The dance: School letters/forms & docs/allergists

[LinksEtc]

Getting school letters (ex - 504 eligibility letter) & forms filled out from docs/allergists (in a way that we are satisfied with) can be tricky at times.

The docs are busy, and let's face it, forms/letters are not that interesting or fun.  Plus some docs are not familiar with 504 elig requirements or the details of certain forms.  In addition, many of us here have our own opinions about medical stuff like hives but there are times the docs may disagree.

For us, forms/letters are important - we are developing formal plans for how our children's allergies will be handled by the school.  The way these things are written matter greatly.

So this is just a general thread about tips and things we've learned about this topic.  Both docs & us will benefit if we can work well together.

[LinksEtc]

I guess I'll start ...

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Things that have worked for me:

1.  Sitting down with the doc while the form is being filled out, and talking together about any concerns/issues/requests.

2.  Asking the doc if they would mind if I wrote up a draft of a letter or if I filled out a form a certain way (which they then sign/date).

3. Being willing to change my mind and be flexible as long as the doc has a good reason for writing a form/letter a certain way.

4. Ask for reasonable stuff.

5. Be considerate of the docs feelings & time. 

6.  Small polite gestures.  For example, somebody here suggested sending a stamped self-addressed envelope if requesting a change.

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Things that have not worked as well:

Talking ahead of time (or even writing my requests on a separate sheet of paper) about a form to be filled out by somebody at the office at a later date.

Being too much of a perfectionist.

Asking too much at once.  (some appointments are short and they are often only once a year.  With a new doc that didn't know me, I tried to squeeze in too much at once ... too many detailed questions, being too picky with the forms, etc.). Although it wasn't my intention, looking back, I can see how it came across the wrong way.

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Things that have really not worked out.

If I feel a doc is really shutting me out of the process and not giving me a say. 

If I feel that a doc is not "hearing" my concerns or is overly dismissive of my perspective.

Ok (cringeworthy moment)... I deserve a big  for this  ... really, I must not have been thinking ... NEVER use a red pen if requesting changes to a form and don't request a "correction" to the form.  Use soft language. 

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Even if you are 100% sure that you are right about an issue and the doc is wrong (I had this happen once - state law would not allow the school to follow the doc's orders as written) - be so extremely diplomatic.  If you make it into a battle, even if you're right - you lose.

In the end, good docs & parents want the same thing - for the kids to be safe at school.  I have found that most docs have been easy to work with and helpful, but it's important to keep in mind that sometimes personalities and expectations aren't a good fit.

Does anybody else have any tips for working successfully together?

[MomTo3]

I guess I'm kind of confused.  Why does the Dr. need to be involved with the 504 plan at all? 

We have 3-5 forms for the Dr. to fill out. 

1) FAAP
2) 2- medication administration forms (1 for epis and 1 for benadryl)
3) General health form
4) 1 "This is why this kid qualifies for a 504- this is the daily activity that is adversely affected"  This was provided to the school before our first 504 meeting and nothing more was needed for "qualifying".


I guess I don't see why the Dr. should be bogged down with much more than this. Most of them don't get the in's and out's of daily allergy life so I'm not sure how helpful they will be with much more.  Perhaps I've just been really lucky with our schools and Dr's but

[LinksEtc]

I guess I'm kind of confused.  Why does the Dr. need to be involved with the 504 plan at all? 

We have 3-5 forms for the Dr. to fill out. 

1) FAAP
2) 2- medication administration forms (1 for epis and 1 for benadryl)
3) General health form
4) 1 "This is why this kid qualifies for a 504- this is the daily activity that is adversely affected"  This was provided to the school before our first 504 meeting and nothing more was needed for "qualifying".


I guess I don't see why the Dr. should be bogged down with much more than this. Most of them don't get the in's and out's of daily allergy life so I'm not sure how helpful they will be with much more.  Perhaps I've just been really lucky with our schools and Dr's but

I'm really talking in general terms about our FAS experiences getting school forms filled out and letters written.  As more people are requesting 504's, I'm just wondering if discussing this topic might help the process go more smoothly for others.

