I had a low day yesterday, and then had trouble getting to sleep even though I took benadryl, and then at 2:00 in the morning my phone rang and that is just never going to be good news. And I could see on the screen that the caller was my eldest son, which was weird; this happened once before, though, when he’d gone outside to get something out of the car and locked himself out. But when I answered, he didn’t say anything, which gave me visions of him badly hurt (calling me RIGHT BEFORE LOSING CONSCIOUSNESS!!) and/or kidnapped somehow. But no: butt-dial. Time it took for me to get back to sleep after this drama: roughly 1 hour 45 minutes.
I have what I find to be a pleasing though boring update on my fretty dentist situation. That post is just a giant tangled ball of stress, so I suggest NOT clicking the link, and instead I will summarize the relevant part by saying I’d canceled Edward and Henry’s routine dentist appointments, then regretted it because Henry has braces and it really seemed as if he ought to have a cleaning, especially since the DAY I canceled the appointment we got a pre-appointment letter from the dentist that made it sound really really safe. And anyway it made me feel as if every decision I make is wrong, and I’d continued to fret about it, but felt too sheepish to call the dentist and ask for a new appointment for Henry. Then I saw Elizabeth’s routine cleaning coming up on the calendar, and I called the dentist office and asked if it would be possible to give Henry that appointment instead of Elizabeth (I’d been planning to just cancel it), and they said yes, so now the kid with braces will get his cleaning, and I feel better.
A friend brought to my attention that kids 18 and older have to sign HIPAA authorizations and possibly medical power of attorney forms, or else their parents can’t have access to their information or make medical decisions for them if they’re incapacitated. That seems…rather crucial, in a pandemic or even not in a pandemic, and had not occurred to me at all. My hope is that at some point someone ELSE, like the kids’ colleges, realized that this was something that needed to be done, and that Rob and William have already signed such forms. Looking at the HIPAA form, I vaguely remember them being given one like it (with some ceremony about it, like, “Now he’s 18 he gets his own HIPAA, Mom!”)—but I don’t FULLY remember if that happened (1) at the pediatrician (as opposed to at an eye appointment or something), and (2) if they filled out our names on it, and (3) if it happened for both Rob and William. So there’s my new/current fret.
To add to that, some pediatricians will continue seeing college kids/past 18 but some won’t & then they are considered a “new patient” at a GP or family doctor, which seems less than ideal in a pandemic…
My mom is a dental hygienist and was basically forced back to work (she’s in her 60s, and her boss told her if she didn’t come back he would hire someone else who would). She is super nervous about it because the ADA says it’s one of the most at-risk jobs during a pandemic, and sure enough she has patients who aren’t following the rules (ie parents coming in with their kids and sitting down in her room taking off their masks, etc). I believe it’s considered safe for the patient but not really for the staff. Yes, she is wearing a mask and face shield but she also has her face 6″ from someone’s mouth for 45 min and the windows in her building don’t even open to ventilate. I fully support anyone who wants to put off dental cleanings right now.
Your friend is not quite right. “Medical power of attorney” (health care proxy) forms allow a person to designate someone to make healthcare decisions for them when incapacitated. Your children certainly don’t have to choose you, but if they don’t have health care proxies completed, you and Paul are their legal next of kin (until they marry or have their own 18+ offspring) and therefore would be legally allowed to make such decisions if they were incapacitated. Having a healthcare proxy is important, but it’s most crucial if you don’t want your legal next of kin making medical decisions for you.
Regarding the HIPAA release forms, whatever form the pediatrician/eye doctor/etc had them sign most likely is one to allow other providers to release records to THEM, not one allowing them to release records to you or to any other individual. (e.g., if Rob was hospitalized, this would allow his primary care provider to request records from the hospital where he was seen). In my experience, they’re institution/practice-specific and we don’t routinely have patients sign release forms allowing records to be released to family members etc.
Yes, this. My (now deceased) dad, who had dementia (but wasn’t completely incoherent or unable to express his wishes, generally) did not have a POA but I still got to make all his medical decisions when he was unable to (e.g. he broke his hip and really was incoherent because — stress, pain) with NO questions about my authorization to do so (ironic, because my dad did refuse to sign a POA, though he also always wanted me there deciding for him if he could not. And he was a lawyer!). The doctors and nurses very definitely do not want to be making those decision for the patient if they can identify a family member willing to do so and plausibly situated ditto (they did become briefly concerned when they realized I’m not an only child, but only because they were worried my brother might disagree with my choices and — lawsuit city. But he did not, at all, was very grateful I was there making them (and for the record, my decisions were pretty much, “Yes, I agree Dad should have the surgery you recommend and will sign here,” not exactly complicated — though obviously, the situation could have been different)).
