My first complaint

This week I got my first complaint from a parent of a patient. Normally, this would be a traumatizing moment for me, as I am a bit sensitive and need to thicken my skin for for future incidents. The last thing I want to do is offend someone or make a bad name for myself, but I know I am not perfect, parents are not perfect, and I will unintentionally offend someone again. I actually found this incident kind of funny and an example of why patients and parents need to use common sense and courtesy.

Monday one of the doctors came to me and said that she received a call about one of my patients. My heart began to race. She told me the conversation and I knew exactly who she was talking about.
Rolling back to Friday... An hour after the scheduled appointment, I see a girl about 8 years old with a chief complaint of runny nose, congestion, and fever for three days. She had not had a fever since the first day, no fever now, and had not taken any medicine for fever (Tylenol or Motrin). No cough, no history of asthma or allergies, no sick contacts. The only thing I found on physical exam was a really congested, runny nose. Meanwhile, the mom had been talking on her cell phone in a heated conversation for about 75% of the visit. Yes, there were signs in the room about cell phones, and I did have the right to leave the room and come back when her conversation was over or have one of the assistants tell her to turn off the phone, but I was feeling a bit laid back and decided to ignore it. I wrote a prescription for some Sudafed Cold and Cough to relieve the congestion; (yes, I prescribe over-the-counter meds all the time because Medicaid will pay for it, and I figure even if it saves them a couple bucks, a couple bucks may be their children's lunch money). I explained that it's most likely a very bad head cold caused by a virus, that antibiotics won't help (when she asked if I was going to give her the "pink" medicine), and with the combination of lack of fever, no sinus tenderness, length of time, and her age, it most likely was not a sinus infection, and that because it was a virus it just needed some time to pass. I told the mom that if it did persist for more than a couple weeks without any relief, to come back in. The mom was not very happy about the medicine and just shook her head on the way out and mumbled about how "this stuff don't work."

Fast forward to Monday and the doctor tells me about the call she received from the same parent of the same patient. The mother said, "I don't mean to be mean, but I saw your assistant on Friday and she told me it was a cold and gave me some Sudafed." The doctor said that the mother's voice got angrier when she started telling her about her experience after the visit. During that same weekend (not sure if it was the same night of her visit or not), she went to an urgent care (wonder if she had to pay a co-pay, but that's another issue). The mother's anger reached it's climax when she said, "your assistant said it was a cold, but they (urgent care) diagnosed it as a VIRAL infection!!" The doctor reassured her that the two diagnoses were the same thing and that I was correct in my decision.

If only this parent had not been on the cell phone, she would have heard me say "virus" at least three times. Oh well. I guess the stronger the medical terminology, the more reassuring it is to the parents... I have also learned my lesson on cellphones: it's gotta be zero tolerance from here on out...

Welcome to Pediatrics

Now that I've been in my job for over a month I guess I can share some experiences. Jumping into pediatrics for my first job has been quite an experience. I've learned a lot and still have so much learning to do. There's been some ups and downs. Downs including demanding parents (PLEASE check your attitude at the door), kids coughing in my face, the shock of having over a third of my paycheck go towards the government, and a few others. Ups include the sincere thank yous, working with great staff, the smiles that I get from kids of all ages, the opportunity to express standards and morals (monitoring TV programs, abstinence, etc...) while being viewed as "an authority" - that part is still a little weird. I appreciate those little opportunities where I hope I make a small difference in someone's life during such a short encounter. And then there are those weird, crazy, and funny moments, some are as follow...
* A rule for parents: please do not bring your puppy to your child's doctor appointment. Even more important, do not weigh your puppy on the baby scale or use any other clinic equipment on your dog.
* Another rule for parents: Please do not steal soap from the rooms. That is just ghetto. Ghett-o.
* I do confess that there are quite a few parents who ,"do not present themselves well," as one of my friends would say. Sometimes they don't have to say a word and sometimes their kids will say it for them. I had one tot whose first words, according the parents, very closely resembled "shut up" and "stupid." The only response I could say was ,"Wow." I remember my program director in PA school very early on in our training teaching us the importance of the "thought bubble" - as seen in cartoons and comic strips - and keeping our potential reactions and thoughts inside that bubble. I have used my "bubble" often.
* I am often humored by "creative spelling" of kids names. I know with some of the parents English is their second language, and some parents are trying to be unique, but I can't help to chuckle when I see names like "Melony" and "Marical" and quite a few others. Plus, it makes me look a little foolish when I attempt to say their name after I read it off the chart.
* One of the important rules I learned in pediatrics: Teenagers will always take more time. Always.
* I love my Littman stethoscope. It has endured some trauma during this past month, but its durability has not let me down. On my one week anniversary working at the clinic, I came down with the stomach flu. Near the end of the day as I was observing one of the doctors start putting some sutures into the last patient of the day, my stomach could no longer keep my breakfast and lunch down. Before I bowed to the porcelain god, I threw my stethoscope off my neck and onto the floor. After I finished what I needed to do, I noticed that the chain was broken in the toilet. I removed the lid of the tank and placed it on the trashcan so that I could reattach the chain. As I was fiddeling with the toilet , the trashcan tipped over and with with a loud noise (enough to scare another staff member and have her knock on the door) the tank lid fell right on top of the bell of my stethoscope. Fortunately, the tank lid didn't break and the only damage my stethoscope received was a crack in the rubber no-chill ring. Sooo lucky.
Fast forward to yesterday. I had a three year old patient who was going through a major mood swing. After yelling at his mom and calling her some not-so-nice names, he grabbed my stethoscope, pulling it from my ears, bit down on it and pulled on it as hard as he could. After I kept my cool he calmed down almost instantly and with my constant praise for his good behavior, he was an angel for the rest of the visit. After sanitizing my scope with some alcohol, I noticed that there was no damage, no teeth marks even. Amazing! A vet student friend of mine commented on how her stethoscope has survived being stepped on by cows. Huzzah for Littman stethoscopes, Huzzah!!

That's it for now, I'm sure I'll have more stories from the trenches, in a HIPPA-protected sort of way. Stay tuned!