As many of you know, I love working with kids. There is something about treating that population that I feel makes all the hard work in school and residency worth it. However, it does take a special kind of person to know how to deal with the challenges of this population. In the last couple of weeks, I was reminded why some of my colleagues just outright avoid this age group altogether.
When it comes to handling patient concerns, dealing with one patient can sometimes present a challenge in and of itself. When dealing with the pediatric population, it is not usually the patients themselves who present the challenge. It is usually the family.
It is hard enough to gain the trust of young children so they will let you examine their feet. However, when you have an overbearing adult as well, sometimes it can turn this seemingly simple task into quite a frustrating endeavor. Often when dealing with the family of a teenager, you end up being not just a health practitioner but a referee. When you are dealing with the parents of a child of any age, it is just as important to make them comfortable as it is to make patients comfortable.
Another issue is a medicolegal one. Some parents do not bring their children in themselves but let their minor daughter come in with her 21-year-old boyfriend. Try explaining to that parent that the child needs a legal guardian or parent to bring them in. “But why, doc?” Explaining that just because someone is 21, it does not give him the legal authority to make medical decisions for your daughter seems not only slightly ridiculous, but makes you realize that some people are just not in tune with what is really going on with their children.
This happens constantly. I am asked about this when I do lectures for our colleagues. Realistically, protecting your business is paramount and this is one of the things that happen too often. Minors cannot make medical decisions for themselves. If a legal guardian or parent is making those decisions for the patient and something goes wrong, there may be problems for you down the road. (I’m not an attorney so if you have questions about this, please consult the attorney who represents your practice.)
A few weeks ago, I had a patient scheduled for a subtalar arthroereisis. She was ready to go and the parents where in the pre-op area. I had talked her out of her very nervous state and reassured the parents that I would talk when them as soon as the case was done. I headed off to change into scrubs.
After I had changed and was checking the board for what room I was in, I saw the anesthesiologist heading my way. Uh-oh. It turns out that my young patient became so nervous that she started vomiting after I left to change. The anesthesiologist was concerned that she had a viral infection because her mom said she had been “stuffy” the last few days. The mother did explain that her daughter shared her fear of hospitals, that she was also “pukey” before surgery and it was nothing to worry about.
The anesthesiologist noted that now the patient’s throat was inflamed and expressed concerned that if she needed a laryngeal mask airway, it would not only further inflame the patient’s throat but also put her at risk for aspiration. Whoa.
They canceled that case in the patient’s best interest. I never argue with anesthesiologists over these things. If they are not comfortable with doing the case, it is better to just let it go. I had to explain to the parents that even though they both took the day off for this and the patient was already there, the anesthesiologist did not feel comfortable with the circumstances. The anesthesiologist recommended that the pediatrician see the patient (again) for clearance and provide an antiemetic medication before the next surgical attempt.
The patient’s family was upset (not at me) but understood. We rescheduled the case at another hospital that is more used to seeing the pediatric population. Phew! Not an easy morning.
What is the moral of the story? Do not argue with the anesthesiologist and make sure whoever is doing the anesthesia knows kids. Happily, the family knew that I had nothing to do with the surgery cancellation. That was my saving grace in this situation.