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assumed 'tags' in /websites/forum2008/viewthread.php(601) : regexp code on line 2 Notice: Use of undefined constant tags - assumed 'tags' in /websites/forum2008/viewthread.php(601) : regexp code on line 2 Notice: Use of undefined constant tags - assumed 'tags' in /websites/forum2008/viewthread.php(601) : regexp code on line 2 Notice: Use of undefined constant tags - assumed 'tags' in /websites/forum2008/viewthread.php(601) : regexp code on line 2 教你如何找對小兒科醫生及選對醫科 - 親子 - 噓!論壇 _ 無忌的論壇 ~ 歡迎芝麻小事,別聊國家大事 ~

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教你如何找對小兒科醫生及選對醫科

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教你如何找對小兒科醫生及選對醫科

心肝寶貝生病時,焦急的父母常不知所措,《康健》為你請教專家,提供就醫指引。

12歲的敏敏常覺得頭痛、愛睏,老是賴在床上不去上學。媽媽帶她看一般兒科內科醫生,醫生沒有仔細檢查評估,就認為身體不適是孩子偷懶的藉口。媽媽也持同樣看法,所以沒放在心上。沒想到敏敏易倦、嗜睡的情形愈來愈嚴重,媽媽才趕緊帶她去看小兒神經科。經核磁共振檢查,發現她長了腦瘤,並非裝生病。

5歲的彥明咳嗽不止,媽媽以為是感冒,帶他看耳鼻喉科。吃完藥後雖緩減了症狀,但三天後又開始咳。
媽媽認為孩子只是身體不好,容易感冒,因此只要小孩一咳嗽,就帶去同一家診所,反覆治療持續一年仍未改善。後來經過朋友介紹,轉到小兒過敏科就醫,發現小孩原來有氣喘。醫生對症下藥後,才控制住。

小孩生病時,該帶去看哪科?選哪位醫生?是多家長心中共同的疑問。

然而現代醫療系統分科愈趨專業精細,兒科專科下又細分新生兒、小兒心臟、小兒感染、小兒泌尿等次專科,加上沒有第一線基層醫師(家庭醫師)導航,只能由家長自行判斷。但醫療的專業是一堵高牆,民眾很難輕易跨越。「孩子生病時,我已經很?J急,看到那麼多科別,我更加迷惘,」有二個小孩的關小姐認為要明確掛對科別,對家長是很大的考驗。

另個難題是孩子可能還在牙牙學語、或表達不夠清楚,線索薄弱的情形下,父母通常只能憑小朋友表現出來的症狀求醫,風險很大。譬如,小孩一有咳嗽、發燒就認為是上呼吸道感染,只做局部治療,減緩症狀,但其實小朋友可能罹患氣喘、過敏或其他胸腔、肺部疾病。長期治標不治本,輕度氣喘兒可能惡化成重度氣喘病患,生活品質大受影響。

[B][color="navy"]兒科醫師是第一線導航[/B]

在茫茫醫海中,如何找對醫生、看對科?多位小兒科醫師異口同聲回答,短期來說,若不確定孩子生的是什麼病,先看一般兒科,如有必要,再由他們轉診給次專科醫師,減少看錯科的機率。

台灣兒科醫學會理事長林奏延建議,6歲以下的小孩若受到感染,容易產生其他併發症,例如肺炎、膿胸,況且,小兒發燒不只感冒,可能是尿路感染、胸膜炎、川崎病、熱性疹等,甚或白血病、淋巴瘤、紅斑性狼瘡,「一定要全身性的來看,而非局部性的治療,」因此最好先找兒科醫師。

[B][color="navy"]此外,用藥也是大學問。[/B]

小兒用藥,尤其是嬰幼兒,必須依他們的體重來計算藥劑量,絕對不是「大人的一半或四分之一」。台大醫院新生兒科醫師周弘傑,曾遇過小病患吃了感冒藥後,全身不停微顫。「我一看就知道是藥劑量過多導致的,」果然停藥後症狀就消失。

