Talking Problem

tallaght01

It would be pretty normal. Even the bad ones just refer the kid to the paediatricians without doing an assessment themselves first. It's not ieal, but at least the kiddy gets an overall check pretty soon.

But it's a relatively quick process and most of the GPs do it pretty well. It depends where you are, too. British GPs are the best at it, followed by Irish ones. Then the Oz and new zealand docs are terrible in comparison. that would be my experience anyway.

raemie21

Apologies for late reply but was away the past few weeks.
Hmmm, I understand what you're saying Tallaght but I still don't really agree.. certianly in my experience a typical GP letter for a child presenting with developmental delay/S&L/socialisation difficulties is something like "parent reports XXXX and school agree..past history asthma".

That's not me having a go at GPs either but I can honestly say that I've never seen a referral note or informal observations that you outlined above. It would be great if they were that detailed but unfortunately we tend seen the opposite where a kid comes into the clinic and then staff actually prompt parents to re-check something with the GP even when parents comment "Oh I mentioned that to GP before and he said it was fine" e.g. recurring ear infections, swollen parotid.

I would come from the complete other side and believe that any allied health professional such as Psych, Physio, Speechie, OT, PHN have a very solid knowledge (or should have) of typical child development across the areas as opposed to a GP who has a much wider and varied caseload - putting it rather crudely, they would see six/seven children a day for 40mins each as opposed to a GP who sees patients across the lifespan for a much shorter session.

Perhaps we've had extreme bad luck with GP referrals but I wouldn't and don't expect a GP to give such detailed information.
Either way, it's certainly not a "bad idea" for the OP to go straight to Speechie first.

tallaght01

raemie21 wrote: »

Either way, it's certainly not a "bad idea" for the OP to go straight to Speechie first.

It is.

Assessing "development" (like, say physiotherapists who work with kid are excellent at) is much much much different to looking for other causes of developmental delay (the speechie/physio etc won't look in the kids ear for physical problems, they won't listen to their heart, they won't have the details or the understanding of mum's antenatal issues......did she present to the GP with mumps during pregnancy etc).

You can keep going on about a speechi being the first port of call, but no paediatrician will ever agree with you on this. Speechies are great. They''re very important. But telling us how disordered a kid's speech is becomes less useful if no-one has diagnosed the underlying genetic illness, say.

I would also disagree about quality of GP letters. There are some bad ones, just like there are from speechies, physios etc. But in Ireland the standard is very high, and people should be using their GP as their first port of call for undifferentiated illness.

lostinnappies

id have to agree with tallaght, having know a few children with developmental delay (in speech and other areas) one of whom is a family member, I have found that when they approach their GP first they are refered straight away after a health check. Quite often in this sham of a public health system (or even if you go privatly) you will be waiting a very long time to get all the appointments (a year for the psychologist). While some of the children I knew had a simple and solvalbe physical problem rectified by the GP and had no need of any other services, two of the children I know needed ALL of the services and I dont think the "speechie" as you call them actually refered them to anyone.

Having said that, with one child the "speechie" was invaluable and diagnosed the problem that the others were just guessing at.

It would be my first port of call to go to a GP first while waiting on other appointment.

raemie21

Meh, you can keep going on about causes and GP examining for signs but children mostly present with speech and language difficulties in the absence of any other 'problem' or cause. I think more so for three-four year olds if nothing has come to attention beforehand (i.e. cleft palate, physical/significant intellectual disability).

The assessment you outlined earlier, that would be fantastic if that was the norm but I've never seen anything like that.

Nope, any previous report available to a consultant is much appreciated and speeds up the overall assessment & intervention plan, rather than a GP letter alone.

Either way, kids who are 'late talkers' are at a risk for going AWOL and undetected by GPs. It absolutely does happen.

