should I insist my child see a specialist????
This page is provided by Thomas J. A. Lehman MD
Delivering the best care - with great care
Dr. Lehman is the
author of many textbook chapters and articles on the care of children and young
adults with rheumatic disease. He
practices in New York City. Click
here for more information about Dr. Lehman or
the Hospital for Special Surgery.
If you want a
more detailed discussion click here for information regarding a book I have
it's getting harder and harder to see a specialist. If you have preferred
provider or health maintenance organization insurance you will often find it
necessary to ask for referral to a specialist. Some plans have specialists on
their panel, others don't. If there is no specialist on the panel you will have
to ask for outside referral. Some plans are happy to oblige. Others make it
difficult. You may have to work hard to get a referral and you might need to
pay extra money for seeing a doctor outside the plan.
Is it worth it?
Well I'm a specialist so I'm biased. What do I tell my patients?
Medicine is still an art, not a science.
Experience and wisdom play a major role in making the right choices and getting
the best results. It's true that every doctor graduated from medical school. Still,
you wouldn't want me to treat you for cancer or operate on you.
book is not a substitute for experience. Think about making soup. If I open up
a cook book and put a chicken, a few carrots, an onion and the recommended
amount of spices in a pot with 4 cups of water, set the stove on medium and
walk away for two hours; I might come back and find good soup or a burned pot
with charred vegetables on the bottom. An experienced cook would be checking on
the soup every 20 to 30 minutes, watching the heat and water level and
readjusting everything as necessary. Experienced doctors are like experienced
cooks, they know what to watch out for, what the hidden tricks in the recipe
are, and how to adjust for things that don't seem to be going right.
to the specialist might cost you extra money. However, it should give you more than
your money's worth in good advice and peace of mind. Many parents and children
come to me with little understanding of the disease, the medicines, or what to
expect. Often they have had hundreds of dollars of unnecessary tests, but never
the right ones. In many other cases their doctors can't figure out why they are
sick. To put it briefly, you can't diagnose what you never thought of. This isn't a matter of
'good' or 'bad' doctors, it's a matter of experience and specialization.
have the guy who makes lunch sandwiches at the deli cook a fancy roast beef for
a dinner party? Or would you go to someone who routinely cooks for fancy dinner
parties? Either way you might do fine, but which would you do if 'the boss' was
coming over for dinner?
rheumatology is a unique subspecialty staffed by physicians who have proven
training and experience in treating children with arthritis. They have a
minimum of three years training in pediatrics and at least two further years of
training in the care of children with arthritis. Your doctor will be able to
tell you if he is American Board of Pediatrics certified in Pediatric
Rheumatology. If not, you can get a listing of Board Certified physicians at
your local medical library. Pediatricians with other subspecialties and adult
rheumatologists also take care of children with arthritis. Some are very good,
but none will have the experience and resources of a fully trained pediatric
more information on the difference a seeing a specialist could mean to your and
your child see …
Dr. Lehman is
the author of many textbook chapters and articles on the care of children and
young adults with rheumatic diseases including SLE, JRA, dermatomyositis,
scleroderma, Kawasaki disease and related
conditions. He practices in New York City. Click
here for more information about Dr. Lehman or the
Hospital for Special Surgery.
book –click here to order at a discount from
“Dr. Tom Lehman’s experience and compassion are evident on every page of this
book, and they help guide the reader—child, parent,
and healthcare professional alike – through the
world of childhood arthritis. This book
is an absolute gem written with a single goal in mind: improve the lives of kids with arthritis.” -- Jack Klippel, M.D. President and
CEO of the Arthritis Foundation
“Dr. Lehman has given parents and families of children with
arthritis the first book that speaks to the parent and child as equals. His book explains the illnesses, the
medications, the lab tests, and the disease course in simple, understandable
lay language and givens them valuable insight into how a pediatric rheumatologist
thinks. Bravo!”-- Charles Spencer, M.D.,
Professor of Clinical Pediatrics, University
of Chicago, La Rabida
It’s not just
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments
Click here to see the
table of contents
has always been a frustration trying to answer the many questions I have
received from people over the web. I can’t
take the time and give them the detail I would like to. I have to take care of my patients. This book is a distillation of my experience
answering questions for parents and health professionals over 25 years of
practice. If you want to know about the
diseases, the tests, the medications, or how to be sure you are getting the
best care– If you are the family member of a child with joint pains, this book will
give you the answers. If you are a general physician, a
pediatrician, or a nurse who cares for children with these diseases it will
answer many of the questions families ask you, and you can recommend it to
them. It will also answer many of your
questions about what shots to give, what precautions to take, and the other
questions families, pediatricians, and other health care providers have asked
me over the years.
major cause of poor outcomes for children with rheumatic diseases in the United States today is the
delay in getting the proper diagnosis and the proper treatment. The majority of children under the care of an
experienced pediatric rheumatologist do well.
For too many children it took too long to get to an experienced
pediatric rheumatologist. Fireman are great at putting out fires, but
if you want to prevent the house from burning down you have to call them at the
first sign of a fire, not wait until you’re sure you are in trouble. With proper medication we can stop most
rheumatic diseases, but we can’t always repair all the damage that was done
before the child got to us. I want
people to read my book so they can be sure they are getting the proper care for
their children. Then I want them to share the book with their doctors so their doctors
can be sure they are giving children the proper care.
Click here to order -- at Amazon.com
This site provided by
Thomas J. A. Lehman MD
Chief, Division of Pediatric Rheumatology
The Hospital for Special Surgery
535 E 70 St, New York, NY 10021
212-606-1151, fax 212-606-1938, e-mail firstname.lastname@example.org
erythematosus, dermatomyositis, Scleroderma, progressive systemic sclerosis, pss, jra, juvenile rheumatoid
arthritis, childhood arthritis, growing pains, rheumatism, children with pain,
bone pain, pediatric specialists, my child hurts, chronic disease, chronic
childhood illness, the best care, Kawasaki disease, mixed connective tissue
disease, SLE, JCA, JIA, juvenile chronic arthritis, sports injuries, frequent sports injuries,
cyclophosphamide, Methotrexate, diclofenac, voltaren, Relafen, children’s health care, educational
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