Navigating the Health Care Maze

I want to tell you what pediatricians used to do decades ago, but I want you to understand that we didn’t have today’s resources, and we were incredibly inefficient with our time.

By Dr. Robert B. Golenbock

On the other hand, we didn’t have the same challenges with insurance that we do now. So, what was it like? Pediatric offices were available six days a week, but pediatricians also went to the hospital twice a day to see inpatients and newborns, and made house calls, especially for patients who didn’t have a car available. Usually, that meant the mom was home with the child while the husband drove to work. We were available for phone calls at all times. If there was an emergency, we met the child in the office or at the emergency department. We also ran to the hospital to attend Cesarean sections or premature births. We often took time to sew up small lacerations. We billed the patients, and they dealt with the insurance. If there was a financial problem, we worked out a payment plan or reduced the fees.

I do not miss those days! And not because I didn’t like doing any of that, but because it was so exhausting. Fatigue sets you up for errors. Furthermore, there are often better choices for a particular problem. Today, we have pediatric-trained emergency medicine specialists, walk-in clinics, and full-time neonatologists, as well as access to specialists, nurses, nurse practitioners, and physician assistants. But how do you know who to use first?

Prepare in advance. Have the names and addresses of the facilities you need written down. If you are out, a babysitter should know how to call you and your pediatrician. If you are home, a pediatrician is usually your first call. The office may have trained nurses to answer questions late at night. They are happy to help if you have a question that can’t wait until morning. If you or they feel it’s necessary to speak directly to the doctor, you will be connected.

If your child is having serious difficulties, such as persistent vomiting, persistent pain, very high fever that you cannot control, difficulty breathing, or trouble being alert (not because they’re sleepy), you need to get to the emergency department. Any drive of more than 15 minutes should probably be taken by ambulance. If you’re not sure, call your pediatrician. If your child is complaining of an ear infection, a bad sore throat, or other symptoms that you cannot control and the office is closed, a walk-in clinic may be an alternative. You should be familiar with your doctor’s office hours. These days, someone may be available quite late.

You may have concerns that are specific to your child’s problems. For some children with chronic illness in our area, the best place to be is the Connecticut Children’s Medical Center. Discuss this option with your pediatrician and specialist before you drive all the way to Hartford.

Finally, injuries involving bones and joints may best be handled at an orthopedic walk-in clinic. Check with your doctor about availability.

What if English isn’t your first language? It’s true that many doctors will speak your language, but if your English is not good, make sure you have an adult to help you with your calls and visits. Please don’t rely on your child to interpret.

I hope this short article helps you prepare for the worst. But I hope even more that you never have to use that information.    

Robert B. Golenbock, MD, is currently retired. He has cared for children in the Danbury area for 43 years, including at the Center for Pediatric Medicine. The CPM is located at 107 Newtown Rd, #1D, Danbury, CT, 06810. For more information, please call (203) 790-0822 or visit