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Should schools be open or closed during COVID?

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

School staff and families are experiencing tremendous fatigue from the heroic work to maintain in-person education during the COVID pandemic. Millions of hours and millions of dollars have gone into mitigation efforts (like masks and distancing and ventilation).

Most schools use a hybrid model, with each student only in the building 2 days per week. Furthermore, close contacts are quarantined. These modifications significantly reduce the likelihood of COVID spread.

Given the benefits of in-person education and the health risks of COVID, decisions about if and when to temporarily shut schools are very complex — requiring wise judgment. It’s important to avoid being reactionary, when fear clouds fact. The fundamental question should be: “is having our school open right now making the pandemic here now worse?”

Massachusetts has its system of red, yellow and green communities, which marks the degree of caution each district should be using in its decisions. This is a particular challenge for urban cities, where both the rates of COVID and the harms of remote education are highest.

To use a baseball analogy, closing a school is like shifting the infield to double play depth when a runner is in scoring position with one out. It’s a tool that gets you out of a pinch. If this school year were a game, we’d be in the top of the 3rd inning. We need to encourage and reward good managers, who keep an eye on the long view and the final outcome.

Teens and Mental Health

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

Photo by Polina Zimmerman from Pexels

A recent personal experience with the sadness and shock of suicide weighs on my mind these days. Suicide is the 2nd leading cause of death in the US, among ages 15-24. Rates have increased by 41% over the past 17 years. Males have a rate three times higher than females. Dismal statistics like these can sometimes be numbing, which discourages the hopeful proactive energy we need to bring, in order to prevent future tragedy.

When listening carefully to people who have considered suicide, one element that comes up invariably is psychological pain. The pain of loneliness or unworthiness can be as real and unbearable as physical pain. We humans are built for connectedness: an antidote to isolation. The time and energy invested in relationships reinforces that each of our days matter. We are grateful for those who help us, and we take joy in the opportunity to help others.

World Mental Health Day is this Saturday October 10th. Read more about “10 Things Parents Can Do to Prevent Suicide”

En Espanol

5 Reasons Why Everyone Needs a PCP

A primary care physician (PCP) is always there for you, whether you have a common cold, need help managing a chronic condition, or are due for an annual checkup. These doctors tend to be the entry point for patients first entering the medical system, and developing a good working relationship with one is very beneficial to you and your health. Here are five reasons why you should have a PCP by your side.

1. Your Primary Care Physician Knows You

Having an established relationship with your PCP allows him or her to be familiar with you and your family’s medical history. This makes it easier for them to find patterns in your health and know how your body responds to certain illnesses.

2. A PCP is Your Entry Point to the Continuum of Care

Having a PCP is a great way to learn how to navigate the somewhat complicated medical system. They can refer you to specialists who may be more knowledgeable about a specific health issue. Through Pentucket Medical you have access to a network of primary care, medical specialists and urgent care services throughout the Merrimack Valley.

3. You Have Lower Out-of-Pocket Costs

A primary care physician co-pay is typically much cheaper than a visit to an emergency room. Having a go-to doctor who you can easily set appointments with creates a much lighter burden on your wallet, especially in the long run. Take a look at your insurance card to see the difference in cost between an office and emergency room visit.

4. A PCP Can Help You Reach Your Goals

Have goals like weight loss, eating better or general wellness? Your primary care physician can work with you to plan out how you can achieve your goals. Your doctor can recommend diets, exercise plans, and more to help you on your wellness journey.

5. You Can Receive High-Quality Preventive Care

In addition to providing care for acute illnesses and chronic conditions, your doctor can help you take measures to prevent their onset. Your PCP keeps track of your health over time, performs preventive services and screenings to catch diseases early, and offers advice to help you maintain a healthy and happy life.

Establish a relationship with a Pentucket Medical clinician today and start on the path to a healthier you. Our doctors offer same or next-day appointments, online scheduling through the Patient Gateway and an extensive list of accepted insurance plans.

cite: Baylor Medical Center

Sources:
U.S. News & World Report | How to Find the Best Primary Care Doctor
NCBI, U.S. National Library of Medicine | Contribution of Primary Care to Health Systems and Health

 

 

Kids and Screen Time

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

In every era, it seems that adults wring their hands over the new technologies to which their younger generations of children are exposed — the telephone, the TV and now the internet with all its many branches. New technologies obviously allow new capabilities and innovations for people of all ages, but pediatricians continue to try to tease out the good from the bad effects of “screen time” — as we counsel parents and youth about ways to prevent and correct some undeniable pitfalls of excessive use. Teens aged 13-17 spend an average of almost 9 hours per day using screen media. 45% of adolescents say they are online “almost constantly.” 54% of adolescents say they spend too much time on their cell phone.

