Tag Archives: healthcare

Babies+Hospitals- a Good Mix (Pedcast)


Welcome to another edition of DocSmo.com…the pediatric blog that brings you portable, practical pediatric information. From diapers to the diploma, if its kid related, we take it on. I’m your host and founder of DocSmo.com…. Dr. Paul Smolen. Parents often ask me why their baby needs to be born in a hospital and why they need to stay for a while after birth? Continue reading

What Makes an Effective Doctor Visit? (Pedcast)

Have you ever stopped to think what makes an effective visit to the doctor?  Get Dr. Smolen’s perspective on the subject from the doctor side of the equation in today’s pedcast.  Dr. Smolen outlines what he considers essential features of a well run visit to the pediatrician.



DocSmo here welcoming you to another edition of DocSmo.com, the podcast that helps parents with issues from the diapers to the diploma, from the crib to the country club, from the bassinette to the board room… well, you get the idea.



I have been training young doctors for 30 years

One of the things I certainly want them to learn is how to perform and provide an effective evaluation of a sick child.

During my long career I have given a lot of thought as to what makes a good sick visit both for the doctor and the patient.

So today I thought it might be fun for my listeners to hear what this pediatrician considers the essential elements that make a doctor visit effective.

I have previously done a podcast on how to choose a doctor as I see it.  Today you are going to get a little more on that subject as I reveal what I think makes a good visit to the doctor.

After listening to today’s cast, you will have an idea if your child’s doctor would meet the quality standards that I have strived to achieve for myself and my physician students.

In today’s pod cast I will concentrate on the sick visit and not the well supervisory visits.

Let’s go ahead and jump right in, shall we?


So here we go, you are in the exam room and the doctor walks in.


I think the visit should start with an introduction to both the parent and the child.  I like to shake hands or bump elbows during flu season…you know, the CDC approved handshake.

Next comes the ceremonial and visible washing of hands.  Let’s start clean, that’s important.

An open-ended question usually starts the visit which brings up something I consider really important…parents and children need a chance to tell their story without interruption. The families have prepared what they are going to say and it is important that as doctors, we give them a chance to say it in an unhurried manner.

After they have given us what they consider important information, then we as doctors are free to start asking all the questions we want.

I like to let the child who is old enough to have a chance to answer as many of the questions as possible. It’s good practice for them and I get to see their reaction to their symptoms, often very valuable information. After all the history is collected, I try and repeat the important stuff back both to let them know I was listening and make sure I have the story right.


Next comes the examination, which may be difficult for many children.  I always try and do this on the child’s level and in a position that is most comfortable for the child.

For toddlers, that’s being held.

For older children, I try and tell them as much of what I am doing as possible as I do it.  They seem to appreciate this.

Once I have gotten the history and done my exam, it’s time to talk out loud

At this point it’s time to teach.

I explain what I think is happening, why it is happening, and whether there is anything I think will help.  Often this leads to a discussion of the natural history of a particular illness and maybe a little science talk… long time listeners know DocSmo loves science talk.

I give the family some measures that may be helpful and I make sure that there is a plan that is clearly described.  I try and repeat the plan twice or I sometimes even write it down.  I probably should do more of that than I do.


I think it is important to give the family an idea of what new symptoms would worry me and prompt a call back, thus opening the door to feel free to call back with worries


This is the beauty of private practice, of knowing your patients well. I am almost guaranteed follow up for those who need it.  They know and trust me and my staff,  and most of the time are very comfortable calling and giving us follow up.  Rarely do we have a patient who gets much worse after a sick visit without our knowledge.


So, that’s my take on how to provide an effective sick visit: It’s really pretty simple:

The process should include a comfortable and effective exchange of information between the family and the doctor that ensures accuracy and completeness. In my business, gathering a history and listening carefully is the most important part of most visits.

Next, we try and achieve an examination of the child that is as unobtrusive and comfortable as possible for the child.

Next, I think it is important for the doctor to create a conclusion and plan that is clearly laid out and repeated to ensure understanding and agreement.

And finally before leaving, a parent should understand that  they can call back with questions or concerns as well as  know what to look for should the child’s condition deteriorate.



That’s one pediatrician’s take on a good sick visit and I am anxious to hear your perspective.

Feel free to write in with your observations and comments, I welcome them

If you think as doctors we do something poorly, tell us!

I think this cast may generate a lot of interesting comments, or at least I hope so.

If you like what you hear in these DocSmo pod casts, share them with your friends.  I won’t stop you if you want to write a 5 star comment on itunes and be sure to subscribe so you will get the latest content hot off the DocSmo press.  If you are a face book fan, like us there or follow us on twitter.

This is Dr. Paul Smolen, broadcasting from studio 1E, that’s my first child’s bedroom on the east side of the house, hoping that you now have a lock on your next visit to the doc.

Until next time.

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From the desk of Doc Smo: A Constipation Conversation (Article)

How many ways can constipated children come to the doctor?
I am totally amazed at the myriad of presentations that constipated children present to their doctors. I remember listening to MANY complex lectures in medical school and residency about recurrent abdominal pain and trying desperately to memorize the LONG list of conditions that present as recurrent abdominal pain in children. After all these years of clinical practice, common sense has finally taken precedence. Hold onto your seats for this DocSmo pearl: “Common things are uncommonly common.” In other words, don’t look for exotic illness when, most likely, everyday maladies are probably at work. Humans have two “common” reasons their stomachs hurt:

1. A lower intestine that is not completely emptying (Constipation)
2. An overly acidic stomach that doesn’t empty well and may actually reflux (send contents backwards) into the esophagus.

Let’s take a moment to talk about the first cause, constipation. Little kids—and even big ones—sometimes find pooping unpleasant. At some level they avoid it, and it catches up with them. When it does, they come to the doctor complaining of cramping pain (hollow organ trying to empty), feeling sick after eating (nowhere for food to go from the stomach), gas (excess fermentation in the colon), burping (slow gastric emptying), back pain (referred pain), vomiting (no room in the Inn), bloating, leaking stool, rectal pain, prolapse of the rectum… and the list continues. I am sure that another 30 years will bring many new variations on the same theme.

I really think we may have been better off when we lived outdoors, pooping wherever and whenever. I doubt children growing up in those conditions ever had stomachaches for the reasons we do now. Everything has to be so perfect for our children. They need to poop at the right time (when an adult says it’s ok), only in “approved” places, and quickly and cleanly: the so called Demand Poop. No wonder all the fuss!


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How to Choose a Doc (Pedcast)

How would a pediatrician choose a pediatrician. Listen to my thoughts on finding a pediatric practice that will be a good fit for your child and your family.

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

All Rights Reserved.