11/15/2023
When you seek out medical care multiple times throughout a given illness, you may eventually receive more than one opinion. 🩺 Just because the final provider gives you a new/different diagnosis does not necessarily mean that the prior providers were wrong. It doesn’t necessarily mean that the final diagnosis is correct, either. 🫣
Let me illustrate an example.
Say little Jimmy has developed a runny nose, cough, and congestion. 🤧 You bring him in right away. The doctor rightfully diagnoses him with a viral respiratory infection (aka the common cold) and sends him home to rest. The next day, he spikes a fever to 103°F. You bring him to the urgent care center. They do a quick physical exam, check his vital signs, maybe run a rapid test for influenza or COVID-19, and once again send him on his way home.
The next day, poor Jimmy has a full-blown febrile seizure. 😳 You call 911 and he is brought to the nearby emergency room. The doctors run a myriad of tests including a chest x-ray, which shows a patchy area of consolidation in the right middle lung. The doctor diagnoses Jimmy with pneumonia and starts him on antibiotics.
I can understand how confusing and frustrating the above scenario must feel. How did the first two doctors miss this? Were they wrong to send him home? Could they have prevented the febrile seizure from the very beginning? Is the ER a better place to seek out care when a child is sick?
The first two doctors didn’t “miss” the diagnosis of febrile seizures nor pneumonia because neither one had presented itself yet. It’s nearly impossible to prevent a first-time febrile seizure. Furthermore, the “pneumonia” likely wouldn’t have shown up on day #1 or 2 chest x-ray because sufficient pus and inflammation likely hadn’t accumulated yet. In fact, the diagnosis of “pneumonia” in this particular scenario might not even be accurate! Even skilled emergency room doctors over-diagnose pneumonia on chest x-ray when really the patient has excessive mucus build-up leading to atelectasis (small areas of lung collapse and fluid accumulation within the lung).
The first two doctors also were not wrong to send Jimmy home. 🏡 There’s no way to predict a febrile seizure. There’s no prophylactic medication that a child should be taking to prevent it, either. The appropriate course of action (assuming lack of red flag symptoms such as dehydration and respiratory distress) is to go home, rest, hydrate, and let the body do its thing. The development of fever doesn’t change anything – it just confirms the fact that the body is fighting off an infection. Running additional labs and tests at Jimmy’s urgent care visit would’ve been highly unlikely to change the treatment plan. Starting antibiotics “just to be safe” when the history and physical is consistent with a viral illness is irresponsible because it leads to unnecessary side effects and promotes bacterial resistance.
Parents will often say “well I know that the antibiotics were necessary because within a couple days of taking them, the illness went away!” I can see how tempting this logic may be. However, a viral illness ALSO starts to spontaneously resolve after 3-7 days of symptoms (ie, a couple of days after parents typically seek out medical care), so who’s to say that the antibiotic deserves the credit? I like to call this the confirmation bias virus: a parent begs for a tangible solution (ie, antibiotic) to their child’s viral illness, and the child finally starts to feel better while taking said antibiotic, so the parent’s suspicion for bacterial infection is falsely “confirmed.” 😩 This line of thinking perpetuates the inaccurate perception that antibiotics cure viral illness.
I like to remind people that illness exists on a continuum… as in, you don’t just go from perfectly healthy to full-blown sickness. There are stages in between, each with their own constellation of signs and symptoms. If you are seen too early in the course of a given illness, the signs and symptoms necessary to determine the appropriate diagnosis may not be present yet. This is why I love empowering parents to learn the basics of if and when a child needs to be seen. Often times, the best course of action early on is to take a “watchful waiting” approach (aka let the body do it’s thing). This should be accompanied by clear return precautions, which include things to look out for with a list of reasons to return to medical care. The vast majority of minor childhood illnesses will resolve on their own with a bit of time.
Lastly, the ER is NOT the appropriate place to go when your child is mildly sick. The ER is for emergencies. They see an incredibly large volume of patients and need to turn the rooms around quickly. This may unfortunately leave the providers with less time to give appropriate education, reassurance, and return precautions. If you’ve already been seen multiple times for the exact same illness, they might even cave in and prescribe the antibiotic for the sake of time, simplicity, revenue, and/or patient satisfaction. It’s not the right thing to do, but it happens. Just because the last provider gave you a different diagnosis does not necessarily mean that it was the correct one. 😬
As always, please remember that this information does not replace parental judgment nor a medical assessment by your provider.
Parenting is hard, but I'm going to try my best to make it easier on you. ❤️ Comment below if you learned something new!
