Public Service Announcement

This is for the parents who allow their kids to be brats at the hospital or doctor's office.  Yes, I know that pediatricians and their nurses are expected to use "child-friendly" language at all times.  However, if your demonspawn bites someone, don't be shocked if they react with four-letter words.  If you don't want to hear your kid referred to as a little shit, don't let him be one.

Vaccine Package inserts

I am pro-vaccine.  I just wanna get that out there.  That said, I have seen a lot of anti-vaccine activists making arguments and supporting themselves by citing the package insert-somewhat erroneously.

For starters, those inserts are not like food labels; that is, they are not meant to educate the general public.  For one, they are geared toward medical professionals.  They are not written in lay language.  Two, they are mostly a legal document.  They have to tell the ingredients.  When it comes to side effects, that's where the confusion starts.  You see, during a clinical trial, any symptom that develops is assumed to be from the experimental drug.  If a test subject reports that he farted, then "flatulence" will be listed as a side effect.  It does not matter if the symptom is actually related to the drug.  If I were in a trial right now, and was asked if I had pain, I would have to tell them my foot hurts.  They would put "foot pain" as a side effect of the drug-even though I broke my damn foot last week, and THAT is why it hurts.

Because they are not written in lay language, a lot of people misinterpret.  When the insert says, correctly, that a small number of patients don't respond, people take that to mean that the vaccine never works and is useless.  While we're on that subject, many of them will say something like "studies have proven that this vaccine induces an immune response.  No study has proven that there is a decrease in disease incidence with this vaccine."  Again, that is a lawyer-mandated CYA comment.  Of course there isn't such a study.  You'd have to get a big group of  people, randomly give half of them the vaccine and the other half a dummy shot, then (after giving the immune system time to respond) expose them all to the active disease and see which group gets sick more.  That violates human research ethics in so many ways.  Intentionally give people disease?  Google "Tuskeegee Syphilis Study" and read about it.

I get really mad when people go on about how much better immunity is when induced by "a simple childhood illness."  Ummm, the point of the immunity is NOT TO GET THE ILLNESS.  It isn't always sneeze twice and go on with life.  In the interest of full disclosure I will say that I do not now, nor ever have in my career, make ONE SINGLE PENNY from vaccines.  But I want these illnesses eliminated.  I only see sick kids; I wish my whole specialty would become unnecessary because all kids were healthy.

I attended the most appalling committee meeting today.  The meeting discussed using an electronic tool to track "quality measures" of a doctor's performance.  The members of the committee had to decide what to measure (mostly bullshit paperwork), how to measure it, and how to discipline docs who don't meet expectations.  It was bad enough that very few of the measures had any real meaning.  What appalled me is that the committee consisted mostly of administrators and nurses-only 2 docs.  It wasn't that my colleagues didn't come; most of them weren't invited (I don't know how I was; I'm not usually on that committee).

Patience, grasshopper.

Yesterday I admitted a kid with pneumonia.  He looked pretty miserable, with a  high fever, working to breathe and needing oxygen by face mask.  I started him on treatment and told his parents it could take a few days.
Today, when I made rounds, his mother accosted me anxiously.  She wanted me to "run more tests" since, according to her, he wasn't getting any better (in less than 24 hours!).

When I went in to look at him, his fever was much lower.  He was breathing more easily.  He needed less oxygen, and was even hungry.  Needless to say, I did NOT order more tests.

I don't treat to order.

I am SO annoyed by parents who think they know everything.  We occasionally get parents who decide, at home, what treatment their child needs.  Since that treatment has to be provided by a doctor, they bring the kid in.  Not to have the doc evaluate the kid and recommend a treatment course.  Just to have the doc provide the treatment that the parents already decided they want.  The parents get so pissed when I insist on examining the child and offering only appropriate treatments.  Medicine has gotten so commercialized that people think they can just order whatever treatment they want.

Public Service Announcement

Parents of the world:  taking your child to the emergency room (or urgent care, or primary doctor) for a viral infection does not magically cure that infection.  Your child will likely still have symptoms, including fever, for several days.  There is no need to bring your child to the ER every day until they admit you.  Let your kid rest, give plenty of liquids and Tylenol as instructed.  Thanks.

Hospital floors

Every day, I see either someone letting their baby crawl around on the hospital floor or letting their kid run barefoot in the halls.  You can't say anything to these parents without eliciting an angry, defensive response.

This really grosses me out.  Hospital floors are covered in millions upon millions of disease-causing germs, tracked all over from various rooms.  These germs, while together on the floors, share mechanisms for resisting antibiotics and evading the immune system like suburban housewives trading recipes. ("You simply must tell me how you manage not to be killed by antibiotics!"  "Of course!  But only if you tell me how you manage to fool those immune cells so neatly!")  Hospital staff don't observe the 5-second rule.  If a piece of food falls below knee height, it's done.

If that weren't enough, hospital personnel clean those floors with very harsh chemicals in an attempt to keep the population down (yeah, right.  Hospital germs would survive a disaster that killed all the cockroaches.). No eco-friendly, non-toxic stuff here.  And it isn't rinsed off the floors, either.  The longer it stays there, the longer it takes the population of germs to rebound.

So, a baby who crawls on that floor (then puts her hand in her mouth!! Ewwwww!!) is likely to either catch a horrible disease or be poisoned by chemical residue.  Or both.  Keep your kids off the bare floor!