Why do I have to wait soooo long when I get to the doctors office? The reasons are numerous. Many times you have a slow doctor that frequently gets behind. Many times (as is the usual problem with my personal clinics) the patients earlier in the day were late, thus putting the clinic behind for the rest of the day. I can't tell you how many times I've been twiddling my thumbs early, only to be totally slammed later. But probably the thing that backs up the clinic the most are lame complaints. (Is it still PC to use the word 'lame' or is is offensive to the weak and/or paralyzed members of the community?) Yes those complaints that really should have just stayed at home and saved the copay. Let me first say that I came from a family where you had to be dying to go to a doctor, and in fact I was once at home with a broken collar bone for a week before my parents took me to the doctor. I'll outline some of these complaints and we can all save some time together, starting today with:My all time most annoying complaint:
Dr. Jay, my son woke up with a temp of 100.3 today, and I just wanted to bring him and make sure everything is okay. No he doesn't have any other symptoms. Can you please tell me what to expect?
Point 1 - The definition of a fever is 100.4 or higher. Some physicians are very strict about this and won't even listen to you unless it is measured rectally, as that is the most accurate way to measure. I for one, am not that picky (my wife will laugh because I used to be), and have never measured my childs temperature rectally, so wouldn't expect that to happen with my patients, either. The studies to compare rectal vs axillary (armpit) vs oral vs forehead/temple have all been done with pretty poor scientific reliability. So I don't usually subscribe to the add one degree here or 0.5 degrees there philosophy. Truthfully, the exact height of the temperature in kids doesn't really make that much difference until you get to the 106-107 range (unless you are dealing with a newborn - less than two months - in which case you want to let your pediatrician know about any fever over 100.3). Please don't use the kind of thermometer pictured below. It won't give you the desired results.
Point 2 - Lets assume the fever is for real (and not just due to overbundling a baby or running a mile); it just started. It is very difficult to determine where a fever is coming from on the first day, as it will most commonly just precede a cold. Just wait a day or two to see what happens. If cold symptoms develop, there you go... a cold. Some kids get a fever for a couple of days and nothing else and then a rash all over after the fever is gone. This is called roseola, and you definitely need to see the doctor for this right? Nope. The rash is the extent of the illness, and your baby doesn't notice it and it doesn't last long. I usually spend a significant amount of time preparing for the many things that could come up to save the next days annoying complaint: "Dr. Jay, my son has a runny nose, so now what do I do." We'll talk about annoying cold complaints in another post. I'll do it soon, as it is cold season and all.
Point 3 - Many times a parent says, "I just want to make sure the ears are okay," at this point. Ear infections typically come AFTER a cold or late in a cold, so this early of a check is usually completely worthless.
Point 4 - Coming in early in the course of a fever may result in more invasive evaluation that may not have been needed. If you bring a child that is less than 6 months with a fever and no other symptoms, many doctors will feel the need to find the source. This will include blood tests and urine tests. And since most 4 month olds aren't good at peeing in a cup it will buy him/her a catheterization of their bladder, which most people find uncomfortable. Two hours later they get a runny nose, and we say, "Now we know where the fever came from, too bad we did all those mean things to the baby." I personally won't usually chase a fever in a baby (unless less than 2 months old) on the first day unless it is high (>103) or the baby looks sick, but many doctors will. I won't ever chase it in a bigger child unless it is >105 or there is something else going on (but then I guess that takes away the fever with no other symptoms distinction).
This visit usually ends with me saying, "Your child looks perfectly fine. I can't tell you what's causing the fever, or if it is even a fever. I can't predict what's going to happen the next few days, but your child will likely be getting sick." This kind of answer is unsatisfying for the patient and the doctor, so please wait at least a couple of days before coming in (unless a newborn, but you already picked up on that). The only time I feel a fever, in and of itself, NEEDS to be seen is after 5 days with all other things being normal and the patient is >12 months old.
Bonus point: Q: At what temperature is it best to give tylenol/motrin? A: At the right temperature (or any other smart alec remark you want to insert). Stop getting hung up on numbers (this was actually hard for me personally to do). Give the medicine to your child, not to the temperature. If your kid's temp is 99.1 and they look miserable, give them the medicine. If your kid's temp is 102.5 and they are happy and running around like normal, don't give it to them. A fever is a good thing when you are sick and helps your body get better. There is no reason to bring it down unless your child is miserable.
