My Therapeutic Goals
My goal is to provide
comprehensive specialty care for infants, children, and
younger adolescents with ear, nose, sinus, and throat
problems.
I achieve this goal by the application of maximal medical management, a
blend of comprehensive diagnostics and creative therapeutics all
directed toward the control and eradication of your child's problems without the need for surgery.
I am a member of the founding cadre of pediatric
otolaryngologists, ear, nose, and throat specialists who treat only
infants and children. After more than 33 years in the
field, I apply a unique set of diagnostic skills which includes
the use of specialized instrumentation and distraction techniques in
order to establish the contributing factors for any given child's
issues. Once such factors are identified, I use both cutting edge and
time-tested medical therapy
to eliminate them. Only when all less invasive avenues of
treatment are exhausted or proven to be ineffective, will I recommend
and perform surgery with your advise and consent.
Good
communications
are critical for good health care.
The foundation of high quality
health care is a close doctor-patient relationship. I
want to establish a close working relationship with you
and with your child. This begins during the course of our
initial meeting and continues to develop during
subsequent visits we have together.
Please plan to arrive for the first
appointment at the time given to you. Built into that
appointment is the necessary administrative time to
register your child prior to the actual visit with me. If
you are unfamiliar with the area, please allow extra time
to negotiate traffic and find the office. We also
encourage you to follow our directions (see 'How to find
our office' to the left) rather than Mapquest or your GPS
device. For all follow up visits, we request that you
arrive no later than 10 minutes before your appointed
time.
I like to begin each session with a
discussion of your concerns about your child's ear, nose,
and throat problems. It is most important that you feel
comfortable about sharing with me all information
relative to your child's medical condition. Some parents
find it helpful to jot down in advance high points of the
medical history as well as their observations and
questions, so that they are certain to include all
important details during our discussion. I also welcome
the chance to review any written information or test
results that you or your primary care physicians have
available. Please don't hesitate to bring this
information along for your visit or to fax a copy of it
to me in advance.
After my examination and a
summarizing discussion, I will prepare a note for your
child's chart as well as a letter to your child's
pediatrician. I have a policy of sharing all information
with patients and their parents via an email sent as soon as possible after each visit.
My
examination.
During the examination, younger
children will sit on a parent's lap in the examining
chair. Older children usually sit by themselves, but you
may wish to stand by them if this is reassuring. My
examining chairs have electric "elevator" features which
never cease to delight children and many adults as
well.
I will help you position your child
to minimize sudden, unpredictable movements which could
be painful. It is natural for a child to dislike having
instruments in the ear, nose, or mouth. Thus, to
obtain the most complete examination possible, I employ a "cast" of
animated characters of all varieties who sing and dance for the
children. Such distraction therapy keeps them focused on fun
and not on the fact that I will be gazing into their ears, noses, and
throats. If our examination proceeds in a way that is minimally
uncomfortable and even enjoyable, you will find that it will be easier
to convince your child to be examined on subsequent occasions.
During each visit, I will
examine all regions but
concentrating on the area of concern unless a new problem
involving another area has surfaced since the previous
visit. Please alert me if this is true.
I try, if possible, to arrange and
coordinate any necessary tests at the time of your visit. Hearing tests, blood tests, and routine x-rays will be
arranged for your child at facilities convenient either
to your home or nearby my office. Once results are
available, I will discuss them with you either by phone
or during a subsequent visit.
Therapy.
As mentioned above, most problems may be managed with medical
regimens, and I will outline for you an initial and
updated strategies as we go along. My regimens combine
over-the-counter medications and devices with
prescription drugs.
My prescriptions are computer
generated with dosages individually calculated for your
child’s weight. They include an information section
at the top which includes a copy of your prescription
including the drug name, dosage, instructions, and
refills. Prescriptions written by me may be filled at any
pharmacy in Connecticut or Massachusetts. I will almost
always provide you with at least one refill for each
prescription in order to cover you if you run short of
medicine. Please be certain that the pharmacist labels
the medication bottle accordingly.
If I recommend surgery and you and
your child's pediatrician concur, my office will make the
necessary arrangements with the hospital and will notify
your insurance company in order to obtain the necessary
precertification. Every effort will be made to
accommodate your schedule. Please remember that patients
with the most urgent problems must be served
first.
All surgical patients are scheduled
for a pre-operative visit with me, usually several days
to one week prior to the scheduled surgery. When they are
necessary, your child may also be scheduled for
laboratory tests in advance of the scheduled preoperative
visit at one of your healthplan's approved testing
centers. I perform most surgery at the Connecticut
Children’s Medical Center, and the hospital operates
a pre-operative orientation program which I highly
recommend. Please ask about it.
At the time of your pre-operative
visit, I will provide you with all necessary instructions
and prescriptions. I recommend that you fill
prescriptions for post-operative medications prior to the
surgery to eliminate hassles during the day of
surgery.
I see all patients at least once
post-operatively one to three weeks following surgery.
Frequently, I will see you child back at quarterly
intervals to monitor progress post-operatively. Those
children undergoing ear surgery will have a
post-operative hearing test arranged for them at an
appropriate time.
© 2011 Howard
G. Smith MD
PENTA
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