For myself, what I wrote about above is related to my experiences with different docs over a period of several years.

For example, with our 504 eligibility letter ... We discussed things with our allergist and I think I gave him a printout of the basics that should be in the letter, but when I got his letter it didn't have all of the basic stuff needed like the "major life activity" stuff.  I didn't want to offend him and I really appreciated his help, but I needed the letter revised.  So I called the office and asked if they wouldn't mind if I wrote up a draft ... the nurse was skeptical that he would sign, but agreed.  They put my draft on his letterhead and he signed and the school accepted that dd qualified.

Another example .... there is this one school form that drives me crazy.  It is for non-medical staff and the nurse told me those employees get nervous sometimes and they really go by what is written on the form.  One line on the form has things like "itching", "tingling", & tongue swelling on the same line.  So if the doc checks the line, dd might get epi for the slightest rxn which wouldn't make sense in our situation ..... and if it's not checked, she might not get epi if her tongue swells which I would want her epi'd for.  So the other alternative is to write a sentence or two clarifying the situation.  When I've tried asking the docs to write the clarification, I haven't been entirely successful .... but when I asked for and received permission from the doc to write it in myself, it was easy.  Oh, another tip from this story - I had my mom write in the doc's part of the form (except signature/date) so the school wouldn't think that I wrote it in  .

Another time, I requested a slight change to a form and the doc said she'd prefer to write it in a different way to keep it simple for the school.  That made sense to me so I was fine with her decision.

I hope that explains where I am coming from a little better.

[LinksEtc]

My dd once asked me if she was weird because she liked cleaning.  I'm beginning to wonder about my attachment to forms.   

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Where others seem to see a chore, I see an opportunity to make sure kids with FA and/or asthma are safe.

I think my meticulous nature that makes me an ideal mom in terms of asthma/FA compliance (ex - taking the meds as directed, carrying epi, etc.) can drive docs bonkers (if I am not very careful in my approach - which I try to be now) when it comes to school forms.

Dd had a pulmo appt & the doc printed me off 2 copies of the asthma plan and said I could give one to the school nurse for next year.  I told him that the school won't accept medical forms for the next year that are dated prior to the summer.  He said something about that being school policy, not law, & that we all should start to fight back (not his exact words ... just my rough take on the conversation).

He has lots of patients and that would be an issue if they all needed forms in the summer.  Plus, he seemed to be under the impression that all that was needed was the hospital's asthma plan .... but in our state, if a child wants to self-carry asthma meds (my dd has now for a few years) a separate school form also needs to be signed off by a doc. 

I see lots of areas where the handling of school forms could be improved.  I wish docs, patients, & schools could iron out some of the kinks.

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While I'm on this topic, I was once caught in the middle when the school nurse wanted me to use the school's asthma & allergy forms/plans ..... while the docs wanted me to use their hospital allergy/asthma plans.  No matter what I did, somebody was not going to be happy.

[LinksEtc]

Tweeted by @RobertPearlMD

"Does Your Doctor Feel More Like a Medical Clerk?"
http://health.usnews.com/health-news/patient-advice/articles/2014/05/20/does-your-doctor-feel-more-like-a-medical-clerk

Physicians say they're mired in paperwork – and why it matters to patients.

With pressures to see more patients each day, doctors have fewer minutes to spend with and listen to each individual

[CMdeux]

Exactly, Links-- that's a great find, btw.


One to add to your list of best practices--

give your doc whatever it is that you want/need in clear, well-written language, and explain WHY you need what you need-- in writing and in electronic form.  I drop things off with a USB drive in an envelope.  I also give the doc permission to cut and paste to his heart's content.

If specific language/phrasing is key, I say so.

Then I try to give him AT LEAST a week or two to produce documents. 

This has (over time) led to an incredibly positive working relationship with our allergist.  He has learned that I do my homework-- well-- and that I can save him a lot of time.  I'm not offended if he makes changes that are based in his medical opinion, and I am super careful never to overstate things, and to (in my own language) use the terms he's shown me that he prefers.

  I've learned that he is REALLY hard-working and busy, but that he knows his stuff.

