Wednesday, February 16, 2005

To Prescribe or Not To Prescribe

Read this post by Dr. Charles. He laments his inability to impress the patient with his knowledge as much as Dr. Sven can with his smile.

In the ER, this is even more of a problem. At least in my private office, I have developed something of a rapport and reputation with my patients. They are there because they chose me, as opposed to simply getting me by the luck of the draw.

In the ER, I often don't have much time to teach my patients or to explain what we are doing. They don't know me and don't want to tell me whole truth (and nothing but the truth.)

I know that if I don't write that 4 year old with a URI a prescription, his mother will take him to his local doc the next day and there is a better than even chance he will get one there. Guess who is wrong? That ER doc that you don't even know or the doc you purposely chose who has cared for your kid for 4 years?

I have had complaints in the past that "that doc told me my kid wasn't even sick." I can assure you I have not said this, even if it is frequently true. Now what I tell the parent is:

I can understand your concern. I understand why you chose to come in to the ER and I think a lot of people would have made the same choice. I don't see a bacterial infection that I need to treat with antibiotics, but it is obvious that your child is sick. She has a bad cold and the only reason she is doing as well as she is doing is the excellent care and attention you have given her.I don't want the fact that I am not going to give her an antibiotic to make you think that I don't think she is sick. She definitely is.

You just have to reassure them that you believe their kid is sick and that they made the understandable choice to come in for an evaluation. I add:

The only thing I am 100% sure about is that I am never 100% sure about anything. If things worsen, don't hesitate to come back or go in to see your local doc. He might see evidence of a bacterial infection that isn't present right now. At that time, he might want to prescribe antibiotics.
The Art of Medicine in the ER.