Check out the following Family Media plan, relevant for all ages. If you think your child is using media too much, or becomes aggressive when you try to set limits on their media use, talk to their health care provider about your concerns, and ask for guidance on helping them cut back.
https://www.healthychildren.org/english/media/Pages/default.aspx#home

Mask Mythbusters: Five Common Misconceptions about Kids & Cloth Face Coverings

Submitted by Dr. John Maddox, Pediatrician, Pentucket Medical/ Haverhill

1.        Can wearing a mask make it harder for my child to breathe?

Recommended cloth face coverings do not block the exchange of oxygen or carbon dioxide.  The vast majority of children age 2 or older can safely wear a cloth face covering for extended periods of time; this includes children with many medical conditions.  Begin now having your child wear masks at home.  Start with short periods, when they are doing their favorite activities, and gradually increase the length of time, so they get used to it.  All schools will offer mask breaks.

2.       Can masks themselves spread germs?

Masks get damp over time, from the same respiratory droplets that spread COVID, flu and other germs, so face coverings should washed regularly.  It is important to have cloth face coverings that fit a child’s face well, so that they are not tampering with the mask.  You should perform hand hygiene before and after touching your face covering.

3.       Can a child with special health care needs, like the autism spectrum, wear a mask?

Some children will need extra attention to the way a mask feels and fits and smells.  Some kids will benefit from strategies like Social Story (see below), which help explain new situations with both descriptions and directives.  Schools are prepared for some students with special needs to be unable to wear masks full-time right away.  Occupational therapists and applied behavior therapists will work with students to teach them new and important skills.

4.      Should a kid wear a mask during sports?

Cloth face coverings help young athletes protect their teammates and themselves.  They also help protect the sports season.  Whenever safe and possible, athletes should wear a cloth face covering.  This includes on the sideline bench, in team chats and going to and from the field.  Exceptions include when they are actively exercising.

5.       Do masks really prevent the spread of COVID-19?

Cloth face coverings are one of the most effective ways to prevent the spread of COVID, flu and other germs.  Very early on in the pandemic, there was concern about having enough masks for health care workers, so widespread mask use was discouraged.  However, it is very clear now that states, communities, and schools that have contained COVID— despite imperfect social distancing, ventilation and hand hygiene— have used cloth face coverings to prevent spread, even in asymptomatic people.

 

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Cloth-Face-Coverings-for-Children-During-COVID-19.aspx

https://www.healthychildren.org/spanish/health-issues/conditions/covid-19/paginas/cloth-face-coverings-for-children-during-covid-19.aspx

https://drive.google.com/file/d/1R1lSbfZ8TRchbHCiK_4svK7WLH62lS

https://vkc.mc.vanderbilt.edu/assets/files/tipsheets/socialstoriestips.pdf

https://www.nytimes.com/interactive/2020/08/19/well/childrens-face-masks-comfort.html

Your Good Health is your Most Important Asset

 

Did you know that in the United States, Americans use preventative health care services about half the recommended amount? Despite the benefits of preventative health care services, many of us choose to go without them.

Seven out of 10 deaths are attributed to chronic diseases such as heart disease, diabetes, and cancer. These diseases are often preventable and with regular screenings be identified in the early stages.

Recommended steps to being your healthiest are annual physical exams, age-appropriate screenings, immunizations as needed as well as engaging in lifestyle choices that include physical activity, sleep and a healthy diet.  Learn what you can do by checking out these Health Preventive Guidelines below:

Men’s Health Guidelines:https://pmaonline.com/wp-content/uploads/2019/06/Pentucket-health-Maint-guide-men-1-1.jpg

Women’s Health Guidelines: https://pmaonline.com/wp-content/uploads/2019/06/Pentucket-health-Maint-guide-women.jpg

Recognizing the Importance of Foster Parents

Dr. John Maddox, Pediatrician/ Pentucket Medical/ Haverhill

In my work as a pediatrician, few things are as inspirational and selfless as foster families that agree to take on the responsibilities of caring a child with nowhere else to go. (We should not lose sight of the substance abuse problems in our society: the primary root of neglect and mistreatment.)

Foster parents often have their own biological children, whose needs are being juggled, but — with amazing dexterity and balance — these homes, enriched with family love, are wonderful environments for the newly arrived foster child. Like a repotted plant that was once wilting, one can see a child in foster care begin to flourish in a matter of days. Furthermore, the foster parents go to extraordinary lengths to help DCF maintain children’s connections to their biological families. I realize that not every foster situation is a happy one, but many are and should be celebrated and exalted.