If the OP goes to GP alone and is reassured that there doesn't seem to be any problem, then I would still strongly advise to seek another opinion from a child development professional with more expertise in the area, be it speech and language, psychology, occupational therapy etc.

tallaght01

raemie21 wrote: »

Meh, you can keep going on about causes and GP examining for signs but children mostly present with speech and language difficulties in the absence of any other 'problem' or cause.
.

I'm perfectly aware of this.

But are you actually implying we shouldn't check for physical/medical causes???? PLEASE tell me that's not the point you're making.

The GP will refer tot he paediatrician and the speechie. The speechie won't refer to the paediatrician. The child needs both. that should be an easy concept.

I don't know where you're a paediatrician, but I don't share your experience. The GP letters I get tend to be pretty good. Even if they're not, the kid ends up with a paediatrician, and that's the important thing. If a letter arrives on my desk saying "3 year old, no speech", then at least they're going to be seen and assessed properly. Those letters are about as much use as a full speech assessment telling me the kid is speech delayed, to be quite honest.

Would you go straight to the cardiac rehabilitation nurse if you had some chest pain?

metrovelvet

Tallaght- I think it depends on what country you are in. In the US you would probably go stright to the specialist. Kids and babies tend to go to the pediatrician to start with and not a GP.

And yes if people had chest pains they would go to the cardiologist and when I had UC I went straight to the gastroenterologist, or if I had needed a cervical smear Id go to the gyne.

In my experience it does tend to make things faster as it cuts out the middleman so to speak. I prefer this system to the GP referral system, especially when it comes to scans because then you have a whole other delay.

lostinnappies

Also if you go straight to the specialist in this country with out a referal from your GP your insurance will not cover the costs because it was not "deemed to be medically ness" Its rediculus but there you have it.

Also some children have other problems that just arent noticable, as well as speech delays. This was the case with one of my family members.

But at the end of the day if you want to have your insurance cover everything then you need a referal from your GP. If they have speech problems and get sent to a speechie and later find out that that was not the problem then it is still covered because your GP sent you. Where as if you go ahead and go to a speechie in that case your insurance will say that it wasnt ness. and wont pay for it.

tallaght01

metrovelvet wrote: »

Tallaght- I think it depends on what country you are in. In the US you would probably go stright to the specialist. Kids and babies tend to go to the pediatrician to start with and not a GP.

And yes if people had chest pains they would go to the cardiologist and when I had UC I went straight to the gastroenterologist, or if I had needed a cervical smear Id go to the gyne.

In my experience it does tend to make things faster as it cuts out the middleman so to speak. I prefer this system to the GP referral system, especially when it comes to scans because then you have a whole other delay.

The US is very different to Ireland, because there's enough supply to cover demand, and insurance covers most of the middle classes to go privately.

Can you imagine if everyone in Dublin with a sick kid went to the clinic in Crumlin or Tallaght. Would be a meltdown.

Plus, your chest pain could be muscular, or respiratory. That's why you should go to a generalist first.

But even if the paediatrician in America example held water....that paediatrician can assess the kid, and work out of there's another medical problem (ie somehting that the speech delay is a SYMPTOM of), whereas the speechie won't do that.

raemie21

tallaght01 wrote: »

I'm perfectly aware of this.

But are you actually implying we shouldn't check for physical/medical causes???? PLEASE tell me that's not the point you're making.

The GP will refer tot he paediatrician and the speechie. The speechie won't refer to the paediatrician. The child needs both. that should be an easy concept.

I don't know where you're a paediatrician, but I don't share your experience. The GP letters I get tend to be pretty good. Even if they're not, the kid ends up with a paediatrician, and that's the important thing. If a letter arrives on my desk saying "3 year old, no speech", then at least they're going to be seen and assessed properly. Those letters are about as much use as a full speech assessment telling me the kid is speech delayed, to be quite honest.

Would you go straight to the cardiac rehabilitation nurse if you had some chest pain?

To be honest, you don't seem to be aware of the fact that a child may present with a specific speech & language delay as you keep talking about referring on to other services and the GPs role in this.