Do you know what happens if the next of kin are multiple adult children? Is there a “tie-breaker”, like age or something?
or multiple parents for that matter?
Every state has slightly different next-of-kin laws so this will vary slightly by state. If two parents disagree, typically the hospital’s legal/ethics teams will look for some evidence of what the patient would have wanted. When offspring are the next of kin, I wouldn’t be surprised if the oldest child of legal age is the legal next of kin in most cases, but I haven’t researched it to know for sure. Hospitals would still most likely look to see if there’s any way to find out what the patient would have wanted, before involving the courts.
Thanks!
We meant to do the POA and HIPPA authorization forms for an older child but forgot. With another child returning to college, we need to get on it pronto. We may even do them for the older child, who has graduated from college, but is not yet married. I don’t think that I can put a link in the comments, but if you put “Will you be able to help your college-aged child in an emergency?” into a search engine, an article from CR will come up which talks about the process. It does say that it differs by state, as to things like whether or not the forms need to be notarized.
My husband and kids went to the dentist today. The protocols did make it feel totally safe and fine, there seemed to be a skeleton crew of staff and we were the only patients, etc. HOWEVER they aren’t polishing/using the electric toothbrush thing right now. This seems like vital information that should have been told to us ahead of time! Like sure, they got scraped and flossed or whatever, but isn’t polishing an important step? I’m not sure I would have kept the appointment had I known. Something to ask before going – what do your services look like right now?
My dentist has stopped polishing unless there are extenuating circumstances. It seems (according to my dentist) that research as revealed that the abrasiveness of the polish is harsh on teeth. If asked, they will (in normal times) do it with normal toothpaste instead of the gritty dentist stuff. The most important part is removing the buildup which the scraping part accomplishes. (I haven’t been since this whole kerfuffle. My dentist started this over a year ago.)
I just went to the dentist for a cleaning too. My dentist is in his 60’s and is a self reported risk averse person. He said that there have been no reported instances of patient-dentist/hygienist transmission either direction, and that even without access to N95 masks, the masks they use plus eye/face protection and gloves seem to have been sufficient so far anyway. This gave me a lot of comfort.
I just went to the dentist today.
1) I have terrible genetics for teeth (first crown was at 15) so I’m leery of not seeing a dentist regularly.
2) I was scheduled to have new xrays and have the dentist check everything (it’s once a year for the dentist to poke around at this practice which is very much at odds with my last dentist who saw me every 6 months, but ok) in addition to my cleaning.
3) All the providers (hygienist/dentist/dental assistant) were wearing N95 with regular masks over the top, HEPA filters were running everywhere, patients had to wait outside and be screened for temp before entering, the front office staff were in cloth masks, and there were fewer patients and staff working.
If I weren’t scheduled for xrays and the dentist to do an exam, I probably would’ve skipped, but I wasn’t comfortable risking more expensive work by delaying (and cases are increasing here so who knows when I would feel better about community transmission rates!). I’m glad I went though because holy crap 2 hours away from my family felt like an expensive vacation and two old fillings are washing out(?) so I can get those replaced without them being painful emergencies.
As for the cleaning, the hygienist used the manual scrapers instead of their ultrasonic descalers or whatever they are and no polishing, but they did brush with a manual toothbrush. 🤷♀️ I definitely felt safe seeing what all they had in place, but I would definitely skip any other medical appointment over a dentist appointment because of my situation so that’s probably unusual.
My dentist added at $14 charge in the end of my bill for “Covid”. Half was paid by my insurance. I inquired and was told it was to cover masks and goggles. WHICH THEY WORE BEFORE COVID And didn’t charge me. This is why healthcare is so messed up. Happy to pay extra for something new, but to take advantage and charge for what before was standard makes me angry. It’s not like they upgraded to n95 masks or whatever.
Is the equipment they buy more expensive or difficult to source now? I assume it might be, which may explain the cost. I also assume more cleaning equals fewer appointments.
I agree healthcare in general is messed up.
