Starting With Curious

Simple.  Declarative.  Forceful.  This isn’t just a fluffy, sentimental, feel-good statement.  This four word sentence is a point of advocacy, a recognition that for too long, and still too often, kids don’t actually get the best. It calls attention to ongoing disparities for kids in health care and other areas of society.  For example, while the overall poverty rate is 14.5%, it’s 22% for children. Only 60% of medications used in both children and adults are approved for and have information on pediatric usage. And payment rates for Medicaid, the primary government insurance for children, are lower than for Medicare, which covers adults.

Few people would disagree with the notion that kids deserve at least as good as adults get.  So why do society’s results fall so short of its ideal?  In many ways, the deck is stacked against children’s issues.  Kids don’t vote.  (And they don’t make campaign contributions.). And because they are basically healthy, while children are 28% of the population, they represent only 13% of all health care spending.  So it makes sense that politicians and policy-makers, and health business leaders, are focused more on adult issues.

Now, saying kids deserve the best doesn’t mean adults don’t, too.  Advocating on behalf of kids to bring them to par doesn’t mean I’m advocating against adults.  I’d love for everyone to have a lower poverty rate, or universal access to medications.  But saying “everyone deserves the best” obscures the message that kids have been missing out.  So with all due respect to my fellow adults, I’ll continue to work to ensure kids get what they deserve.   The Best.

As I often do, I had a wonderful run early this morning on the Hank Aaron State Trail!  Extending 12 miles from Lakeshore State Park, just south of Discovery World, to 124^th St (the portion west of 94^th is unfortunately closed during the Zoo Interchange construction), the HAST provides a vital east-west link in the 117-mile Milwaukee County Oak Leaf Trail system.  While there are many wonderful trails in the Milwaukee area (as described by the Journal Sentinel’s talented outdoor writer Chelsey Lewis), the Hank Aaron is one of my favorites.  Love the combination of seeing the Menominee River, the historic Soldier’s Home, Miller Park, and the now re-industrialized Menominee Valley.  One of the joys of being out on the trail is seeing the vibrant mix of bicycle commuters from Tosa and the east side of Milwaukee (including at least a few Children’s Hospital providers and staff!), along with the predominantly Latino and Hmong families from the near south side neighborhoods through which the trail passes out recreating on the trail, all living out our value of health.

To support that value of health, Children’s Hospital of Wisconsin is a sponsor this year of the annual Friends of Hank Aaron State Trail 5k run, on Saturday, August 6^th.  Proceeds from the run support not only trail maintenance and enhancements, but also programming such as the free Bike Adventure Camps for disadvantaged children from the adjacent communities.  It’s a great way for Children’s to partner with other community organizations to provide opportunities for kids in the area to become the healthiest in the nation.

As part of our sponsorship, we have a limited number of complimentary entries for the run.  If you are interested in joining, please contact Robin Pitts.

Several years ago, we had an exchange student from Norway who needed to see a specialist periodically to have a cyst drained.  The day before a big school dance, she told me she needed to go get it taken care of before the dance.  As in, that afternoon!  I explained to her that in the US you can’t simply see a subspecialist to get a non-emergency procedure done at a moment’s notice.  We have these things called appointments.  And you have to make them.  In advance.

Was this just a cultural difference in expectations based on better medical care access in Scandinavia?  (It turns out you can’t just waltz into the ENT office same day in Norway, either.)  Or was it typical Millennial insistence on instant gratification?  Either way, she asked if maybe she could find someone else to do it.  I then explained that her doctor was one of the best, and no, we weren’t going to find just anyone, who might not do as good a job – quality is worth waiting for.

A lot of us in health care tend to rationalize this way.  Quality is most important; convenience is just a frill.  We feel pretty good if our time to next appointment is “only” a week or two.  Yet I routinely get requests from people inside the system who have to wait that long for a family member to see if there is anything that can be done to get them in sooner.  I heard a colleague at another hospital talk about how nearly every day she helps friends and “important donors” get quicker access.  Not only does this create a two-tiered system of easy access for those with connections while regular folks have to wait, it belies the assertion that convenience isn’t important.  Timeliness is one of the six domains of quality espoused by the Institute of Medicine. And while we tend to associate such impatience with the Millennial generation, it appears to be pretty important to the Boomers whom my colleague keeps listed on her phone.

Data from a Healthgrades survey in 2014 suggest that in choosing a physician or hospital, convenient location and hours were cited as factors far more often (56-62%) than outcomes (22-30%).  While this may be accelerating, this has been true for some time: a 2000 study from University of Nebraska of factors used in choosing a primary care physician found that wait time for an appointment was as important as whether she/he had any malpractice history, and more important than factors such as the doctor’s training or years of experience.

To the extent that the prioritization of convenience is a bigger issue for the Millennial generation, then those of us in pediatric health care need to be especially ready to address this, as the Millennials are the parents of our patients.  And they aren’t willing to wait for what they want.