After a rough week of seeing multiple toddlers with nasal congestion (RSV, flu, common cold, allergies, sinusitis, ear infection, teething, strep?) or diarrhea/vomiting (viral gastroenetritis, flu, GERD, diet changes, constipation/impaction, rotavirus, food poisoning, etc, etc, etc) and trying to figure out the correct diagnosis with the variably accurate information we were getting from the parents, it seems a good time to give some hints.
Granted, my experience is rather limited, but some glaring issues came to light this week, as I struggled with a head cold myself (probably a gift from one of the snorky tots I saw last week) to do a good job of diagnosing the kids’ problems. There are so many options for even the simplest symptom, and if the diagnosis isn’t right, the treatment won’t be effective.
Parents need to be aware of what it is like on the other side of the exam room door. There is a list of patients to be seen, usually one every 15 minutes. This limits the amount of time the physician or nurse practitioner has to get to the bottom of the problem, formulate a treatment plan, write up the scripts and instruct the parent in what they need to know to take care of their ill child, and chart everything in the wonderful computer program that is now the chart. This is not easy! The previous records need to be reviewed to know the background and medical history of the child, which may have a great bearing on the current situation; then we interview mom or dad and the child if old enough to get a history of the current complaint; then the physical exam which has to be focused but also general enough to catch other signs/symptoms which may be relevant. Then any last questions need to be resolved with further questioning of mom or a test such as the strep test, or a CBC.
So, what can Mom or Dad do to help the process and insure the best outcome for their child? Here are some good hints:
- Come on time for the appointment, and leave other kids at home if at all possible. Having more than one child milling around in a small exam room can be very distracting to both mom and the NP. It makes it much more difficult to do a good concentrated interview and exam.
- If you do have more than one child, maintain order. Allowing kids to run around the room, or out the door, or get into the drawers or the NPs tools, or talk constantly, also prevents the opportunity for good communication and physical exam.
- Do not ask the NP “Oh, by the way, my other child is sick, too, can you check him out real quick?” Make a separate appointment. Remember, the NP has 15 minutes, and if you add a second child, it cuts it down to 7.5 minutes, or causes everyone else to have to wait longer. This is not fair to your kids or the other patients.
- Have a log of your child’s symptoms. If you say that they have had a fever for 4 days, we have to ask how high the fever was for each day, how did you take the temperature, what did you do for the fever (such as give ibuprofen) and whether it worked. If you have a log of the temperatures, with times and remedies you tried with effect, this would be a great help. Same way for episodes of vomiting or diarrhea. How much, when, what did it look like, what do you think precipitated each episode, if you know: a coughing spell started a vomiting episode, or they have diarrhea right after everytime they eat something. For example, diarrhea should be listed like this: Wednesday, 10 AM, large amount of brown liquid.
- Keep track of how many wet and poopy diapers your infant has, and how much and when he eats, listing the ounces of formula.
- If you have a list of questions, that is good, but keep it reasonable and focused on the problem of today. If you add other stuff, things may get off track with a poorer outcome. Keep unrelated stuff for another visit, or the well visit.
All of this makes things easier for both you and your child, and also the practitioner.