In response to your capital letters, no I'm not saying that - reread my posts and if you're still finding it hard to understand, PM me and I'll explain it further.

I'm in CAMHS, not Paeds for whatever use that is.

I'm very happy that you get 'pretty good' GP letters - I can only draw on my own experience and after seeing letters from well over 100GPs, I'm afraid it's not the same in my catchment area.

"The kid ends up with a paediatrician, that's the important thing"
:rolleyes: What a fantastic advertisement you are for the medical model of service delivery, I love it!

And then your point about previous contact with professionals -
A letter telling you that a 3year old has no speech is as much use as a full S&L assessment..???
Does that mean that a note saying that a child has learning difficulties is as much use as a full psychological assessment report?
A note that a child has motor difficulties is as much use as a full occupational therapy report?
A note that a child has musculoskeletal problems is as much use as a full physiotherapy report?
Wow.


We could go on and on about this (and maybe we should, in the best interests of the public and health promotion) - we clearly have vastly different opinions and clinical experience and are unlikely to reach an agreement.

In the best interests of the OP and other parents reading this - just to say that even this week, I had three sets of parents in my office talking about how their first port of call was their GP and each of them were falsely reassured with the "..ah he's fine, sure I didn't speak til I was four".
I think what was more interesting thing about these cases, was that each of these children have been receiving services for the past few years but yet this memory of the initial GP contact and that feeling of not having done enough as early as they could, is still in parents' minds 4 to 7 years later.
And for the record, it ended up being a speech and language therapist that advised the referral in two cases and a trainee psychologist who was on placement in the preschool who did the other.

metrovelvet

tallaght01 wrote: »

But even if the paediatrician in America example held water....that paediatrician can assess the kid, and work out of there's another medical problem (ie somehting that the speech delay is a SYMPTOM of), whereas the speechie won't do that.

What do you mean by "held water"? Babies and kids do go to pediatricians, including the ones on public health insurance.

Why wont the speech therapist do that?

Shelllz

Hi OP

Here's a link to a website with some information on 'normal' speech and language development. I would say if you have any concern at all bring your child to have an assessment. If intervention is indicated, your child is at the right age for therapy.

In relation to your bilingual home enviornment, this may have a temporary delay in the onset of both languages.

You should also get your GP to rule out any middle ear infections as this may have an effect on your childs speech and language development.

Anyway here's the website: http://www.speech-language-therapy.com/devel2.htm

tallaght01

raemie21 wrote: »

To be honest, you don't seem to be aware of the fact that a child may present with a specific speech & language delay as you keep talking about referring on to other services and the GPs role in this.

In response to your capital letters, no I'm not saying that - reread my posts and if you're still finding it hard to understand, PM me and I'll explain it further.

I'm in CAMHS, not Paeds for whatever use that is.

I'm very happy that you get 'pretty good' GP letters - I can only draw on my own experience and after seeing letters from well over 100GPs, I'm afraid it's not the same in my catchment area.

"The kid ends up with a paediatrician, that's the important thing"
:rolleyes: What a fantastic advertisement you are for the medical model of service delivery, I love it!

And then your point about previous contact with professionals -
A letter telling you that a 3year old has no speech is as much use as a full S&L assessment..???
Does that mean that a note saying that a child has learning difficulties is as much use as a full psychological assessment report?
A note that a child has motor difficulties is as much use as a full occupational therapy report?
A note that a child has musculoskeletal problems is as much use as a full physiotherapy report?
Wow.


We could go on and on about this (and maybe we should, in the best interests of the public and health promotion) - we clearly have vastly different opinions and clinical experience and are unlikely to reach an agreement.