My mom’s (dental) office could not open for weeks because they could not source the masks/shields needed and even though the ADA recommends gowns her dentist could not get them but decided to open anyway. The ADA also recommends certain filtration systems and not using anything that can spread viral droplets (aka polishing, ultrasonic) and their building is an old house that does not have a HEPA filter or windows that actually open. My mom bought her own personal HEPA system for her cleaning room AT HER OWN COST and her dentist (who owns the practice/building) decided it wasn’t worth it to upgrade the rest of the building. Talking about the US healthcare system is one thing but seriously, the risk hygientists and dentists are taking to see patients is crazy and I would think the extra cost is absolutely necessary. (I don’t mean to come off angry at you but I am absolutely livid at my mother’s work situation and since her state’s governor decided dental services could resume there really was no choice but for her to go back to work even though her boss couldn’t guarantee her the basics that the ADA laid out for a safe opening)
I found my dentist to be very safe; I hope yours is the same. The hygienist wore complete PPE, like gown, hat, face mask and shield, booties, EVERYTHING. I hope the same for Henry. My younger son has braces and because of this it looks like he will be wearing them longer than hoped…but that’s a small thing.
Re: lack of polishing. I read an article a while back in the NYTimes that claimed the polishing part of a dentist visit is basically an optional cosmetic step. I have no relevant medical knowledge to back this up, but my guess is that the scraping is the most important part of the cleaning. And on top of that they check for gum disease, signs of oral cancer, kids who need sealants redone, adults with fillings that are starting to fail, etc. So even without that step those appointments still accomplished something.
(Anyone with actual education in dentistry is more than welcome to correct me here!)
I have no interest in being in a medical or dental office. but I also worry about the dental hygiene of my braces-wearing 13-year old. It’s definitely time for a cleaning. He also had one of his brackets fall off recently. It was definitely time to see the orthodontist. So we went. In fact, they wanted me and all 4 of my children to come in so they could be checked to see if they’re progressing nicely (orthodontically speaking). I called NOPE on that. I did bring the 11-year old because he may have to have some of his teeth extracted if they don’t progress soon and that seemed like a thing. Little did I know the poor boy would have a full on panic attack at the idea of entering a dental office. How are we coping? We’re coping just fine. The orthodontist came out to reassure him that they have filters going in every room. Everyone is wearing masks. Everyone who comes in has their temperature checked. Everything is being cleaned even more often than usual. He calmed down and got checked out and it was fine. Everything was going fine. Until an assistant from another room popped into our exam room wearing a face shield, but with her mask under her nose. Hmmm. Since she left the room right away, and not wanting to trigger another panic attack, I didn’t say anything. But I started planning our getaway route immediately. We finished our visit. And that same assistant, with the face shield and now with her mask UNDER HER CHIN came into the room to schedule our follow up appointments. I took the first thing she gave me and we got the heck out of there. Then I found an article that explains how face shields protect the wearer but not the people around them and emailed it to the orthodontist’s office telling them they should really insist that their staff wear masks correctly to protect the patient who is laying mask-less with their mouths wide open a mere two feet from her mask-less face. ANYWHO.
I also had a suspicious-looking mole-like thing on my thigh. And it had been more than a year since my last skin check. And I have a family history of skin cancer so I KNOW I need to be cautious. So I made an appointment with the dermatologist. He is one doctor. He has one assistant. So, why is it that when I arrived on time for my appointment there were two other people arriving for appointments at the exact same time? Hmmm. I tried to triangulate my position in the not-as-empty-as-I’d-like waiting room just right, and luckily got called into an exam room right away. Ok. Get undressed. Wait for doctor in empty room. No problem. This is fine. The doctor entered the room wearing a regular surgical mask, checked me head to toe, confirmed my suspicious thing is nothing to worry about. As we were talking, his mask kept getting pulled down by his chin, uncovering his nose. Then he’d grab it and pull it back up. This happened about 5 times in the few minutes we were talking. He’d like me to come in to his office every two weeks to get chemical peels for the dark spots on my face. I THINK NOT. I’ll keep my dark spots thankyouverymuch.
I’m glad somebody mentioned the POA/HIPAA release thing above because it is likely really not something you need to worry about in the situations you are imagining. As long as Rob and William would be comfortable with you and Paul making decisions for them while they are incapacitated, that’s the default option anyway and requires no paperwork. And if they are not incapacitated in a given situation, then they can sign whatever forms are needed then.
Also, if I might recommend prescription drugs, my psychiatric nurse practitioner suggested a mild, non-habit-forming medication called hydroxyzine that is used off-label as-needed for anxiety. It is an antihistamine, so it also helps me sleep. So that might be something worth running by your primary care provider. My wife was so impressed by how well it works for me that she got a prescription for herself and uses it occasionally during these pandemic-y times.