Two Chief Complaints that drive me nuts.

[BoardingDoc]

We all know this is true. Consider these two scenarios:

Frantic mom brings in their snotty nosed 3 yr kid with a fever of 101.4 at 1:35 AM. They wait 1 hour to be seen. The kid is running around the room playing. Mom is SO SCARED about the fever.

The kid needs nothing. Doesn't even need Tylenol. He needs Kleenex.

Scenario 1: You try to explain to frantic Mom why he doesn't need anything. You are in the room for 15 minutes because mom is so scared, and she is saying repeatedly "you are going to do nothing about this?!?!?!" You spend a god-awful amount of time trying to reassure them. 10% chance you will get a bad report from Mom and Admin will talk to you.

Scenario 2: You are in the room for 1 minute. You tell them if CXR is +, they get Abx, if negative, you need Kleenex". Now you know there is a 1/500 chance of CXR + for true lobar pneumonia, and maybe 1/20 chance of reading "atelectasis vs early infiltrate." And you know you don't act on all of those rads hedges either. So the odds are pretty low, maybe 1/40, that you are going to be discharging that kid with Abx. So...Mom and pt leave much earlier with a very low chance of getting Abx. There is a 0.1% chance you will get a bad report from Mom.

I'm starting to think that I either work in a different system and / or have a completely different patient population than other people here. 85% of the time in this scenario I have: talk to Mom for 3 minutes. Explain kid is fine and lungs sound great. It's viral. Go home and come back if worse. They say ok and go home, or they freak out and I spend another 1-2 minutes Jedi mind tricking them into behaving like a rational human.

15% of the time they ask for unnecessary testing and I say no and discharge them. If I get a complaint about it, my admin are all reasonable enough to say "here's the complaint. Looks like appropriate care. K thx bye."

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[thegenius]

I'm starting to think that I either work in a different system and / or have a completely different patient population than other people here. 85% of the time in this scenario I have: talk to Mom for 3 minutes. Explain kid is fine and lungs sound great. It's viral. Go home and come back if worse. They say ok and go home, or they freak out and I spend another 1-2 minutes Jedi mind tricking them into behaving like a rational human.

15% of the time they ask for unnecessary testing and I say no and discharge them. If I get a complaint about it, my admin are all reasonable enough to say "here's the complaint. Looks like appropriate care. K thx bye."

Or maybe you're good! Maybe you have honed good doctoring skills and your Jedi mind manipulation techniques. You should teach them to us.

My Jedi mind-altering skills go something like "now hold on....callllllllmmmmmmm down. I'm an ER doc, and do you think I would send you home if your snotty nosed kid was really sick? Like ICU sick? Nahhh…….I don't do that. *wink*" Do Jedi's wink?

I should probably do a study on the number of xrays I order myself in this population. I like to think I'm low (maybe 1/8) and it's a product of my residency training. There are guys in my group who are the opposite.

 

[SamtheWise]

Scenario 2: You are in the room for 1 minute. You tell them if CXR is +, they get Abx, if negative, you need Kleenex". Now you know there is a 1/500 chance of CXR + for true lobar pneumonia, and maybe 1/20 chance of reading "atelectasis vs early infiltrate." And you know you don't act on all of those rads hedges either. So the odds are pretty low, maybe 1/40, that you are going to be discharging that kid with Abx. So...Mom and pt leave much earlier with a very low chance of getting Abx. There is a 0.1% chance you will get a bad report from Mom.

I like to grandstand a little bit, but sometimes I just order a whole body CT on the kid. To 'localize' a possible source of fever. CTH, soft tissue neck, chest, abd/pelvis and runoffs. Parents love it, they leave with a script for amoxicillin and a smile on their face. But come back the next night because I forgot to tell them how to dose tylenol and motrin.

 

[deleted109597]

I mean, I had the same kid come back 4 shifts in a row because "the fever keeps coming back". Well no **** sherlock. I told you that the last 3 times. I sent you home with the dosing charts. There's literally nothing else for me to do but call CPS if you don't stop coming back.