2017 The role of the allergist

[Mr. Barlow]

Has the role of your allergist changes over time? 

[PurpleCat]

Not at our office.  I have heard from other parents that their kids see the allergist less, that the nurses are doing more.  Our allergist is very hands on even popping in often during food challenges to "check in".

[lakeswimr]

Yup.  He spends maybe 1/4 to half his time at the desensitization clinic and half in the allergy office.  That's a big change. 

[CMdeux]

Dr. Awesome is as awesome as he's ever been.  He's always had terrific nurses on-staff, and they operate much like a well-oiled machine, IMO. 

We get calls back from him personally any time the nurses don't know the answer to something, they call refills in without hassling us, and any time we need documentation for anything, that office is ON TOP OF IT. 


I love them so, so much. 


As DD has gotten older, she is taking the lead as patient with that office, and they are making the transition very gracefully.   

[ajasfolks2]

Our allergist sees too many patients now, IMHO.  Our visits are very quick . . . . but I do understand that our kids are not there regularly for problems or reactions.  We've been really REALLY lucky in past few years.

Our allergist is now in a large statewide allergy group that I think is in a larger allergist/provider group/network.  But I've not tried to figure it all out.

~ ~ ~

And, FWIW, our allergist is still in group who believes private practice OIT is NOT READY FOR PRIME TIME due to reactions and other related health risks (EoE) . . . .

[Mr. Barlow]

One new item we'll have to add: How do we, meaning family and allergist, make sure our relationship is protected from the chorus of Facebook groups, bloggers, and Twitter allergists jockeying for self-promotion and brand building among themselves?

As an aside jumping subjects, inside Sicherer's patient waiting area was a sign that banned food for the safety of patients.  I still have the photo somewhere on my hard drive.  Patients had to leave the allergy waiting room in order to eat anything.  Those were Mt. Sinai's rules--not ours.

[PurpleCat]

No food or drink have ever been allowed at our allergist going way back to the beginning.  I would find weeing someone eating in the waiting room quite disturbing!

[gvmom]

inside Sicherer's patient waiting area was a sign that banned food for the safety of patients

What?  No bowls of peanuts to play with while you wait, cause holding them isn't the problem right?

I'm wondering how many of his patients have a 504, or have been dissuaded from getting one.

[Mr. Barlow]

Hard to say.  I'm leery of any single turn of phrase that fails sophisticated, informed analysis.  That's how we get cookie-cutter medicine and law, which is not the intent of either.  We were patients of Dr. Sicherer.  Our experience with him left me with the distinct impression he was an impeccable scientist, caring, thoughtful, and not terribly quick to judge without a fuller picture.  But that was paid office visits in review of our full medical profile.

This internet stuff with docs tweeting turns of phrase in 140 characters... I don't know what to say.  I prefer to let MY doc do the driving, and when our doc was Sicherer himself we did NOT experience any of the internet-based truncations attributed to him by others.  Then again, our attorney handles our legal needs leaving our physicians to handle medical needs.  Never had the two contraindicate one another on the ground level in the way I see it occur in social media fervor.  Though I have heard the occasional attorney comment that allergists are too anxious and should put all FA kids in private practice OIT because of something he or she read (LEAP study news article--not journal, etc.).

Nevertheless, yes.  Sicherer may put an allergen in hand during a visit, he may put 2 mL of peanut butter in the small of a patient's back for 30 seconds before wiping off, and these are done with the intention of generalizing to environmental casual contact, yet by the time it makes the rounds to the outer world it's metastasized to mean proof of gross ingestion one-size-fits-all in every possible permutation.

Somehow, the physics of those proclamations to live confidently with allergens does not apply to his waiting room explicitly "for the safety of patients." Could I have confronted him about that?  Sure.  Would that have accomplished anything?  No.  They were caring, competent medical support and I had no wish to point out that glaring contradiction.

[gvmom]

Then again, our attorney handles our legal needs leaving our physicians to handle medical needs.

I was of course joking, though with a bit of an eye roll.  Though, does that mean Mt. Sinai disagrees with one of their allergists? 

