Family Medicine: Ignorance is NOT bliss

One of the first patients who came today was a couple with two sons, a four-year-old with spastic encephalopathy (his legs are very weak and he can't stand without support) and a seventeen-month-old toddler. And they were both behind on their shots; the four-year-old was due for his six-month shots and his four-year-old shots and the toddler was due for his four month shots only. The only reason their mom brought them in for well-child visits today was because that was the only way they could qualify for food stamps; before that, they hadn't been seen in a year. Now, it's one thing to give a little baby 3-4 shots in one day because there's only so much they can struggle, but to give a toddler 3-4 shots was a nightmare in the making. We could hear the kid screaming throughout the entire nurses' station (which is very large), and finally Tawanna (the nurse) left the room and yelled, "Dr. RR!" Dr. RR was in the next room seeing another patient, and he immediately came outside to see what was going on. "I can't do my job," said Tawanna. "He keeps pulling the needle out, and she (the mother) doesn't want me hurting her child!" Dr. RR had to go in and explain things to the mom, and I think the kid ended up getting those shots in the end, but Tawanna was pissed. "Ignorance, girl," she said to me. "It's plain old ignorance. She should have brought them in a long time ago." I agree; it would have made everyone's job easier. There's a reason why you give most kids shots when they're babies.

One of my patients today had a clear-cut case of strep, but I ordered a strep test anyway just to be sure. Later Dr. RR took me aside and told me that if it looks like a child has strep (fever, headache, exudates on the tonsils, red throat), then it's all right to go ahead and treat it like strep. "There's no need to run a strep test if you're fairly sure it's positive," he said. "It's a $50 test." Oops. =( I guess this is what I get for trying to be more productive in the clinic. We discussed knee pain again, and this time I mentioned different exercises and Dr. RR talked a little about muscle activation vs muscle energy. I brought up Dr. KR from TSH (psych rotation) because they'd graduated in the same class. He didn't know that she was working at TSH, and he commented that she was well-suited for it. Yes...she definitely is.