Stories like this make me very glad that I got my pediatric experience in a good children’s hospital before starting medical school. The attending physicians made sure to drill it into everyone’s heads that if the parent is expressing concern about a change in condition or “something just not being right”, you report that to the patient’s physician and nurse ASAP. Everyone from the physicians down to the admin folks were empowered to challenge decisions they thought weren’t in the patient’s best interest.
Hell, I even had a case where, as the ER tech, I challenged a physician on her diagnosis of a child and refused to let her discharge the kiddo without looking at him again. The mom told me something was wrong, and even with just an EMT license, I was able to see something was subtly wrong as well. It turns out the mom and I were right and the physician changed her diagnosis and admitted him to the hospital for treatment instead of discharging him home to follow up in clinic in a couple days.
That doesn’t mean you ignore them. You listen to what they’re saying, maybe take it with a grain of salt, and actually get a good history and physical.
You have to be very careful about “filtering” as well. It becomes far too easy to write off a legitimate concern if it has to pass muster with your “filter” before you consider it. The HPI and subjective portions of a note are explicitly for the things the patient (or their caretaker) tells you. It is subjective. Then you do your objective examination and testing, then you make an assessment, and if you can justify that assessment with the testing and history, then you can make a plan. SOAP notes go in that order for a reason.
Stories like this make me very glad that I got my pediatric experience in a good children’s hospital before starting medical school. The attending physicians made sure to drill it into everyone’s heads that if the parent is expressing concern about a change in condition or “something just not being right”, you report that to the patient’s physician and nurse ASAP. Everyone from the physicians down to the admin folks were empowered to challenge decisions they thought weren’t in the patient’s best interest.
Hell, I even had a case where, as the ER tech, I challenged a physician on her diagnosis of a child and refused to let her discharge the kiddo without looking at him again. The mom told me something was wrong, and even with just an EMT license, I was able to see something was subtly wrong as well. It turns out the mom and I were right and the physician changed her diagnosis and admitted him to the hospital for treatment instead of discharging him home to follow up in clinic in a couple days.
Thank you for your advocacy! Agree its a whole team involved in patient care
99.99% of parents over react to their children’s “illness”.
That doesn’t mean you ignore them. You listen to what they’re saying, maybe take it with a grain of salt, and actually get a good history and physical.
Never suggested ignoring, more about how you filter through it all.
You have to be very careful about “filtering” as well. It becomes far too easy to write off a legitimate concern if it has to pass muster with your “filter” before you consider it. The HPI and subjective portions of a note are explicitly for the things the patient (or their caretaker) tells you. It is subjective. Then you do your objective examination and testing, then you make an assessment, and if you can justify that assessment with the testing and history, then you can make a plan. SOAP notes go in that order for a reason.