Parents tend to expect the "miracles of modern medicine." When they take their sick little one to the doctor, they expect that doctor to do tests, instantly discover exactly what is wrong with the child, and prescribe curative treatment. If that doesn't happen, they think their doctor "didn't do anything."
When I see a sick child, I start by taking a history. Much of the time I spent learning what questions to ask seems wasted, though, because no one wants to give me any detailed answers. I frequently get such vague, uncommunicative answers that I wonder if the parents actually live with the child. They certainly don't seem to know much about the child. I was trained to use the answers to my initial questions to guide further questions. This is often met with impatience, as parents don't seem to understand why I need this information.
After I have given up on prying any more information out of the parents, I examine the child. Small infants are pretty easy; the worst thing they can do is puncture my eardrums by screaming while I try to listen to their lungs. Toddlers don't understand what I am doing, and I don't blame them for resisting; but the little shits are strong, and often leave bruises. The trauma of a toddler exam-to both the child and the doctor-can be minimized if a parent will help. Too often the parent is texting and ignoring the kid. Even if they aren't, many don't want to hold the kid still enough. While I don't mind being hit or kicked by toddlers, I DO mind that behavior from supposedly normal school-aged kids. I understand that a medical examination is unpleasant and scary. But school-aged kids are old enough to understand that they need to hold still for a few minutes. I have seen kids who are never made to obey at all. I have seen kids who hit and kick their own parents-who just sit there and take it. However, I get as thorough an exam as I can.
Once I have done that, I put the history and physical findings together to figure out what is most likely going on. I may need to do tests to confirm my diagnosis; I may not. I don't do tests that I don't think are necessary, because I find it unethical.
After I have examined the child, and decided if I need tests, I can recommend the best course of treatment. Believe it or not, sometimes the best thing to do is rest and fluids. At home. This is when it gets hairy. You see, all I did is talk to the parents and poke the kid, then gave the same advice they already got from their grandmother. No zillion-dollar tests to pinpoint the EXACT problem. No unpronounceable medications that were in TV ads. No CURE. Why the hell would I just tell them the kid has a cold? How lazy can I get? They will go somewhere else, and keep doing so until they find a doctor who will DO something.
I spent a lot of time in training to learn when to do what. If the kid has a viral upper respiratory infection-a cold-there is no need to know which virus it is. It's all treated the same. By treating the symptoms. No antibiotics. If a baby spits up, try smaller feedings, not a cat scan and drugs. Have some sense. Please. You can even get it without a prescription.
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