But, in a past life we dealt with people who would take a statement like the one that was made about putting a peanut in someone's hand to show they wouldn't die, and have it used as a way to dismiss accommodations for my PA/TNA child.

Having a doctor that would be willing to state openly some things, especially one cited as an expert, is reckless especially if they actually know what a 504 is, and why many families are driven to get them.

And, just in general, many families don't have lawyers when they are sitting in school meetings.  They are left to face trying to refute something like his statement by themselves.  You are very lucky if you had a lawyer with you.

Many of our children don't get treated as individuals in the 504 process, like they are as patients with a doctor, and anything that can be used stated by a doctor to brush all food allergic children similarly in order to deny accommodations typically is par for the course. 

But..... I'm digressing from the topic of the thread.  Sorry.

Just as our allergists have changed over time, their roles have changed.  What we needed from a doctor when we went with an 11 month old for the first time approximately 16 years ago, dealing with a newly discovered peanut allergy, is completely different than what our children need now.  Frankly, allergists don't know that much more now than they did then.  Our children primarily go now for periodic testing, and, when warranted, a food challenge.   

 

 

[lakeswimr]

My son's former allergist (who retired and became his former allergist at that time) did not believe people could have contact ingestion anaphylaxis.  My son's body didn't seem to get this message and had contact ingestion ana multiple times.  This same allergist would not agree to do a peanut butter contact challenge before DS went to a higher grade in school where you smear a small amount of pb on a desk so it isn't visible to the eye and then have the child work at the desk for a while and see if they react.  I knew someone who did that with their child at a different allergist's office.  He said it would be too dangerous to do it.  So, while he logically didn't believe in contact ingestion reactions, he didn't want to take on the responsibility or chance to do a challenge to prove this in his office.

He insisted DS must have eaten food and lied about it the last time he had contact ingestion ana. 

That said, he was an amazingly great allergist.  This was one area where he wasn't strong.  He also didn't believe in 504s for FAs.  I don't think those things made him a bad allergist.  He knew his stuff.  He wasn't ever going to think differently on those two topics unless we had double blind placebo challenged the contact ingestion ana and the 504 wasn't ever going to change.

I liked the many strong points about him. 

Current allergist may or may not believe in contact ingestion ana but is polite when I talk about it and listens and never makes me feel coo coo about that topic.  He is supportive of 504s.  He's pretty darn awesome.  He also desensitized DS to two allergens. 

[Mr. Barlow]

I am for the most part pro se, meaning I represent myself with occasional consult (which is not representation).  However, when it comes down to a matter that requires the authorized practice of law by a person licensed to practice in our state of residence, it is not a choice whether a doctor would like to opine on a legal matter.  Similarly, it is not within an attorney's authority to render medical advice where it would require licensure to do so.  That some attorneys or doctors feel as if they could practice in each others spheres due to Dunning-Kruger effect or pure hubris is a separate matter.

The professional scopes are prescribed under regulatory or statutory schemes, not my own.  Though I am able to make my own legal and medical decisions for myself, my spouse, or my minor children.  It is ultimately a service they offer me in exchange for payment.  I am not their subordinate or employee.  We have a relationship based on information and interpretation for advice, albeit life and death matters at times. 

Random doctors on the internet not so much.  There is no relationship there, and in the interest of being a good patient I do not tend to look to the internet in lieu of his advice.   

I know some are opposed (noted), and it is neither with indictment nor endorsement I predict an increase in private practice OIT.  Burks and Wood are holding out on private practice OIT, and have even responded with a strong healthy skepticism towards LEAP findings based on more nuanced analysis citing Levin, et al.  Yet in USA this does tend to be where treatment is heading.  A good portion of Aimmune research utilizes anxiety meta-analyses, and I have problems with the underlying quality of the studies the meta-analyses are based upon.  Nevertheless, anxiety will continue to be propped up as a straw man to propel FDA approval for Aimmune, and where there may be skepticism to use that pharmaceutical version I believe private practice OIT will fill the gap.  I've reviewed the qualifications of the participating allergists.  Overall not bad pubs as primary investigators in food allergy.  I'd have to refresh my memory on specifics, but I was expecting much worse in academic and medical pedigree than what I saw.