My 4 year old has a growth plate fracture in the femur. She has an appointment in the orthopedics department tomorrow, but with a physician assistant (PA) rather than a doctor (MD). When I asked for an appointment with an MD, I was told that the MDs only see patients with injuries requiring surgery (I have Kaiser HMO). So I confirmed the appointment with the PA.
Since my daughter's fracture involves the growth plate, I would really like her to be seen by an actual doctor, but don't want to be one of those difficult patients. Wondering if it's normal/common practice for kids to be seen by PA only for this type of injury and I'm being a difficult patient OR if I should push them for an appointment with an MD.
My friends and I have seen a PA regularly. A PA is well trained. They work with an MD. They will ask an MD if the case is more difficult. I believe a PA is as qualified to treat most things as an MD. I suggest you go to this appointment and ask questions before asking for a specialized MD.
I'm all about going to a PA under most circumstances but in this one, I would wait for an MD. I've learned that sometimes you have to be one of those "difficult patients". It sounds like a pretty big deal to me.
In my opinion, a PA can be a great resource. I haven't seen an ortho one, but my daughter regularly sees a PA in electrophysiology (cardiac specialty). The PA is directly responsible to an MD, and in our case, was completely knowledgeable and capable. Like all medical professionals, there are the great ones and the horrid ones. You may find that this PA is caring and skilled and personable.
I'd continue with the appointment, but I'd keep the idea of a second opinion in the back of my head, if I were you. I'd be aware of the follow-up care they're suggesting, as growth-plate fractures in children require some monitoring for a period of time after the cast is removed or the fracture is healed.
Ask how the PA communicates with his or her MD supervisor, and what would happen if surgery were to be required in the future.
And check out the PA or the supervising MD on healthgrades.com.
I hope the appointment goes well and that your daughter has a full recovery.
My understanding (I could be wrong) was that the growth plate is made up of cartilage. So it's not like it has to be set so much as just immobilized, with a split or cast. So that it can heal.
If it were a fracture to the actual femur or it had to be set, realigned, or required surgery (screws, etc.) then I'd be wanting to see a doctor. But I think you're ok. If you're at all concerned though, could you call your pediatrician and ask what they think.
i have consistently received better, more comprehensive, more compassionate and more useful medical care from PAs than i have doctors.
your experience may vary.
khairete
S.
My only experience with a PA was at my hand surgeon's office. My finger was locked (trigger finger) and I didn't want to wait a week to see the orthopedic doctor. I took the first appointment which was with the PA. She was great and brought in the doctor to look at the X-ray, approve the diagnosis and treatment. I would definitely feel comfortable taking my kids to a PA.
Another time, I took my daughter to the doctor for a lump on her neck. The doctor asked another doctor to come in and examine my daughter. I think most medical professionals will seek help if they are not sure themselves. Certainly during the appointment you can ask if it is something a doctor needs to look at though.
Like Suz, I have received more thorough, more compassionate treatment and more patience from physician assistants. I described by daughter's knee injury in your post the other day. Her PA was phenomenal!
I love our family doctor, but it is almost impossible to get in to see him. Nine times out of ten we see his PA. His PA is exceptional! He always follows up with our physician and we often get personal phone calls from him to follow up on how we are doing after an appointment with him. I often see PAs at our express care clinic. If the PA sees anything concerning, there will be follow up with an MD.
I have no personal experience with a PA. Honestly, I would keep the appointment and see how it goes. If you aren't satisfied, get a second opinion. Doesn't matter if you are that Mom or not, you are paying for a service and YOU are the advocate for your child. Remember, Doctors are service providers and can be fired at anytime.
I don't know but you could take her to this appointment and then get a 2nd opinion from a MD. Call today and make a 2nd appointment at a different orthopedist near you. I would be suspicious that since the Dr is busy they are trying to get you in with the PA who may or may not be as good.
It doesn't matter whether you are being a difficult patient or not. You want your child seen by a physician and you are 100% right. Shouldn't the decision about how the fracture will be managed be made by an MD? Is this your LA Children's Hospital or a smaller practice?
I really don't understand what the big deal is. Her break is set and splinted, I assume by a doctor. All they are going to do is xray to see if it is healing correctly, which will probably be read by the doctor, and then the leg set in the cast. Why does this require a doctor?
Are you thinking she might need surgery?
We prefer a nurse practitioner. A PA isn't a bad choice. If you really want to see a doc for a fracture then find a DO, they are so much better than an MD anyway. Or find another doc's office that doesn't have a PA.
Absolutely go see the PA. I am a nurse, & see much more individualized care and concern for pts from a PA than an MD. The word "assistant" just means that they work directly with an MD. They're not running behind their MD taking notes or whatever... They practice medicine & write their own scripts. They will ask questions if they're not sure if something, but so will any good healthcare professional.This PA is in the ortho dept you said? You are all set. Let us know how you make out.
I'm so sorry. I agree with you. Maybe you can see the PA but depending on the outcome, make an appt with the MD. Can you get a second opinion? I see you live in LA, Kerlan Jobe is an excellent place that I recommend (although the wait time is ridiculous). Good luck!
