I am going to chime in here Bert. I think you have a good reason to have a pit in your stomach. I think from what you tell us, it seems to be more of a lack of understanding/education issue. I would start by trying to get the family and the endocrinologist and you in the same room at the same time for a meeting and discuss and listen to what his issues are with starting GH (and making sure that he will continue synthroid). I know this seem utopic rather then realistic and maybe I have too much time on my hands because my practice isn't super busy yet and only seeing 40 patients a week. I do think that if you can get him and mom in the same room with both you and the endocrinologist and see what the issue is, it may help. I have had several cases where the patient kept not taking meds and then finally when put it to them bluntly they got it..i think talking about long term ramifications are def important.
Of course you probably already did something of the sort, but just at thought.
If they refuse the meeting and/or after the meeting they still refuse I would just call and mention it to the agency saying you aren't sure if this is somethign to report or not, but here is the deal.
In the end you are protecting your patient...and a child...if an adult doesn't want to take something to help themselves, that is fine, when they interfere with children's health, i have an issue with that.
Ketan
