One free seizure

Penny woke up at 5:30 this morning and said "I'm hungry. I'll make you a bowl of cereal all by myself, kay Mommy?" Never was I so happy to hear that little voice so early in the morning.

We went to primary care for Penny to be evaluted again. We didn't see our family doctor since she was booked, but the one we saw was excellent. She did all sorts of exercises with Penny: hop on one foot, follow my finger with your eyes, puff your cheeks, wink, squeeze my fingers, etc. Penny thought she was hilarious. There was no need to ask Penny questions like how old are you or what's your favorite book. Being her usual chatterbox she offered all that up and more: "This is my Dora skirt. I got it for Christmas. It says Dora, see? that's a D"

The doctor was still leaning towards sending us to neurology based on the notes from the ER, but due to Penny's excellent evaluation today she decided to consult with pediatric neurology. I'm not quite sure how Mayo does this, but it seems there is always someone on call from the specialty areas to answer questions from other physicians. I'm sure in the long run it is much more efficient then rescheduling appointments in those areas for decisions that can be made collaboratively over the phone. So the family doctor spoke with the pediatric neurologist, they reviewed all the lab work and EKG from yesterday and discussed Penny's very normal behavior today. The pediatric neurologist said that so many kids have seizures, the vast majority of them happen once and never again and the tests don't show any reason for them, so they have a rule that kids get one free seizure. If anything abnormal happens in the next week, or if she ever has another seizure, they will do all the brain testing.

So I guess yesterday was similar to the "get out of jail free" card. From my logical side I know that the US does excessive testing that doesn't improve our outcomes any more than other developed countries that do much less testing. One of the major differences of Mayo vs other health systems is their doctors are on salary and have been since the early 1900s. This is one of the reasons when looking at Medicare data, Mayo acheives some of the best results in the country at a much lower cost than other medical facilities. Maybe I'm wrong. Maybe most neurologists would have said the same thing, but I think there's little chance our family doctor would have been able to call through to a pediatric neuroglogist who could pull up Penelope's record in seconds and within minutes have his opinion. In most places in the US, we would have been sent to a neurologist specialist probably not in the same system as our family doctor. Once we got the appoinment and insurance worked out, there's a good chance that specialist  would order tons of tests to rule everything out "just to be sure". Those tests are also how they get paid. Cynical way to look at it, but that's one of the main criticisms of the US system. Fee for service, not results. Since I've worked for health non-profits, I've been reading articles for years and more recently some books by Atul Gawande about our current broken system. Many say if the new system that bases payment on results is going to work, then doctors should be on salary. In our case the Mayo pediatric neurologist is making his decision based on the statistics of kids seizures and the rare chance of actually finding a reason for it in a test. Logically I trust him that Penny doesn't need all these tests...

...but emotionally? I feel like having them scan every part of her "just to make sure."  Once again I think this is due to our over test and over treat US mentality. We like answers. We don't like flukes or things that happen for no reason. This seems like the oddest comparison but I HATE the movie Birds. Not because it is scary but because they never explain why the birds show up. If there was a reason given, I could settle in and watch everyone run around like crazy. In my life I want challenges to have a specific order: problem, reason for problem, solution. Unfortunately the human body, especially a growing one, rarely works that way.

So we watch and wait now.