In the best interests of the OP and other parents reading this - just to say that even this week, I had three sets of parents in my office talking about how their first port of call was their GP and each of them were falsely reassured with the "..ah he's fine, sure I didn't speak til I was four".
I think what was more interesting thing about these cases, was that each of these children have been receiving services for the past few years but yet this memory of the initial GP contact and that feeling of not having done enough as early as they could, is still in parents' minds 4 to 7 years later.
And for the record, it ended up being a speech and language therapist that advised the referral in two cases and a trainee psychologist who was on placement in the preschool who did the other.

I am still fascinated by your stance. I had assumed you were a paediatrician, as you keep talking about GP letters that come to paediatricians being of poor quality.

I think you're mistaking quality with length. I know a great GP in my catchment area, who will write "dear Tallaght01. Please see this 4 year old who has delayed speech. She can say the following words......
Nothing else to find physically. No psychoscial concerns".

To me that's acceptable, as I know a lot of our GPs. I know "nothing else to find physically" is a nice shorthand way of summarising his findings. But if you're not a doctor, I'm not sure what your perspective on GO letter to paeds is. Allied health letters are almost alwas too long. But I digress.

Nothing you say counters the argument.

You're talking about isolated speech delay. That's fine. It's common. I'm talking about how we know it's isolated. Someone has to decide it's isolated. That should be a doctor. Because no-one else is qualified to rule out other causes. You talk about a hundred GPs in your catchment area, and you talk about 3 kids who weren't referred quick enough. To be honest, I could give you more than 3 examples in my patch. Just like I could give you more examples of where speechies, and mental health services or whatever have cocked up.

My question is this....what would you do if a kid walked in through your door with speech delay. Tell me what you'd look for. I've told you what "The medical model" involves....ie full physical examination, referral to paeds with concurrent referral to physio, speech, audiology, OT or whatever. Will you examine the child's ears/dysmorphism/tone/development/growth?

I have never seen that happen.

Metrovelvet, when I talk about your argument "holding water" what i mean is that if Irish kids could go see a paediatrician routinely. In the states, the paediatrician is like the kiddy GP, as there's so many of them. It's a ridiculous waste of a paediatrician's skills, but that's US healthcare. The speech therapist isn't qualified to work out of there's another underlying medical problem.

tallaght01

raemie21 wrote: »

"The kid ends up with a paediatrician, that's the important thing"
:rolleyes: What a fantastic advertisement you are for the medical model of service delivery, I love it!

.

Can I also double check what the above means? Cheers.

Because I took it to mean that, regardless of the quality of the GP letter, at least the kid is getting referred on to us. Do you think it would be better not to refer kids with speech delay? What a bizarre stance. I'd much rather a kid got referred badly, than not at all.

lostinnappies

tallaght01 wrote: »

Can I also double check what the above means? Cheers.

Because I took it to mean that, regardless of the quality of the GP letter, at least the kid is getting referred on to us. Do you think it would be better not to refer kids with speech delay? What a bizarre stance. I'd much rather a kid got referred badly, than not at all.

Id have to agree too.

Far be it for me to say but wouldnt a speechie like to perform their OWN complete clinical assesment without influence from what the GP has said... the little that is said the more the speechie will have to investigate which imho would result in a more accurate assesment.

Also in realtion to one of my realitives who has speech delay and was assumed it was dispraxia, now turns out it wasnt. It was due to further MEDICAL complications that now they are saying it is a medical problem. The jury still isnt in but all signs are pointing to a medical problem..... she has very few other visable problems and only a Dr. would be able to determine this.

