Interview with Dr. Florence Sandmann MD – Pediatrician

Several physicians have graciously consented to interview on my Save the Child blog. It is my pleasure to introduce the first today. She is Florence Sandmann MD – Head Pediatrician at Hu Hu Kam Memorial Hospital OPD (out-patient department) on the Gila River Indian Reservation.

Margaret: How does working for a government-run facility differ from private practice, vs hospital owned clinic?

Doctor Sandmann: There are a lot of policies and procedures! And MEETINGS!!!! Also, nothing fancy by way of exam rooms and offices. Just the usual Government Issue furniture. Not bad though. Sometimes simplicity is what you need. This facility is excellent because there are many different services in the building, such as lab, X-ray, Pharmacy, some specialists, Physical Therapy, Eye Clinic, and Dentistry! They even have Behavioral Health Services in a building next door.

Margaret: What do you view is your role as a pediatrician?

Doctor Sandmann: A dispenser of knowledge and to keep the kids healthy and safe.

Margaret: You work with a Native American population. How does your office try to accommodate their culture, beliefs or native treatments when they prefer to use them?

Doctor Sandmann: First of all, I think we are hired because of our personal cultural sensitivity. A lot of our handouts/booklets use traditional pictures and often include a few of the traditional ways of doing things. There are times, however, when we have to talk to the parents about some of the old practices and how they can actually be detrimental to the child. For the most part, we can combine traditional and conventional medicine in a way that is understandable by both sides – and very helpful.

Margaret: Can you give us some examples?

Doctor Sandmann: When the anterior fontanelle feels depressed, it is considered “fallen” and needs to be suctioned up. I freaked out when I heard this one! But after finding out just what the treatment was – the hair over the fontanelle is pulled up and a finger presses on the hard palate – I was okay with that particular tradition. I did explain, though, that it does nothing to the fontanelle at all.                                                                            We also try to work with the old traditional Indian foods to promote healthy eating.

Margaret: What percentage of cases seen present with a parent/s that disagree with what is recommended such as immunizations, or other necessary medical treatments?

Doctor Sandmann: Not very many. Most of the parents and grandparents (many have primary custody) are respectful of the medical community and our recommendations. (Unlike some of my former private middle to upper class parents!!) It is compliance and follow up that becomes the issues.

Margaret: How does your office go about obtaining compliance to your recommended protocols and regimens?

Doctor Sandmann: With frequent phone calls and public health nurses who go out to the homes.

Margaret: We are governed by the tribe and have to run past the board all that we do. The parents support the board.

Doctor Sandmann: We are governed by the tribe and have to run past the board all that we do. The parents support the board.

Margaret: What criteria do you consider legitimate reasons for refusal of recommended medical care?

Doctor Sandmann: Religious beliefs, I guess.

Margaret: Do you offer or use any complimentary or alternative medicines in your practice? Can you give us an example?

Doctor Sandmann: Not currently but I am not adverse to it.

Margaret: Would that be different if you were in a private practice, or non-government based clinic?

Doctor Sandmann: No.

Margaret: Are you aware of any other pediatric practices that use complimentary or alternative medicines? Which ones would they be? Do you refer patients there?

Doctor Sandmann: There are a number of practices that use some form of alternative medication, whether they be vitamin therapy or specific herbs. I’m not sure here in AZ what practices do this though. It is more popular in the adult medicine circles with acupuncture, massage therapy. We use music therapy for kids.

Margaret: What is the largest health problem you encounter in the pediatric population you treat?

Doctor Sandmann: Obesity!!!!! And bad teeth!!!

Margaret: At what age do you feel a child is competent to make his/her own decisions and choices regarding healthcare?

Doctor Sandmann: Generally we allow them to come in by themselves without an adult and make decisions once they turn 18. (Here on the reservation, the age is 17.) Girls can come in any time with an adult but I can see them in the exam room alone and they can make decisions regarding birth control use without the knowledge of their parents. We want them to be able to confide in us without the fear that we will tell their parents. We get more accurate info from them that way and it helps us better address their issues.

Margaret: Are there factors that may make exceptions to this situation?

Doctor Sandmann: Mentally incompetent, parental refusal, patients want to hurt themselves or others, etc. The usual.

Margaret: Do you have problems dealing with insurance / financial reimbursement for your services?

Doctor Sandmann: It is different for us here. Generally we get a set fee for every patient under contract health regardless of how severe their problems may be or how minor. It evens out in peds because we see a lot of minor illnesses! Some of our patients have AHCCCS so they can get more services. It can be frustrating for those who can’t get AHCCCS (and us) because we can’t refer them to specialists and have to treat them ourselves. We get grant money for programs, which is great! There are a lot of great free services for our patients.

Margaret: Can you give an example as to how much this impacts your practice?

Doctor Sandmann: Not much for us here but reimbursements in private practice insurance reimbursement issues are a big deal.

Margaret: I appreciate that you spent your precious time with me today Dr. Sandmann. I am trying to let my readership understand the issues that surround factors like Parental Rights in their children’s HealthCare. Your answers help enlighten part of the picture. Thank you very much.

PS  Tina Scott interviewed me today on her blogspot about  Save the Child URL: http://www.totallytinascott.blogspot.com . Thank you Tina!