Most doctors take the Hippocratic oath when they complete medical school. They know one of the main principles is “First do no harm”. While in part this may seem obvious: doctors should not harm their patients by performing unnecessary procedures or prescribing unproven medications that may harm them. In reality this concept of doing no harm, which is never far from my consciousness when making medical decisions, runs much deeper. It is a concept most doctors adhere to and use to guide their ethics when making difficult decisions regarding their patients.
In pediatrics limiting the pain and suffering in our patients is of the utmost importance. Protecting their lives is the number one priority however. Therefore I don’t think many of us find it difficult to order shots or perform painful procedures or subject our patients and their parents to stressful and sometimes expensive tests if it may be life saving for them.
The decisions become more difficult in the middle ground when the severity of the problem may not be as clear and in these cases we must take into account all of the variables of pain and suffering to the patient weighed against the possibility of missing a serious diagnosis if nothing is done. These variables include not only physical pain to the patient but undue family stress being caused from the anxiety of going thru an evaluation to the financial hardship that can be caused by expensive tests. These factors must be weighed against the severity of the possible medical diagnosis and the likelihood of it progressing and causing serious irreversible consequences in our patients.
Some things can be followed and don’t need a definitive answer or treatment right away. Pediatricians tell parents that the treatment is “watchful waiting” for these problems which may go away on their own. Other concerns may require some testing or referral to further evaluate the problem and determine if treatment is in the best interest of the child. I know that in some instances some parents may feel frustrated at times that “nothing was done” for a certain condition but it may be the case that the reason had to do with the way in which we apply the principles discussed above in caring for our patient’s. In these cases it may be informative to ask your child’s doctor how they made a particular decision and what they were thinking.
As Pediatricians we are always thinking of these things when we make decisions regarding your child. When you call after hours we must take into account all of the above factors when advising you to go to an after hours facility, local Hospital ER, a Children’s Hospital ER or calling our office first thing in the morning to see us the next day. We have seen children who have undergone unnecessary procedures and sometimes even hospitalizations, which may have been prevented if we had been able to evaluate the child in the office or sent them to a facility that only cares for children. We have the advantage of knowing your child and their medical history as well as the judgment and experience of many years of only treating children. Local ERs are a godsend and save lives but they are not always the best place to evaluate your child.
We are on call for your child 24/7. In the middle of the night you may talk to a Pediatric nurse from All Children’s Hospital first, or on certain weekends it may be another Pediatrician sharing call with us, but there is always someone to give you expert advice on what you should do if you are worried about your child and if they need to be seen. Please call us first at any time if you are considering taking your child in for emergency care. Believe me, we never mind taking an after hours call to make sure your child gets the most appropriate evaluation for whatever medical problem you are concerned about.
By Dr. Doug Hasell