While winter is traditionally the busiest time of year for pediatricians, this winter has been particularly difficult in the Midwest with not only a larger number of ill visits, but a late and heavy flu epidemic hitting at a point where most of us were already wearing out. With this flu epidemic, our urgent cares, same day sick clinics and ERs have been setting all-time highs for any particular calendar date almost every day for the last several weeks, and the staff and providers are feeling it.
As I entered the urgent care lobby for a recent evening shift at one of our urgent care sites, I noticed that there was not an empty chair to be found. Haggard parents looked at me with anticipation. “Looks like the extra doctor has arrived,” I heard a few say.
The haggard looks were also to be found on the faces of the staff and the other providers.
“How’s your day been?” I asked my colleagues.
I could palpably sense the defeat in their replies. Logging in, I noted that there were 15 patients waiting to be seen. “It is going to be a busy shift,” I thought as I looked over the records for the first patients I was going to see.
While we don’t want to admit it out loud we all get stressed in such situations. With that stress and fatigue come the thoughts that you try to block out but are there.
“Why are you here for a regular cold?” or “Don’t get mad at me for waiting this long … you could have avoided this all with a flu shot for your child” are two such thoughts. While we try to hide them, they live there in our near subconscious and affect our moods.
As I walked into the room, I saw two younger girls laying on either the bed or in mom’s lap. They looked tired and sick.
“Hi I’m Dr. Alex,” I said being as energetic as I could.
The girls smiled weakly. During the brief history taking mom stated that since her daughters are usually healthy she did not agree to the flu vaccine in the fall, but now we were waiting for the nasal swab to prove my strong suspicions. That subconscious thought about “get a flu shot next year” immediately came forward, but Mom beat me to it.
“I know they have the flu and I know that they should have gotten the vaccine.”
I was taken aback by her frankness.
“They have been sick five days and yes getting better. But I want to be sure that they are OK. You probably seen the reports of kids in Ohio dying from the flu and I’m worried.”
Immediately the dad in me roared forward in my brain.
“I worry about my kids too,” I said, “so I understand your concern.”
The flu tests came back as expected, but instead of focusing on the diagnosis we went over Mom’s concerns, what to look for, when to worry and when to come back. I reassured her that the girls should be fine soon.
This visit reminded me that we too quickly jump into the role of “diagnoser and treater” instead of trying to figure out what the families are most concerned about. Even with multiple online resources that allow folks to self-diagnose the number of visits to our ER and UCs still increases nearly every year. Why? I feel that diagnosing is just part of the job. It is the ability to hear out our patient and family’s concerns and address them using our knowledge and experience that the families seek. Yet, our focus in most of our encounters seems to be on the diagnosing and treating aspects of care, instead of taking the extra minute or two to hear out our patients.
I came back into the room with the after visit summary and asked if mom had any more concerns. Though no prescriptions were written or labs ordered or shockingly clever diagnoses made, the mom seemed very satisfied with the visit. It was a stark reminder that taking an extra 30 to 60 seconds per visit makes a huge difference for our patients and families and reminds us, despite very busy days, why we choose this field to begin with. Yes the shift was busy and yes I was tired at the end, but I found myself in a good mood on the way home because I was able to at least partially connect with fellow parents and help them, albeit in some small way, care for their beloved children.
Alexander Rakowsky is a pediatrician.
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