If your GP fobs it off by all means go to a speechie yourself, perhaps they can determine if it is something which needs further investigation. However my money is and will always be to go to the GP first. I think it is the most responsible thing to do and to say on these boards. Chances are they WILL be refered to a speechie and im sure given however long that may take the speech delay will still be there.

dairygold

Hmm... there are a lot of points going back and forth on this topic. From what I can tell, Tallaght01, for whatever reason you seem to have a poor opinion of speech and language therapists. I take your point about a GP looking at underlying root causes for speech and language delays but at the same time, any good SLT would also look at this. It is standard practise for an SLT to explore gross and fine motor development, any diffiuclties at birth, medical history etc as well as speech and language difficulties. In my experience (which seems to be the opposite of yours) SLTs frequently are the FIRST professional to flag a more general medical/developmental issue such as ASD, muscular dystrophy, dyspraxia etc (again, stressing that I am not suggesting that the OP's child has any of these issues!). Many SLTs DO work in a diagnostic setting and have the skills and experience to evaluate a wide variety of developmental issues and refer on to other professionals (e.g. neurologists, physio, OT, psychology etc)
However, getting back to the original post she/he did specify that the child had already been to see a GP as well as the PHN so therefore I would agree with raemie21 that the next step would be an SLT evaluation, either through the HSE or privately (www.iasltpp.com is a list of SLTs in private practise in Ireland if you are interested). Also, RE the post about going directly to a private SLT and then not having insurance covering the costs as it is "not medically necessary" as far as I know (and I could be wrong on this) for VHI/Bupa the only requirement is that the SLT be a member of the Irish Association for Speech and Language Therapists (IASLT) in order to claim back on insurance... but again I could be wrong!
Hope that helps

tallaght01

dairygold wrote: »

Tallaght01, for whatever reason you seem to have a poor opinion of speech and language therapists.

Utter nonsense.

I work with the best speech+language therapists in the state.

I have huge respect for my neurosurgery colleagues too, but I wouldn't recommend them as your first port of call if you had a headache.

dairygold wrote: »

I take your point about a GP looking at underlying root causes for speech and language delays but at the same time, any good SLT would also look at this. It is standard practise for an SLT to explore gross and fine motor development, any diffiuclties at birth, medical history etc as well as speech and language difficulties. In my experience (which seems to be the opposite of yours) SLTs frequently are the FIRST professional to flag a more general medical/developmental issue such as ASD, muscular dystrophy, dyspraxia etc (again, stressing that I am not suggesting that the OP's child has any of these issues!). Many SLTs DO work in a diagnostic setting and have the skills and experience to evaluate a wide variety of developmental issues and refer on to other professionals (e.g. neurologists, physio, OT, psychology etc)

If you think that

A) there's huge groups of kids kicking around who've had their developmental delay flagged by SALTs

SALTs are trained in physical examination

C) SALTs can reliably pick up subtle physical signs of developmental delay/DMD, such as heart murmurs, altered epicanthic folds, hypertrophy of the gastrocnemius etc etc etc etc.....

well, there's probably nothing I can say to convince you that you're so far wrong. The most dangerous healthcare professional is the one who doesn't know their own limitations.

But I guess most people make the right decisions at the end of the day.

raemie21

tallaght01 wrote: »

I am still fascinated by your stance. I had assumed you were a paediatrician, as you keep talking about GP letters that come to paediatricians being of poor quality.

I think you're mistaking quality with length. I know a great GP in my catchment area, who will write "dear Tallaght01. Please see this 4 year old who has delayed speech. She can say the following words......
Nothing else to find physically. No psychoscial concerns".

To me that's acceptable, as I know a lot of our GPs. I know "nothing else to find physically" is a nice shorthand way of summarising his findings. But if you're not a doctor, I'm not sure what your perspective on GO letter to paeds is. Allied health letters are almost alwas too long. But I digress.

Nothing you say counters the argument.

You're talking about isolated speech delay. That's fine. It's common. I'm talking about how we know it's isolated. Someone has to decide it's isolated. That should be a doctor. Because no-one else is qualified to rule out other causes. You talk about a hundred GPs in your catchment area, and you talk about 3 kids who weren't referred quick enough. To be honest, I could give you more than 3 examples in my patch. Just like I could give you more examples of where speechies, and mental health services or whatever have cocked up.