至於長期而言,建議為孩子找一個值得信賴、容易親近的家庭醫師,他能提供醫療保健的諮詢與照護。好的家庭醫師最好有合格的兒科專科執照、願意花時間與家長溝通、解釋病情、而且有耐心、有愛心、不會亂開藥(非慢性疾病,通常不會給超過4顆藥)

[B][color="Navy"]就醫自保原則[/B]

除了選對醫生,父母也要掌握聰明就醫原則,才能獲得理想的醫療服務。

1.成為醫生與孩子間的橋樑:仔細詢問、並觀察孩子不舒服的症狀,並且清楚、詳細的告訴醫生。

聰明的家長還會做筆記,把小孩幾點幾分有哪些異常,在症狀出現前,曾做過哪些事、吃過什麼食物或藥物、症狀持續多久等等,記錄下來,提供醫生參考。

此外,不要抱著考醫生的心態,隱瞞孩子的病情。長庚兒童醫院內科部主任黃璟隆觀察,有些家長會隱瞞實情,故意考醫生,想看看醫生的能力如何,「這是大錯特錯的心態,」他加重語氣說,家長提供的線索愈完整,愈能幫助醫生下正確判斷。

2.多提問:對於病情有任何疑問,都要開口問。包括孩子生病的原因、如何預防、日常生活中如何保健等等。

例如孩子若有氣喘,要知道過敏原是什麼,才能有效預防。

父母也可以做小抄,把自己的疑問一一條列,不但不會漏問問題,還能把握看診時間,充分表達需求。

3.藥物方面:美國「健康照護研究與品質機構」(AHRQ)建議家長,要確定每位醫生知道孩子服過的藥物,包括處方藥、藥房買的成藥,以及草藥或維他命等營養補充品;並且確認醫生知道你孩子的用藥史、體重、對藥物的任何過敏或不良反應;拿到藥物時,最好詢問為什麼要吃這個藥、該怎麼吃、吃多久、可能有什麼副作用、一旦有副作用該怎麼辦、以及孩子不可以吃什麼食物、飲料,或不可從事什麼活動?

4.邀請一位親人或朋友陪伴你帶孩子一同就醫。

他最好是平時照顧小孩、或了解小孩健康情形的人,如家裡的長輩或保姆。

5.就醫後,持續觀察、紀錄:觀察孩子服藥後的反應,有沒有好轉或惡化,對藥物有無不良反應,並且記錄下來,供下次就醫的參考。

6.尋求第二意見

萬芳醫院小兒部主任郭雲鼎建議,如果同一個醫生,看了兩次還沒好,且沒有給明確的解釋,建議家長換另一個醫生看,尋求第二意見。

而第二個醫師的專業程度,應起碼不低於第一個醫師。例如先在一般兒科看過病,再來就應針對診斷結果,找次專科醫師看病,詢問另一個專業意見。------>{個人建議不要在同一個醫院給兩個醫生看診過,因為沒有人會自己打自己的嘴巴..個人經驗}

7.充實醫療資訊

幾乎所有的兒科醫師都認為,多讀醫藥健康相關書刊雜誌報導,蒐集相關資料,是父母很重要的功課。

至於該如何判斷資訊的可靠性,馬偕醫院小兒遺傳科主任林炫沛曾為文建議,至少要清楚作者的專業背景及學經歷。長庚醫院兒童過敏氣喘風濕科醫師姚宗杰則認為,若對某些報導或說法感到懷疑時,可以跟熟識的醫生討論,以解答疑惑。

或者直接徵詢醫生手邊有無相關文獻可看。在國外,醫生甚至會主動找資料給家長讀。陳媽媽十年前旅居澳洲時,帶幼兒看病,醫生翻箱倒櫃找文章給她閱讀,「讀完後,我才知道感冒分成病毒和細菌感染兩種,當小孩流黃鼻涕時表示病菌感染,才需吃抗生素,」她也感嘆,回台灣後,就再也沒有遇過這種會跟病家溝通醫學常識的醫生。

孩子的健康是家長一生的功課。正如和信醫院院長黃達夫在《用心聆聽》中所言:醫生有優劣,治療效果因而有差異,因此為了保護自己的權益,病人(家屬)也要有足夠的知識背景,去做明智的判斷。
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