[LinksEtc]

I think the process of setting up a 504 requires a spike in the amount of help & time needed from an allergist/doc.  This should maybe be acknowledged and talked about up front?  There will probably be more sharing of info, more questions & discussions, more letter/form fine tuning, etc.  Maybe the allergist would prefer you set up a separate appointment to allow for more time & fairer payment ... maybe there are other approaches that the particular doc/patient pair would prefer.  Maybe some hospitals/offices will have a greater role for nurses or other office staff in coordinating 504 work.

It's important for the doc to know that this is a special situation, that most visits will most likely be normal/routine.

Now that FARE, KFA, etc. are more involved with 504s - certain processes, letters, recommendations, etc. might become more standardized (hopefully not too cookie cutter as individual circumstances might warrant special accommodations) ... but right now, a lot of allergists/docs may not have helped set up too many 504 plans.

Keep in mind that your stress level also may be up a bit so watch how you are communicating.

Many of us have done a lot of research on 504s before asking the doc to get involved ... but if the doc-patient relationship is not solid/strong (ex - new doc) ... you may want to be extra careful in your approach so you don't unnecessarily annoy the doc, overwhelm with sharing too much info, appear to be a google think-she-knows-it-all-mom, a challenging mom, a mom who will use up too many office resources, etc.  (or dad or other caregiver  )

So this is not necessarily stuff most people would think important to put in a forms thread, but I see the value of including it here so I am linking as I often do.   


Docs helping patients to surf the internet

"Are you giving your doctor a headache?"
http://www.cnn.com/2011/HEALTH/07/07/ep.doctors.complaining.cohen/

getting information from other patients online is dangerous because "you don't know who these people are."

Share Internet information with your doctor wisely. Don't walk in with a stack of printouts that your doctor won't have time to read during the appointment.

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"Doctors Confess: 11 Most Annoying Things You Do"
http://www.rd.com/slideshows/annoying-patients/?utm_content=bufferd925c&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Ask too many questions.

If you have three pages full of questions, show them to the nurse. Say ‘How many of these should I wait to ask the doctor about? How many can you help me with?’”

"Doctors Complaints About Patients' Behavior"
http://patients.about.com/od/doctorsandproviders/a/doctorcomplaints.htm

Some doctors just don't want to work with empowered patients. They can't be bothered, or they are intimidated. Mary Shomon, the About.com Guide to Thyroid, reported that a doctor she used to see wrote "petite papier" (meaning "little paper" in French) on some patient records. The notation referred to the fact that Mary did much of her own research, and would compile questions ahead of visiting her doctor.

I think that a lot of docs like educated patients, but there are other issues like time, communication style, respect, understanding that the docs are the experts, different perspectives, etc.  I've definitely made mistakes in how I approach docs with internet info.

Tweeted by @Talking2YourDoc

"Understand patient expectations as part of a negotiation"
https://www.acpinternist.org/archives/2014/07/communication.htm

Doctors have things they want to address, but patients have things they want to address.

And there should be an explicit negotiation about the agenda of the visit. Both parties should realize that there’s going to be a negotiation, and that means that neither party is going to be completely satisfied.

[LinksEtc]

"Sympathy For The Doctor.  On the Unmeasurable Toll of Bureaucracy in Medicine"

http://www.forbes.com/sites/elaineschattner/2014/08/07/sympathy-for-the-doctor/

I’d suggest that her story points to a serious problem in health care: A physician’s time is insufficiently valued.

There’s no denying the huge cost, and hassle, of paperwork for pre-authorizations of drugs and procedures, insurance coding, etc.

the reality is that many hospitals are cutting back on ancillary support, such as secretaries and clerks

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I don't think that I have too much more to add to this thread.  Whether for forms/504 or other doc-patient issues, there's not going to be a one-size-fits-all approach to working well together ... but if both sides have a commitment to the following, I think that it will help a lot:

Communication, empathy, respect, & shared decision making.

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I know that I got a little deep for a forms thread  , but my thoughts go where they go at FAS  .


If anybody has any other tips on working with the doc to get forms filled out or setting up 504s, feel free to post here.  Even very simple & short tips might prove helpful to others reading this thread.