Bonus bonus point: Tylenol/acetaminophen vs motrin/ibuprofen. Motrin works better for both pain and fevers, in my opinion, but comes with more side effects. These include stomach upset and, in rare cases, stomach bleeding. So if you give it to your child, give it with some food. I personally give my kids tylenol first and if it isn't cutting it, add the motrin. So, yes, you can give both. The most frequent you can give tylenol is every 4 hours, and motrin every 6 hours. Giving them both does not affect these frequencies. In other words, they don't interact, so you can still give tylenol every 4 hours counting from the last dose of tylenol, not the last dose of motrin. Some parents find it beneficial to alternate every 3 hours, so there is always new medicine coming in and each medicine is spaced from itself by 6 hours. I don't personally do this because, as above, I treat my child not the fever, and people who do this tend to be more obsessed with the actual the fever itself, rather than how their child looks/feels.
Point 3 - Many times a parent says, "I just want to make sure the ears are okay," at this point. Ear infections typically come AFTER a cold or late in a cold, so this early of a check is usually completely worthless.
Point 4 - Coming in early in the course of a fever may result in more invasive evaluation that may not have been needed. If you bring a child that is less than 6 months with a fever and no other symptoms, many doctors will feel the need to find the source. This will include blood tests and urine tests. And since most 4 month olds aren't good at peeing in a cup it will buy him/her a catheterization of their bladder, which most people find uncomfortable. Two hours later they get a runny nose, and we say, "Now we know where the fever came from, too bad we did all those mean things to the baby." I personally won't usually chase a fever in a baby (unless less than 2 months old) on the first day unless it is high (>103) or the baby looks sick, but many doctors will. I won't ever chase it in a bigger child unless it is >105 or there is something else going on (but then I guess that takes away the fever with no other symptoms distinction).
This visit usually ends with me saying, "Your child looks perfectly fine. I can't tell you what's causing the fever, or if it is even a fever. I can't predict what's going to happen the next few days, but your child will likely be getting sick." This kind of answer is unsatisfying for the patient and the doctor, so please wait at least a couple of days before coming in (unless a newborn, but you already picked up on that). The only time I feel a fever, in and of itself, NEEDS to be seen is after 5 days with all other things being normal and the patient is >12 months old.
Bonus point: Q: At what temperature is it best to give tylenol/motrin? A: At the right temperature (or any other smart alec remark you want to insert). Stop getting hung up on numbers (this was actually hard for me personally to do). Give the medicine to your child, not to the temperature. If your kid's temp is 99.1 and they look miserable, give them the medicine. If your kid's temp is 102.5 and they are happy and running around like normal, don't give it to them. A fever is a good thing when you are sick and helps your body get better. There is no reason to bring it down unless your child is miserable.
Bonus bonus point: Tylenol/acetaminophen vs motrin/ibuprofen. Motrin works better for both pain and fevers, in my opinion, but comes with more side effects. These include stomach upset and, in rare cases, stomach bleeding. So if you give it to your child, give it with some food. I personally give my kids tylenol first and if it isn't cutting it, add the motrin. So, yes, you can give both. The most frequent you can give tylenol is every 4 hours, and motrin every 6 hours. Giving them both does not affect these frequencies. In other words, they don't interact, so you can still give tylenol every 4 hours counting from the last dose of tylenol, not the last dose of motrin. Some parents find it beneficial to alternate every 3 hours, so there is always new medicine coming in and each medicine is spaced from itself by 6 hours. I don't personally do this because, as above, I treat my child not the fever, and people who do this tend to be more obsessed with the actual the fever itself, rather than how their child looks/feels.
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4 comments:
But... but...but.... my child looks sick Shouldn't you do something about it?
Oh wait... I should have italicized that....
i am the annoying patient, always getting Dane's ears checked. that's just because zach had like 5 or 6 ear infections, and Dane has had one, but always behaves as if he has one, only to make me look like a sorry sucker.
Kids with recurrent ear infections don't annoy me. Actually, in those cases parents know well when their kid is infected. They can come in and say, "he's just making this face he makes when his ears are infected." And they are usually right. But regular kids with regular ears typically don't get ear infections out of the blue, they usually come after a cold.
This is pretty funny stuff Dr. J. After 4 kids they have to be on their death bed for me to take them in. Poor Cameron had some annoying flu last week and I didn't realize it so I kept sending her to school with a comfortable dose of Motrin. I felt like a jerk on Sunday, though, when I got it and couldn't get out of bed.
I appreciate reading your opinions and advice. I can see this will actually be a useful and entertaining blog.
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