the emergency department?

What would your answer be if the scenario included that this child from out of town also was the niece of one of your nurses?

I ask this question because the issue of how one manages visiting families comes up almost weekly in our office. Because our license plates here in Maine include the slogan “Vacationland” and because Brunswick sits on the shores of scenic Casco Bay, we have lots of visitors.

Our policy has always been to find an appointment slot for someone who tells us they are visiting from out of town regardless of whether they have been referred by a family that we know. I hope that the bulk of our motivation is just old-fashioned New England hospitality. But, a lot of it is just habit. In the not-so-good old days before there were such things as emergency department physicians, we were going to end up seeing the patients from out of town anyway. And it was usually more convenient for us to have them come to our office.

Even when staffed with well-trained physicians, an emergency department is usually not the optimal diagnostic or therapeutic setting for a moderately ill young child or infant. And most families who are accustomed to good office care at a medical home know this.

Although it's hard for me to imagine why anyone who lives in Vacationland would want to travel out of state, from time to time it does happen. And, when our patients' families return we occasionally hear horror stories of their attempts to find pediatric care. I recently had a mother tell me that a referral from a current patient and an offer to pay cash failed to unlock the tightly guarded pediatric office in the suburban community where she was visiting her parents.

I am sure that there are some communities with large transient populations in which our visitor-friendly office policy might be committing economic suicide. And, I suspect that many larger communities have emergency departments that can offer nonurgent pediatric care that would pass my “Is it good enough for my granddaughter?” test.

However, it troubles me to hear how shabbily some of our families are treated when they venture far from their children's medical home.

When we became fellows, the American Academy of Pediatrics didn't ask us to promise that we would see any patient who has a medical home supervised by one of our brother or sister pediatricians. Nor do any of us have written contracts with the families in our practices stating that we will agree to see any child who comes to visit them. But, if you have found yourself in a strange town with a sick child as I have, you know what you should do when a distraught mother visiting from out of town calls your office.

Let me ask you a question. Your receptionist receives a call from the mother of a 7-month-old who has been feverish and irritable for 3 days. She is visiting from out of state and staying with a family whose three children have been your patients for 13 years. The mother is “pretty sure” that her insurance will cover an out-of-network visit.

Would your receptionist: (a) schedule an appointment, (b) ask you if it is okay to book the appointment and then warn the mother that she will have to pay at the time of the visit, or (c) suggest that the family take the child to the emergency department?

What would your answer be if the scenario included that this child from out of town also was the niece of one of your nurses?

I ask this question because the issue of how one manages visiting families comes up almost weekly in our office. Because our license plates here in Maine include the slogan “Vacationland” and because Brunswick sits on the shores of scenic Casco Bay, we have lots of visitors.

Our policy has always been to find an appointment slot for someone who tells us they are visiting from out of town regardless of whether they have been referred by a family that we know. I hope that the bulk of our motivation is just old-fashioned New England hospitality. But, a lot of it is just habit. In the not-so-good old days before there were such things as emergency department physicians, we were going to end up seeing the patients from out of town anyway. And it was usually more convenient for us to have them come to our office.

Even when staffed with well-trained physicians, an emergency department is usually not the optimal diagnostic or therapeutic setting for a moderately ill young child or infant. And most families who are accustomed to good office care at a medical home know this.

Although it's hard for me to imagine why anyone who lives in Vacationland would want to travel out of state, from time to time it does happen. And, when our patients' families return we occasionally hear horror stories of their attempts to find pediatric care. I recently had a mother tell me that a referral from a current patient and an offer to pay cash failed to unlock the tightly guarded pediatric office in the suburban community where she was visiting her parents.

I am sure that there are some communities with large transient populations in which our visitor-friendly office policy might be committing economic suicide. And, I suspect that many larger communities have emergency departments that can offer nonurgent pediatric care that would pass my “Is it good enough for my granddaughter?” test.

However, it troubles me to hear how shabbily some of our families are treated when they venture far from their children's medical home.

When we became fellows, the American Academy of Pediatrics didn't ask us to promise that we would see any patient who has a medical home supervised by one of our brother or sister pediatricians. Nor do any of us have written contracts with the families in our practices stating that we will agree to see any child who comes to visit them. But, if you have found yourself in a strange town with a sick child as I have, you know what you should do when a distraught mother visiting from out of town calls your office.