Lesse, I have Elle, the mare, who is around to be a companion. Then Daisy the Donkey, who is around to be cute, and to keep away snakes, and annoying dogs. Then there's James, who is my dressage horse. He's 13 this year. The reason cantering is a big deal is because he is recovering from laminitis. We were off riding pretty much from November to March. So we're trying to get back in shape while still treating him for the laminitis.
Usually if a patient goes to the ER (your A&E, I think?) they are seen by an ER doc. If they need to be admitted, and it's late at night, we just call in orders, and see them in the morning. If it's during the day we come see them. But, if they go to one of the smaller hospitals in the outlying areas, then need to be transferred to the pediatric floor, we have to come in to see them and give orders when they get there. I am a pediatrician, so I only see kids. But, I see them in the clinic mostly, and then in the hospital if they need to go there (except the ICU, of course). So, a bit different from a GP. Over there Pediatrics is a specialty, right? Here we're a general practice, but just for kids (yay, kids!).
Ouch, laminitis sucks, glad he's on the mend though, it sounds like he had a pretty serious bout :(
Ah, your system sounds completely different to ours, and more so than I realised. When kids go to A&E (yup, your ER ;) although now we're trying to call it the ED (emergency department) to try to stop people using it for minor things that can be treated at a minor injuries unit or walk-in centre or GP), anyway, when kids go to A&E, they get seen by the A&E docs, then if they're admitted they go under the care of the hospital docs for the duration of their admission. Usually the GP only finds out about the admission after it's happened - they get a discharge letter from the hospital docs when the child is sent home.
Our GPs virtually never come into the hospital, it would be a very rare case indeed if they did (perhaps for a discharge planning meeting for a complex child, but that'd be more likely to be the community paediatrician). Our GPs see adults and children (the community paediatricians see kids if they have particular, more complex conditions), and these might be hospital paediatricians who have a community clinic. But mostly there is a distinct divide between community and hospital care.
So if your kids are admitted, do you have to go see them every day, or just on admission?
Yes, the laminitis was pretty bad, but luckily *keeps fingers crossed* we're working through it.
Okay, I wondered where pedis fit in. I knew they were specialized, but wasn't sure if they went out of the hospital or not. So all the well child care is done by a GP? And then if it's something chronic, or whatever, they see a Pedi? Will it be a forever thing, or only as long as that child has that particular condition?
As for the hospital thing, we have some places that do that here. There can be hospitalists, that either see all the patients, or just the ones that don't have their own doctor, or have doctors that don't go to the hospital. Also, at hospitals with residency programs, the residents can take care of the child the whole time. Where I went to med school they pretty much only had the residents (and attendings) taking care of the patients. Here the residents only take care of their university patients, and then some of the private patients if the pediatrician lets them.
If I have a kid in the hospital, as long as they are on the regular floor, I will take care of them the whole time they are there. That way I know what's going on, and they know who I am and etc.
So all the well child care is done by a GP? And then if it's something chronic, or whatever, they see a Pedi? Will it be a forever thing, or only as long as that child has that particular condition?
Yup that's pretty much it - if the kids got tonsillitis they go to the GP, if they've got something more complex like a heart condition, they'll go to the paediatrician (of course it's never that simple, if the child with the heart condition gets tonsillitis, chances are they'll be seen by their GP not their paediatrician!).
It sounds pretty complicated! I'm kinda glad we don't have that system here, at least if we've got a child that hasn't been seen by a doctor that day we just have to chase their team in the hospital, not get them to come in from home! But like you say, at least then you have one person really leading their care who can make all the decisions.
So what happens if one of your kids in the hospital needs a new line or something? Do the hospital docs do that or do you have to go in for that too?
Does it work like this in adults too? I know a lot more care happens in the community than over here (I remember being astounded that many hospitals do AuSCT as an outpatient service over there, here it's very much an inpatient thing, and talking to people who work on the unit, they were amazed that it's done any other way! I guess it's very much a funding thing, and perhaps insurance companies are more concerned with minimising costs than the NHS - which is probably why we're in the state we are now!)
Hmmm... maybe TMI ;) and TMQ (too many questions ;)) but it's really interesting to see how different systems work... we're in a period of rapid change here (too rapid most of us think) although change has to happen, for the better, 'cos it's pretty bad right now!
No, it's so very interesting to learn about the medical system different from our own. :D So...what sort of line are you talking about? Regular IVs and blood draws are done basically by the RNs. If, for some reason-very rare-, the child needs a central line or more permanent peripheral line, then one of the critical care doctors do it, or a specially trained nurse will do it. Really, the only procedures general pediatricians do are lumbar punctures and circumcisions. Interesting about the Pedis vs GPs. It sounds like the Pedis are kind of in the place that we use the specialists-pedi cardiology/gastroenterology/etc. We send them for second opinions/extra help/etc, but in general we take care of the kid after that. We do a lot of stuff outpatient. Probably a lot because of cost, but it's also nicer for the patient to be able to stay in their own homes. And if they are admitted to the hospital, they tend to only stay there for a short amount of time. I try my best to keep kids out of the hospital, and lots of us will follow a kid who's somewhat sick very closely, and try to treat outpatient-we can always put them in the hospital if they don't do well. Does that happen a lot over there? As for adults, I'm not quite sure, but I think it's pretty much the same. The insurance companies do get a bit annoying, though, at times. We have whole sections of the office who's job is to deal with them. There are games we have to play to get paid, even if we do everything right. And sometimes they try to specify what we can and cannot do. So that's a bit frustrating.