For more information visit:
https://www.healthychildren.org/…/Pag…/Foster-Parenting.aspx

Joy of Childhood through the eyes of a Pediatrician

Dr. John Maddox, Pediatrician

As I reflect on 20 years of being a pediatrician, during these uncertain and apprehensive times, encounters with children continue to bring joy.

Reviewing a child’s growth chart with a family is a particular delight.

There is such fascination in asking, “How tall will I be?” Whether the answer is four ten or six-ten, the essential question is, what is my full potential and how can I reach for that?   Like rings of a tree that testify to years of abundance and of adversity, height and health require the right mix of nature and nurture.

While DNA and diet are important, more than anything is, every child needs supportive relationships, within the family and the community, to weather tough times and resiliently thrive.

Transcendent of daily headlines and stresses, it is a privilege to be part of each young person’s journey, hopeful for all that lies ahead.

 

Telemedicine. Just a Substitute or the Real Deal?

 

I am going to start by saying this is part of the evolution of medical care.  We have gradually moved toward patient-centered medical treatment. I listen to old radio shows of Dr. Kildare from the 1950s (and yes, there was a TV show by the same name in the 1960s).  He and his mentor, Dr. Gillespie, had a very paternalistic approach toward patient care. Doctors “knew best” and it had been that way for a long time. There is no doubt, however, that they had the patient’s best interest in mind.

Fast forward to the 21st century and especially the past decade. We started what we called “Patient-Centered Medical Home” with the patient, not the provider at the center of care. We included “shared decision making” to make sure patients were educated about their illness and treatment options and were active participants in the decision-making process.

There has also been a push toward making medical care more convenient for patients. Years ago, this began with more convenient outpatient testing rather than hospital admission for diagnostic, the Minute clinics. Patient portals have allowed patients to review medical notes, check on lab and test results, communicate with physician offices, and even schedule appointments.

Mass General Brighman (formerly Partners Healthcare) had been dabbling in telemedicine (telephone and video visits) for several at Express Care (our urgent care center). It was a fun experience for both the patient and me.   Then came the sentinel event that shook up telemedicine and moved it by leaps and bounds—the Covid-19 pandemic.  At Pentucket Medical, we jumped from a few telemedicine visits to 90% of our usual visit volume. We tried different video platforms and now have Zoom integrated into our electronic medical record.  It is anticipated that 20-30% of medical visits will be by telemedicine even after the pandemic has passed.

Just like moving to patient-centered medicine, patient education shared decision making, and increased convenience for patient visits, telemedicine has the power to put patient needs at the forefront. Many patient concerns can be handled by a good telemedicine visit. Great for elderly frail patients and maybe Great for elderly frail patients and may be  very well suited for behavioral health.

Millennials, being so tech-savvy, will also be happy about the telemedicine options. There is even a term now for bedside manner called “Webside” manner. It is a learning curve for all of us. I view this is as progress that once again puts patients at the center. It seemed to happen in an instant and is here to stay.

Kenneth Adams, MD, FACC
Senior Cardiologist and Medical Director at Pentucket Medical

We Are Here for You.

 

Pentucket Medical is dedicated to keeping our patients, staff, and community members safe as we reopen our practice sites. We are fully prepared to provide you with the care you need while committing to keep you safe every step of the way.

What To Expect At Your Next Visit 

Along with prudent safety measures, your experience at our practice sites may have changed since your last visit.

A face mask is required to be worn throughout your entire visit. Our staff will also be wearing Personal Protective Equipment, which may include a face mask, a face shield, and goggles. 

We ask that you arrive no earlier than 10 minutes before your appointment. This will help reduce the number of patients, visitors, and staff in one area.

You will no longer need to stop at the desk after your visit has ended. You will receive your visit summary electronically. If you need to schedule a follow-up appointment, you may do so by telephone or Patient Gateway. 

It’s Time To Take Care of Your Health

 As we reopen, we are fully prepared to provide you with the care you need in a safe environment.

If you have current care needs, please do not delay your care; waiting can make your symptoms and conditions worse, which may require more complex treatment. From the beginning, our clinicians have been implementing innovative healthcare such as virtual visits (telephone and video), and ExpressCare, and will continue to do so that you and your family will have more options when seeking care. 

We encourage you to contact your clinician’s office to learn more and to schedule a visit if you have any health concerns. Thank you. 

COVID-19 testing is available by referral only.

Please contact your health care provider for an appointment. 

Safe Care Commitment

To everyone who needs us now, come get the care you deserve. Our Safe Care Commitment is in effect across our system to provide the safest possible environment for our patients, visitors and staff.

We screen to protect you, your families, and our staff.

We clean our hands and spaces and make it easy for you to do the same.

We protect everyone in our environment.