Saturday, January 2, 2010


According to Webster's, 'perspective' refers to "the capacity to view things in their true relations or relative importance". Too often in life we forget to have perspective or to look at things from an alternate point of view.

I work at a large pediatric office. We have multiple offices in the area and have over 50 physicians. Our main location is open 365 (or 366) days per year. Yes, even on Thanksgiving and Christmas day, we are open. When I started 6 1/2 years ago, patients were more than appreciative that we had access to nurses and doctors over the weekends. We were thanked routinely for being available. Times have changed. Take the following three examples:
1. Last weekend I was literally yelled at for taking under 3 hours to return a call regarding lab results. Why did it take almost 3 hours? The lab had to finish processing the blood before we could call with results. The mother did not care that the lab had to finish processing the sample - she wanted the results NOW (despite the fact that the results would not have altered her daughter's treatment).
2. A few weeks ago a parent was angry that we couldn't refill her son's ADHD medication. First, we do not have access to charts (our charts are not on-line - they are paper and reside in the patient's "home office"). Second, most ADHD/ADD meds are "Schedule II drugs". According to the U.S. Drug Enforcement Administration, Schedule II drugs are drugs with "a high potential for abuse", "are accepted in medical use with severe restrictions", and "may lead to severe psychological or physical dependence". Think amphetamines...after all, that's what many ADD/ADHD meds commonly are! Third, they could have called on any day between Monday and Friday for a refill. And, fourth, the only problem they will have is a child with increased distractability and hyperactivity (and for only 1-2 days).
3. Today, I had a father call, concerned about his child's symptoms. The 7 year old had a fever of 99-100 for less than 24 hours, cold symptoms, and a cough. The patient had albuterol and was using it as needed. He had no wheezing, no shortness of breath, no retractions. He had a cough. At this point, we had no appointments left. I triaged the call according to protocol. Based on his symptoms, etc., home management was recommended. The child had no symptoms warranting an urgent care or E.R. visit, or even a visit at our office. The father was concerned, as his child was born at 32 weeks gestation (let me remind you, the child is now 7 years old)! He then stated he was in the parking lot and demanded an appointment. I discussed the case with the on-call doctor, who agreed that an appointment wasn't necessary, but agreed to fit the patient in at the very end of the day. By this time, the father was standing in the waiting room with his child. The child was in no apparant distress. I offered them the which they'd have to return 3 hours later. Guess what? Viral. No treatment done in our office.

I worked the day after Christmas. We saw over 200 patients and had 130+ calls. We were fully booked by 11:30am. It was BUSY! I also worked today (the day after New Years). We saw over 200 patients and had 120 calls. We were fully booked by around 1:00pm. It was also BUSY!

Mid-morning today, a 9 month old was seen for vomiting x 4 hours. No fever. No diarrhea. Urinated prior to the appointment (so no signs of dehydration). Exam was normal, other than the vomiting - there was nothing on exam that would have indicated anything other than a stomach bug. Patient was sent home to monitor and push fluids. Had the mom called to talk with the nurses earlier this morning, we would have given them home-care advice (as vomiting for 24 hours without other alarming symptoms or signs of dehydration is not a cause for worry). Just a few hours later, the parents called back. I spoke with the mother who indicated her child continued to vomit all clear fluids, was acting lethargic, and no longer making eye contact. I immediately sent them to the E.R. for evaluation. The patient's status now? She is at Children's in the PICU on a ventilator. She had seizure-type activity, which was determined to be a stroke, as a result of a brain tumor (tumor was diagnosed this afternoon). Prognosis is still to be determined, but is not good.

Patients call and complain. Sometimes they have a valid reason to complain, but many times they do not. Some simply need reassurance. Some need common sense. Some need education on the basics of illnesses. And still there are others. Those who feel as if life revolves only around their family. Those who feel entitled to immediate responses from nurses and doctors (regardless of the issue). Those who don't care that a more critical patient warrants our help first. It is to those parents to whom today's entry is written. Those are the parents who need to view life from someone else's eyes.

This is why my title today is perspective. Within less than 7 hours, a 9 month old goes from being "perfect" to having a brain tumor. No warning whatsoever. Perfect yesterday. Today, may not survive. I could go on to generalize perspective into all areas of life, but I won't. My message is not to tell you to live in fear. My post does not mean that I will embrace EVERY action of my two special kids (and in fact, stay tuned, as I'm sure they will be driving me crazy tomorrow). My post does not mean I will be thankful for Mason's medical issues (because at this moment, his pulse oximeter keeps alarming). My post does not mean I will be thankful for Lauren's anxiety issues (because I'm not - it breaks my heart). Instead, my message is simple: Tonight, tell your child you love them. Give them an extra snuggle time. Say an extra prayer. Be thankful for your children - even the things about them that drive you crazy!

And, if you are the parent waiting for a nurse or doctor to call back (unless of course, symptoms are life threatening), please be patient. Instead of becoming frustrated, ask yourself - is it possible that the nurse or doctor is caring for a patient whose needs are more urgent?

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