Sunday, January 13, 2008

Professional Courtesy

In medical school, we are taught not to bash our colleagues. We all make mistakes, and particularly when you are going to be stuck encountering the same people over and over, it is not a good idea to burn bridges. If someone has mistreated or misdiagnosed a condition, you fix it, and do what's best for the patient without pointing fingers. I think that this is generally a good policy, but sometimes it is hard to not question the other person's judgement or values.

To prevent myself from rambling for several paragraphs, I'll keep it short:
  • A small child was accidently overdosed on an antibiotic.
  • It was a non-toxic ingestion, and we advised the prescribing physician of this.
  • Despite being the one who had potentially harmed the child, the physician was "too busy" to see her in the office and sent her into the ED anyway.
  • The only reaction to the medicine the baby had was 2 episodes of vomiting and 1 episode of diarrhea.
  • I asked why she was put on the antibiotic just the day before.
  • Parents said their doctor "heard fluid in the lung".
  • The doctor diagnosed "pneumonia" in a non-febrile infant without a chest x-ray.
  • What I saw was a smiling, playful infant with absolutely clear lungs and no signs of dehydration.
  • The child was sent home, and her parents were told that she was fine and we did not see any need for the antibiotic (or the oral steroid) prescribed by their doctor, but to discuss stopping the medications with her.

What I would have liked to have done would be to recommend that they find a competent physician, or at least one who cares enough to personally check up on his/her patients when they potentially cause harm. But I didn't. Their doctor will get a copy of the transcribed report about her patient's evaluation, but my guess would be that it will probably just get filed, unread in the patient's office chart.

Willy-nilly handing out of unnecessary antibiotics is a big problem in medicine, but what bothers me more about this case is the apathy of this physician. If you make a mistake, you should do everything in your power to fix it, or at least stay an extra 15 minutes late in your office to see the patient. It is aggravating to be the after-hours dumping grounds for non-emergencies, but this doctor didn't even make a quick call later to see how the patient looked.

I know that primary care providers are under a ton of pressure to see many patients every single day. At the same time though, this family practitioner is the sole provider for this entire family. She delivered this baby, does all of her pediatric care, and she does annual physicals on both parents. From a purely business perspective, isn't it in this doctor's best interests to keep a strong rapport by not just dumping them on the ED? I don't get it.


Chris said...

You are right about it also being in the doctor's best interests. Sounds like that doctor is past the point of burn out and no longer even cares about her own interests. She's just going through the motions.

~~Silk said...

I have known some doctors who would give patients almost anything they asked for, because if they ask for it, and don't get it, and something goes wrong, then it's the doctor's fault, whereas if they do get it and something goes wrong, then it's their own fault. And then these patients have great loyalty to that doctor because "he/she gives me exactly what I need, when I need it, no questions" ("need" being perception, of course).

It's awfully hard to fight that....

I wouldn't be at all surprised if the parents had said "Need antibiotics! Now! Just in case!"

ru said...

I am glad that you were giving the best possible care. I hope that the doctor is not in the habit of treating patients this way.