My question is this....what would you do if a kid walked in through your door with speech delay. Tell me what you'd look for. I've told you what "The medical model" involves....ie full physical examination, referral to paeds with concurrent referral to physio, speech, audiology, OT or whatever. Will you examine the child's ears/dysmorphism/tone/development/growth?

I have never seen that happen.

Metrovelvet, when I talk about your argument "holding water" what i mean is that if Irish kids could go see a paediatrician routinely. In the states, the paediatrician is like the kiddy GP, as there's so many of them. It's a ridiculous waste of a paediatrician's skills, but that's US healthcare. The speech therapist isn't qualified to work out of there's another underlying medical problem.

Don't know why you assumed I was a paed and neither do I know why it matters so much. For what it's worth, I have obviously done placements in different services and areas of medicine, similar to you I'm sure.
Furthermore, GP letters to consultant/reg psychiatrists are not that different to those to consultant/reg paeds.

I'm not mistaking quality with length.

In fact, I think it's quite bizarre that you would not take value from allied health prof reports. As I said already, a profile of, in this case, speech & language diff, is absolutely essential to our diagnosis and overall management.

"Nothing I say can counter the argument" - :rolleyes: IMO, that's a sign of someone unable or unavailable to learn from others. Geez, even I've been flexible and responded briefly to some of your points.

It doesn't have to be a doctor who decided re isolated speech & langauge delay (btw, the porfessional term is Specific Language Impairment, maybe you haven't picked that up yet from your best in the state SLTs?). Sure, I can collect and gather infor from the psychologist, SLT, OT and make a decision but they are also more than capable to do this themselves.

Christ, I have hundreds of examples of delayed referrals, not just three. In fact out of all allied health prof, I think S&L is the one that is not out there enough, little to no public awareness and I don't understood why the association haven't done something about it.

EVEN IF you wanted a medic to ultimately decide re specific lang impairment, I would never do this without a detailed S&L assessment. And about what I would look through if a kid walked through my door, where i work and what I do think works best for us, is that I would have a case file, usually with S&L, OT, Psych or whatever previous reports and they would be a big, big factor before I give an opinion after seeing the kid for an hour or whatever.

raemie21

tallaght01 wrote: »

Can I also double check what the above means? Cheers.

Because I took it to mean that, regardless of the quality of the GP letter, at least the kid is getting referred on to us. Do you think it would be better not to refer kids with speech delay? What a bizarre stance. I'd much rather a kid got referred badly, than not at all.

I mean that even as a medical professional - this notion that everything needs a medical opinion, that the doctor is the be all and end all, that nothing is sorted until the doctor has his say is very dated and frankly, often not the best course of action at all.

raemie21

tallaght01 wrote: »

Utter nonsense.

I work with the best speech+language therapists in the state.

I have huge respect for my neurosurgery colleagues too, but I wouldn't recommend them as your first port of call if you had a headache.




If you think that

A) there's huge groups of kids kicking around who've had their developmental delay flagged by SALTs

SALTs are trained in physical examination

C) SALTs can reliably pick up subtle physical signs of developmental delay/DMD, such as heart murmurs, altered epicanthic folds, hypertrophy of the gastrocnemius etc etc etc etc.....

well, there's probably nothing I can say to convince you that you're so far wrong. The most dangerous healthcare professional is the one who doesn't know their own limitations.

But I guess most people make the right decisions at the end of the day.

Bullsh1t.
Absolutely, in my experience about 60-70% of kids were picked up by SLTS and often after they had seen GP or PHNs.

Obviously SLTs are not trained in physical examination, Dairygold I don't think said that. What she meant was that any SLT or AHP would have the basic skills to note the presence or absence of dysmorphism, for example.

Ha, you're reduced to making comparisons to SLTs and heart murmurs now? The OPs original problem was about her bilingual child with delayed lang... but now we need to do a full head to toe medic exam??? :eek:

I think the most dangerous and unprofessional professional, is one who is unable to work in a team, who puts themselves above others and does not fully understand the value of his/her colleagues.

tallaght01

raemie21 wrote: »

The OPs original problem was about her bilingual child with delayed lang... but now we need to do a full head to toe medic exam??? :eek:

.

