Sunday, August 31, 2014

Pediatric OPD is a Challenge: Treating the Child and Meeting Parents expectations


Scenario


" A concerned mother brings her 3 yr child to the Outpatient Clinic, the child has had fever for 1 day, running nose and cough for 2 days. There are no other serious complains and findings on examination are all normal, except for running nose and low grade fever. A case of common cold that is very common in childhood.
The mother is really concerned about the child contracting a Pneumonia , well there were no symptoms as such and pediatrician counsels her on that, but she wants an antibiotic for safe-side. Doctor explains the condition and hazards of erroneous use of Antibiotics, she is convinced.

She is equally concerned about the cough. She has been giving the child Anti-tussive from Over-the-counter prescription that is pandemic in our country. Doctor advice her to stop the drug as current research does not recommend its use in below four years children. She is not convinced this time, in-spite of counselling"
In such a Scenario either doctor keeps trying to convince her, either he loses the follow-up or he has to go with the flow an prescribe Anti-tussives and Vitamins as the trend is in Private practice.




Pediatrics is a bit different subject to doctors in many sense. Specially in Pediatric out patient department or in private clinics, doctors will often find a mildly ill child but more skeptical parents who might constantly test you with their queries and doubts.
Pediatrics is different in that , not just treatment of the sick child is important but also meeting of the parents expectations, counselling them well and taking them in confidence. Often doctors meet lot of patient who are already on Antibiotics for Viral URTI , so the dilemma sets in- to continue or to stop the medication. The trend in the private practice is so wide-spread that antibiotics are prescribed for cases without any indications. The fault is not just in doctors here but in parents as well who often switch doctors when doctor prescribes less drugs. However it is what the nature of care-taker is, they always want to be on the safe side, while unknowingly they may be harming the child.

Erroneous and Erratic use of Antibiotics have led to Antibiotic resistance.There was a time when Penicillin was Jack of All, a shot of it could treat almost everything,today plain Penicillin rarely can treat any condition. These are the outcomes.

Meeting the Expectations of Parents-
What parents generally expect is that their child should be well with a day of treatment, which is rarely a possibility, because most antibiotics take at-least 24-48 hours to get working.  Counselling about the need and expected time of resolution can convince the parents to be more patient.
They want all their Queries fulfilled and all their doubt cleared. Because they are on behalf of a child patient who cannot express many things and they are guardian to such delicate human beings. Show then the empathy and that you care equally for the welfare of the child. Be patient and answer all the queries they have. Doctors should put themselves in the place of parents and try to fulfill their queries.

They may search for your qualifications and experience , face them confidently and without hesitations. Getting angry at it will not mask the thing, but will cause you to lose a rapport and trust.
They always want best among the pediatrician to treat the child, so they may test you with several questions, doctor must let them know that you are equally good and take them in confidence.
And last of all, ethically don't give up and prescribe medications to satisfy the parents, do it only when you know it is required. And the question is " Is this a possibility?"

I may not be totally right as I have a long journey to go, if you have a different opinion, I welcome your feedback.

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