Why 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 written

These days 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.

Reading the 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.

Getting sent 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.

Would you 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?

Pediatric 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 rheumatologist.

For 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.

Click here if you are interested in making an appointment to see Dr. Lehman


My book –click here to order at a discount from Amazon.com!!

 at Amazon.com

    Dr. Tom Lehmans experience and compassion are evident on every page of this book, and they help guide the readerchild, 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 growing pains.
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments


Click here to see the table of contents

It 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.

The 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 goldscout@aol.com

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