Recently, I took Blur2 to the doctor. He’d been having a diaper rash for weeks. Initially, it started out like any other rash and my usual treatment (40% zinc oxide) worked. But weeks later, it was worsening and my treatment wasn’t working like it should if it was a typical diaper rash. So we went to our doctor.
I love my/our doctor (and the whole office) but I hate going for these minor ailments. As an ED doc, I knew what the next step was likely an antifungal cream; as a Mom, I didn’t want to be treating my own kid. Some of my colleagues and doctor friends would have just called in their own prescription. I feel dumb sitting there, telling the story, just really wanting reassurance. I do have a small supply of medications and laceration repair supplies at home for minor things; we don’t go for every URI/fever/etc but when things aren’t going how I expect, we go to the doctor. When Blur2 went through ear infection after ear infection, I kept hauling him into the doctor, to get them all documented because I was afraid he was going to need tubes - he ultimately did.
We have a separate Pediatric Emergency Department that is staffed by Peds EM and plain EM doctors. I do about 20% of my shifts there and most of them on the overnight shifts. I remind myself of my feelings that I have sitting in my own pediatrician’s office and teach my residents that the parents are often just looking for reassurance - that this fever is a virus, that this GI bug will pass, that this rash is not a serious rash, that the simple closed head injury does not need a CT scan - and guidance as to what to look out for next that would mean something serious.
I got my reassurance and prescription for an antifungal cream. And I feel better and so does Blur2.
When do you take your kid to the doctor? What’s your threshold? What do you take from your personal healthcare experience and add to your practice?
I'm an internist, so when she was really little I knew I couldn't treat her and I didn't. I chose her providers carefully and let them do their thing - although there was the time she came down with strep on a Sunday afternoon and I called the NP who was her PCP at the time at home rather than calling the urgent illness line...which is more about taking advantage of a friendship than treating my own kid.
ReplyDeleteWhen Eve was about 10, she had a bad URI and my husband stayed home with her. He called me at work and asked me to bring an otoscope home because her fever hadn't come down with ibuprofen and she was complaining about her ear. The weather was foul and he didn't want to take her out if it wasn't necessary. I looked in her ear and sure enough, one drum was crimson and bulging and she also had exudative tonsils and a temp of 102.5 two hours after ibuprofen. I told her I was taking her to the doctor. She burst into tears and said "YOU'RE a doctor and I feel AWFUL and I don't want to go ANYWHERE". So I weighed her, check the dosage for amoxicillin and called it in. Felt guilty about it until the next afternoon when the fever broke and she felt better.
I use a lot of my parenting experience in my practice, more to help my patients through relationship issues than anything else - but my first inpatient stay 25 years ago taught me to tell my patients what they had ordered prn. I would have loved to know that I had an NSAID available when I didn't want to take the opioid any more.
I am a pediatric anesthesiologist. When it comes to my kids, I do my absolute best to behave like their mother and not like their physician. I assume that my pediatrician probably thinks I'm silly for some of the stuff I've come in for over the years, but I'm willing to accept that; in turn, I'm pretty sure he knows that he is truly functioning as my kids' pediatrician and not just someone we go to when I'm in over my head. As for treating my kids, I will use my otoscope to decide whether or not a trip to the pediatrician's office is warranted and I have once refilled my daughter's albuterol when we were on vacation and had neglected to pack it. I don't bother his office with the endless school forms, aside from getting a copy of vaccination records. Here is an article that came out relatively recently, which I read at the time, and found useful, in NEJM against treating family members and friends: http://www.nejm.org/doi/full/10.1056/NEJMsb1402963 I guess, in general, I feel like treating family members is a slippery slope and one that I really don't want to be on.
ReplyDeleteI'm a family physician, but still feel like when it comes to my kids, I'm just mom. I have diagnosed ear infections at home, but still usually bring them in to see one of my partners for confirmation (occasionally have asked them to call something in on the weekend without bringing kids in). I feel like in some ways, my mommy brain kicks in and my doctor brain turns off when it comes to my own children. I want that confirmation even when I think I know what's going on. When our son was 3 months old (1 week after I went back to work), he was hospitalized with RSV. he was febrile and having respiratory distress and getting dehydrated and of course it was a Sunday and I debated but finally decided to bring him into the ER. If I wasn't a doctor, I would have probably brought him in sooner, but I was overthinking things. I have occasionally called in prescriptions for family for things like pink eye on a weekend, but try not to. Fortunately my family members are good about not asking me to do things like that very often. =)
ReplyDeleteMy personal rule is to not be a doctor with my kids (obviously emergencies are the exception). I can't see my kids or family in the same way as I look at other patients, and I can't be impartial. Denial is a powerful force and it is astounding to see how much it can blindside you.
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