I think this is the most telling piece of argument you've put forward. Quite frankly, that in isolation makes you a liability.

I don't know what you do for a living, but the above makes me worried.

I know I was, until 2 months ago the child development/child abuse registrar in one of the largest units in the country. I have done the same job in the Ireland, the UK, New Zealand and Australia. In both groups of children, speech pathology and developmental delay are very common.

If you really believe that 60% of cases of devlopmental delay (Including duchenne's!!!!!!!!) are picked up by speechies, then you're living on another planet.

Your attitude is dangerous and misguided. You have the same chip on your shoulder about doctors that lots of allied health profesionals have. You take an questioning of the fcat that you're an all encompassing independent practitioner, as some kind of slight.
You talk about me not taking any value from allied health reports, which, even by your standards, is a shocking manipulation of my words.

The reason I assumed you were a paediatrician is because you talk with such authority about who needs physical examination, and about the quality of doctors' letters you receive. It is now VERY obvious that ou are not a paediatrician.
You obviously have no idea what you're talking about in that respect.

The points I've made right from the start are pretty simple:

A child with speech delay should first have a medical examination (regardless of what you think, that holds true. Hoping the SALT might spot gastrocnemius hypertrophy is prett scabby practise). Dysmorphic kids don't all look like your classic downs children. SALTs rarely measure a head circumference, for example, or look at a child's gait. A "developmental assessment" by SALT is a sham. A speech assessment by a SALT is very useful.

Once the kid is deemed to have no major medical issues going on the GP has 2 sensible options:

1) Refer to a paediatrician and a SALT at the same time
2) Refer to paeds in isolation. Then paeds will refer to SALT.

Usually we get referred the kid, and then we have a chat to our speechies. We talk about all our kids in our multi-disciplinary meeting before the next clinic, and all goes well.

That is what developed countries do with their at-risk children. This is how SALT is supposed to work. Getting offended because the proper pathway is being followed is a bit much.

We're getting the same stuff a lot more now....the physios want to start assessing injuries in A+E without a doc being involved etc. Things like that will start to happen in the future, and speechies will start being the first port of call for kids. This will happen because it's cheaper.

But cheaper doesn't mean better. I, and most paediatricians, will continue to treat all speech delayed kids as potentially globally delayed/suffering from other significant pathology.

Whether egos from other services like that or not, it's how good medicine is practised, and it's how any doc with their patients' best interests, rather than their own, at heart will continue to function.

lostinnappies

Wouldnt it be nice to have "centers" where all these professionals were situated under the same roof for one purpose only, developmental delays in children (or whatever they specialise in), and that a parent could just make an appointment to see all in one sitting. Far fetched i know, but wouldnt it be nice.:D

I got that from working in the Vets in UK. Larger Vets usually have everything you need under one roof and most vets (bar specialists) could do it all. None of this make an appointment this week for an x-ray, another appointment in 6 months for a scan ... and heaven forbid should you need anything urgent.

tallaght01

lostinnappies wrote: »

Wouldnt it be nice to have "centers" where all these professionals were situated under the same roof for one purpose only, developmental delays in children (or whatever they specialise in), and that a parent could just make an appointment to see all in one sitting. Far fetched i know, but wouldnt it be nice.:D

I got that from working in the Vets in UK. Larger Vets usually have everything you need under one roof and most vets (bar specialists) could do it all. None of this make an appointment this week for an x-ray, another appointment in 6 months for a scan ... and heaven forbid should you need anything urgent.

That would be amazing alright.

I used to work in a setup like that in the UK. I was working in neonatal intensive care at the time. But part of my job was to do the developmental clinic for the ex-premature babies, who'd come back to us for regular checkups until they were toddlers.

