My niece was sick.
Lethargic, vomiting, more like Sick instead of just sick.
My sister sent me messages and called with some questions about what was normal and what wasn’t, asking what else she could do, which to her credit wasn’t much more than I would do. A pediatrician friend of hers suggested slowly re-introducing fluids and calling their own pediatrician if nothing improved.
I told my sister that the only thing more I could do was give her some IV fluid to help her rehydrate and kick whatever was bothering her quicker.
One morning found them in the pediatrician’s office. With my sister at her wit’s end and her daughter asleep half in the chair in the waiting room from exhaustion and dehydration, the pediatrician did exactly what I would have done.
Well, not exactly.
He admitted them to the hospital for IV fluids.
You didn’t misread that. The same intervention you and I do on a daily basis, sometimes with small children, isn’t being done in the office, but clogging up the hospital.
It got me wondering about private practices and just how much the MDs and PAs are doing on their own. They send us out of the office for labs, for screenings, for X-rays and now not even a simple 22g catheter, a bag of fluid and a quiet room to help a sick child under their care.
And why not?
I understand not being able to do the blood work, and the X-rays and screenings, but a simple intervention that could have an almost immediate effect on the patient? Had I arrived at this office and encountered this child on duty, my protocol would REQUIRE IV access PRIOR to hospital arrival. But here is an MD, a pediatrician, someone who I am constantly reminded knows loads more than me, unable or unwilling to intervene in the health of a child under their care.
These MDs today are busy folks. Insurance companies demand they join groups and take on more patients than they can manage to maintain reimbursements. They must see all patients prior to recommending a specialist so they can act as a gate keeper to the system, keeping the useless requests for resources from moving past what can be done in office.
So my sister and niece are heading for a calm, relaxing day in the pediatric wing of the local hospital, exposing her to God only knows what illness in her weakened state, all to get the intervention I have been doing for all these years.
But what about all those nurses at the office who admit us, take our vital signs, administer vaccines and take my payments?
They’re not nurses? But they wear scrubs and give shots, what gives? Oh, they’re “Medical Assistants.” I’ve seen those ads on daytime TV. 8 weeks to a great job working in a doctor’s office.
It is clear that not all offices are staffed with 8 week trainees, I’ve seen those with seasoned professionals, but I still wonder if they would act in the best interest of the patient or ship her off and get that room turned over to get another paying customer through the tills.
Would it really be so bad to set one room aside for a few hours to run in a 20-40cc/kg bolus?
Or is it something more bothersome than that?
If the room is not the problem, and the staff really do care about the patient and her quality of life, what is stopping them from administering this intermediate level skill?
Could it be that last word, “skill?”
Is it possible that the Pediatrician and their staff of scrub wearing billing assistants and medical assistants can’t assist when it comes to patient care? Are there any persons in that office trained or experienced in starting IVs? If not, then why not?
If all they can do is innoculate, why not just hit me up on skype and tell me where to go to actually get care?
I know I am a different kind of parent and not everyone can discern the difference between an exacerbation of bronchitis and another run of croup. I still have to drag my miserable child into the office and wait 45 minutes for a 2 minute “Yup, that’s croup again, here’s a script for what worked last time.”
If the Doctor demands I come in then I think it’s time we demand they start treating us on site. If not, then just let me through to the rest of the system that can help me. Stop fooling us by having your billing staff in scrubs, and leave those to the folks actually doing the patient contact. And name tags would be nice, and right under their name, their level of training. You proudly display “Board Certified Pediatrician” on your coat, let me know who’s who on your staff so I know who can help us and who is just there to take my co-pay.
Licensed Paramedic, Concerned Uncle