A doctor’s reassuring voice can work wonders

A couple recently brought in their 4 month old daughter for fussiness and reflux that was not improving despite input from a specialist. The baby was thriving – gaining weight and meeting her developmental milestones. She also had a twin sister at home who was also thriving but “healthy”. They were visibly frustrated and looked exhausted. They were also very well informed about reflux and had some very good questions about their daughter’s situation and the medications she was on. And, both were wondering if she really had reflux at all. They had last seen the specialist the day before and were not at all happy with the visit. They baby was very fussy all night and out of desperation they came to the ER no knowing what else to do.

The baby seemed to get fussy easily during the exam but when calmed was a very “normal” 4 month old and very engaging. I smiled at the baby and said “Wow – you are an adorable little handful aren’t you?” Both parents laughed and the dad remarked “you are the first person who has ever acknowledged that she is not easy to care for. We thought we were doing something wrong.” What they really needed was to talk and feel like they were doing something right. What was initially an “emergency” suddenly became something much more manageable – and they realized that they could have actually called the on-call doctor and ended up in the same place. Interestingly, as they relaxed, so to did the baby!

This couple was clearly stressed and I doubt there is a parent among us who can’t relate to the pressures they were under. It is very hard as parents to balance out the impact of our stress and our reaction to a sick child with what is in the best interest of our child. If it is 3am and your 2 year old is crying with a fever, that is stressful and your child may need to see a doctor. But is it worth your while and in your child’s best interest to stay at home or should you head to the nearest ER?

Certainly, the ER is the place to be if your child is very ill or has had a major trauma. That said, if you’ve had an ER visit recently, you undoubtedly know how long the wait can be. Unfortunately, ER volumes are very high and the sickest patients need to be seen first. Doctor’s offices use their after hours call systems to help you determine if the emergency room is the best place for your child or if waiting until the morning is more appropriate. Rest assured that getting the advice to stay home does not mean your child is not sick - it just means that your child has something that is safe and appropriate to care for at home a bit longer. Many parents come to the ER after getting phone advice because they have trouble trusting the advice given – their stress and urgency won’t let them believe that they can care for the situation at home just fine.

In the end, we need to somehow see the flowers among the dirt. We need to somehow reclaim the old fashioned doctor-patient relationship so clinicians will better identify the true pressures families are feeling today and communicate better to families. By doing so, families will start to trust that not all “emergencies” require the emergency room – some may just need a deep breath and a phone call.

© 2005 Pediatrics Now.
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