They'd walk in the door and see the nurse, the OT, the physio, the speechie and the psychologist, social work one after the other.

Then they'd come in and see me or another of the docs, after they'd seen the other health professionals.

The difficulty is that the psych will want to write a big letter after they've seen the kiddy, as will the others. So, we used a kind of tick-box sheet that they would all fill out. The letter would follow a week or so later, but at least we'd have some info in the meantime. I'd get a kid plonked in front of me with a whole load of proformas, with the relevant boxes ticked.

It worked pretty well. Then afterwards we'd all have a meeting to discuss the patients.

The problem is that no government will ever dare take money away from a neonatal unit (neonatal units and kids' cancer units are the 2 most difficult to take cash away from, from a PR point of view, so we always had all the cash we needed).

But you just wouldn't have the resources to do that in, say a child advocacy/child abuse clinic, where there's not so much public outcry if they're under resourced. Developmental paediatrics is also generally underfunded. It's a big bugbear of mine. I think we, as a society, should be judged on how we treat the most vulnerable in society. We treat some of our vulnerable kids well, but only really if their illnesses are trendy.

But I do love your idea.

lostinnappies

AAhhhh the NHS, wasnt it great? I know alot of people complained about it but having lived in UK myself for about 6 years, expierenced the NHS and then had the same treatment here ... I have to say the HSE is like being in a third world country.

Hey tallagh, you and me should take over and run the joint lol. We might get things done .... lord knows the politicians dont REALLY need $400 hair cuts and first class plane tickets.

tallaght01

The NHS was great in principle. Free healthcare for everyone. That's an incredible commitment for a country to make to it's citizens.

It just doesn't cope, though. I left it to go to New Zealand/Australia because of burnout.

I'm totally up for a hostile takeover, lostinnappies :P

I'm actually just about to give up a massive chunk of my hospital work next week forever! I'm going into population health, where my job will be working with government to help improve the country's health.

So, I'll be keeping an eye on everyone's suggestions from next week on

raemie21

tallaght01 wrote: »

I think this is the most telling piece of argument you've put forward. Quite frankly, that in isolation makes you a liability.

I don't know what you do for a living, but the above makes me worried.

.

Yawn.
Having just read your reply this evening, only a few points to make:

• I don't take any of your criticism to heart but for what it's worth, the feeling is absolutely mutual.
• Having presented my research and other work at both national and international forums in recent years, I'm very confident that I know what I'm talking about.
• If you think that every child with a speech or language delay in the country needs to see a GP in order to outrule a referral to a hospital consultant..... - it's the most ridiculous thing I've ever heard and I'm sure that clinical pathway would go down a treat in the HSE :rolleyes:
• The OP's kid is language delayed in the context of a bilingual family background. Now, no matter what, this kid will need a assessment of his/her communicative abilities in both languages and a profile of language use in their everyday settings. Who is best placed to do that...you, me, a psychologist or a speech and language therapist?
• The point that you originally made was that it was a 'bad idea' to got for an S&L assessment first and that is what I absolutely disagreed with. There is no reason to advocate a delay in seeking an S&L therapist's opinion, particularly in this case.
• The rest of your reply is not worth responding to but you've clearly misunderstood, misread or ignored some of my previous posts.
• Thankfully, given that we work in two different areas of medicine in two different continents, the chances of us ever ending up working together are very slim.

metrovelvet

I took my son to the pediatrician for his 18 mos check up and he has three words. She didn't talk about any of the underlying causes or send for neurological scans or gastro or anything tallaght mentions. She ruled out autism and is sending me to the speech therapist.

raemie21

I'm not surprised; Tallaght has been talking out of his a$$ throughout this thread and promoting a very ill-informed and misguided view of clinical pathways for children with speech and language impairment.

Best of luck with the speech & language assessment Metrovelvet, hope you don't have to wait too long for it...