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Greetings to our patients and patients’ families.  This newsletter is intended to provide an update on our practice and recommendations for our patients.

First, it is that time of the year for flu vaccine again.  Please do call and make an appointment for the vaccine.  This year the flu vaccine in the form of nasal spray is no longer recommended for use because recent studies on its efficacy showed that it was not effective. Therefore, all flu vaccines recommended for this year are administered by injection.   Is the vaccine safe?  Rare adverse events may occur, such as Guillain-Barre syndrome, but it is more likely to occur with the actual flu infection than the vaccine.  The vaccine does not weaken the immune system, but trains the immune system to be stronger and more prepared for the real infection.  Is the vaccine necessary? Usually a viral infection such as a common cold can induce a fever response that lasts 2-4 days.  The flu tends to induce a fever that lasts longer.  So each time a school aged child has a respiratory infection such as flu, there is a good chance he/she may miss school for 4 days or more.  Each day a child is sick means a day of school is missed (for the child), and a day of work/wage is lost for the parent who has to stay home to care for the child.    The cough, nasal congestion and runny nose can last 2-3 weeks.  Other people who are close to the sick child can catch the virus and get sick as well.  Therefore, even from a financial point of view, vaccination against flu makes sense.

Second, we have been teaching first- and second-year medical students from Tufts Medical School and nurse practitioner students from Regis College and elsewhere.  With your consent, we teach the students on how to obtain a medical history, take vital signs, do a physical examination, analyze the problem(s), make a diagnosis, and then prescribe a treatment.  However, we feel that such “teaching” visits benefit our patients as well, because sometimes a student may ask questions about a patient’s illness that a parent, patient or physician has not thought of and may help in the diagnosis and treatment.  Therefore, it is a process of learning for them and for us, and extra time may sometimes be needed for a patient visit.

Third, Ashley Flynn, a Licensed Mental Health Counselor, has been providing counseling to our patients since March at our office.  She can provide advice to parents about how to deal with children with behavioral problems at home or at school.  She can offer advice to patients with attention deficits disorder, and she can offer counseling on grief, anxiety and depression. The advantage of having her available on site is that we physicians can talk to her about a patient’s needs directly and we can also get feedback from her more conveniently.  We believe that her presence allows us to be a more complete Medical Home for our patients.

Fourth, another person who is vital to the Medical Home is the Medical Home Care Coordinator.  We are fortunate to have Kelly Daugherty, who joined us in October to fulfill that role.  Kelly had previously worked in a similar role in Medford and Lynn.  She will help our patients with special needs to get appointments with specialists and to obtain services through various government or private agencies.  She will also send out reminders to our patients who are due or overdue for an annual well visit, and she will reach out to families who may have barriers to obtain healthcare for their children.

Fifth, a schedule of preventive health, or “well-child” visits has been recommended by the American Academy of Pediatrics, and those visits are all covered by health insurance plans.  During these visits, we have screening questionnaires for patients/parents to fill out and for the physician to review and to address any concerns raised by the questionnaires.  We usually review a child’s growth, nutrition, dental health, school readiness/performance, physical activities, habits, safety, mental health, and family situations, and we will address any existing medical problems, such as asthma, allergies, diabetes, etc.  Therefore, please do raise any concerns you have during these “well-child” visits, even if they are not on the questionnaires.  Eventually, when we adopt a new electronic medical record system next year, we will be able to have these questionnaires sent via internet to our patients/families so that they can be filled out on-line 1-2 days prior to the visit.  We recommend that you schedule your next well visit before you leave the office every time.


Tien-Lan Chang, M.D.
Pediatric Associates of Malden