Here's a question for you. What happens when you go to a different country and need care? Do you have a card, or something that you give to them so they charge the NHS, or something?
So if your kids are admitted, do you have to go see them every day, or just on admission? Forgot to clarify (sorry if TMI) if I admit someone else's kid (in my call group) that's all I do. They take over from the next day.
Usually if a patient goes to the ER (your A&E, I think?) they are seen by an ER doc. If they need to be admitted, and it's late at night, we just call in orders, and see them in the morning. If it's during the day we come see them. But, if they go to one of the smaller hospitals in the outlying areas, then need to be transferred to the pediatric floor, we have to come in to see them and give orders when they get there.
I am a pediatrician, so I only see kids. But, I see them in the clinic mostly, and then in the hospital if they need to go there (except the ICU, of course). So, a bit different from a GP. Over there Pediatrics is a specialty, right? Here we're a general practice, but just for kids (yay, kids!).
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Ah, your system sounds completely different to ours, and more so than I realised. When kids go to A&E (yup, your ER ;) although now we're trying to call it the ED (emergency department) to try to stop people using it for minor things that can be treated at a minor injuries unit or walk-in centre or GP), anyway, when kids go to A&E, they get seen by the A&E docs, then if they're admitted they go under the care of the hospital docs for the duration of their admission. Usually the GP only finds out about the admission after it's happened - they get a discharge letter from the hospital docs when the child is sent home.
Our GPs virtually never come into the hospital, it would be a very rare case indeed if they did (perhaps for a discharge planning meeting for a complex child, but that'd be more likely to be the community paediatrician). Our GPs see adults and children (the community paediatricians see kids if they have particular, more complex conditions), and these might be hospital paediatricians who have a community clinic. But mostly there is a distinct divide between community and hospital care.
So if your kids are admitted, do you have to go see them every day, or just on admission?
Jaz
Reply
Okay, I wondered where pedis fit in. I knew they were specialized, but wasn't sure if they went out of the hospital or not. So all the well child care is done by a GP? And then if it's something chronic, or whatever, they see a Pedi? Will it be a forever thing, or only as long as that child has that particular condition?
As for the hospital thing, we have some places that do that here. There can be hospitalists, that either see all the patients, or just the ones that don't have their own doctor, or have doctors that don't go to the hospital. Also, at hospitals with residency programs, the residents can take care of the child the whole time. Where I went to med school they pretty much only had the residents (and attendings) taking care of the patients. Here the residents only take care of their university patients, and then some of the private patients if the pediatrician lets them.
If I have a kid in the hospital, as long as they are on the regular floor, I will take care of them the whole time they are there. That way I know what's going on, and they know who I am and etc.
Reply
Yup that's pretty much it - if the kids got tonsillitis they go to the GP, if they've got something more complex like a heart condition, they'll go to the paediatrician (of course it's never that simple, if the child with the heart condition gets tonsillitis, chances are they'll be seen by their GP not their paediatrician!).
It sounds pretty complicated! I'm kinda glad we don't have that system here, at least if we've got a child that hasn't been seen by a doctor that day we just have to chase their team in the hospital, not get them to come in from home! But like you say, at least then you have one person really leading their care who can make all the decisions.
So what happens if one of your kids in the hospital needs a new line or something? Do the hospital docs do that or do you have to go in for that too?
Does it work like this in adults too? I know a lot more care happens in the community than over here (I remember being astounded that many hospitals do AuSCT as an outpatient service over there, here it's very much an inpatient thing, and talking to people who work on the unit, they were amazed that it's done any other way! I guess it's very much a funding thing, and perhaps insurance companies are more concerned with minimising costs than the NHS - which is probably why we're in the state we are now!)
Hmmm... maybe TMI ;) and TMQ (too many questions ;)) but it's really interesting to see how different systems work... we're in a period of rapid change here (too rapid most of us think) although change has to happen, for the better, 'cos it's pretty bad right now!
Jaz
Reply
So...what sort of line are you talking about? Regular IVs and blood draws are done basically by the RNs. If, for some reason-very rare-, the child needs a central line or more permanent peripheral line, then one of the critical care doctors do it, or a specially trained nurse will do it. Really, the only procedures general pediatricians do are lumbar punctures and circumcisions.
Interesting about the Pedis vs GPs. It sounds like the Pedis are kind of in the place that we use the specialists-pedi cardiology/gastroenterology/etc. We send them for second opinions/extra help/etc, but in general we take care of the kid after that.
We do a lot of stuff outpatient. Probably a lot because of cost, but it's also nicer for the patient to be able to stay in their own homes. And if they are admitted to the hospital, they tend to only stay there for a short amount of time.
I try my best to keep kids out of the hospital, and lots of us will follow a kid who's somewhat sick very closely, and try to treat outpatient-we can always put them in the hospital if they don't do well. Does that happen a lot over there?
As for adults, I'm not quite sure, but I think it's pretty much the same.
The insurance companies do get a bit annoying, though, at times. We have whole sections of the office who's job is to deal with them. There are games we have to play to get paid, even if we do everything right. And sometimes they try to specify what we can and cannot do. So that's a bit frustrating.
Here's a question for you. What happens when you go to a different country and need care? Do you have a card, or something that you give to them so they charge the NHS, or something?
Reply
Forgot to clarify (sorry if TMI) if I admit someone else's kid (in my call group) that's all I do. They take over from the next day.
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