If you ask old doctors, they will unanimously say that the younger set of doctors relies way too heavily on getting tests. Your history and exam should tell you the diagnosis, they say; tests are to confirm what you already know is there. Spend more time talking to and examining the patient, and you will find out what is wrong with them easily.
There are many situations where I can do just that. I spent years learning the art of history taking and physical diagnosis, and don't need that many tests. That's why I get so annoyed when parents demand them. I really don't get that irritated when parents just ask if I shouldn't be doing some (unspecified) test. But I do get ticked when parents with no medical training whatsoever (except, I guess, from Google U) think they know just WHAT tests I should be ordering. News flash: that was also part of my training. So was risk-benefit ratio. That CT scan you're demanding won't tell me anything I need to know; and will expose your child to a shocking amount of ionizing radiation that will put him or her at higher risk of cancer down the road. And if it is a belly CT, their reproductive organs will get irradiated. You are putting not only your child, but your future grandchildren, at risk. If I feel that a CT is necessary to care for your child, I certainly will not hesitate to get one. But I don't like to get any testing if I don't have something useful to learn from it. Please, let me do my job.
Showing posts with label unnecessary care. Show all posts
Showing posts with label unnecessary care. Show all posts
Monday, February 29, 2016
Wednesday, October 29, 2014
"My doctor didn't DO anything!"
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.
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.
Subscribe to:
Posts (Atom)