Letter to the Editor

Abstract

To the Editor; Thank you Dr Haslam, I really mean it: THANK YOU! I have worked as a community paediatrician for 25 years and have taught family practice residents for almost as long. I cannot agree more with Dr Haslam. I was recently called to see a young nine-year-old girl who had come to our emergency room with abdominal pain. She was thought, by the emergency room doctor, to have “? Appendicitis” and the surgeon was consulted. By the time I was called to see her, she had spent approximately 8 h in the emergency room, and had gone through no less than one ultrasound of the abdomen and two (yes TWO) computed tomography scans of the pelvis. The diagnosis of benign acute gastroenteritis had not yet been made. No one had taken the time to examine her yet, no one had even put a hand on her abdomen to find out whether there was guarding of any sort, and no one had taken the time to ask about the four-year-old brother who had an episode of vomiting, diarrhea, dehydration and fever one week earlier. If someone had performed these basic steps, the diagnosis of rotavirus gastroenteritis would have been made very much earlier. The environment of overwork, the constant medical legal ‘Damocles sword’ coupled with the exponential multiplication of guidelines, clinical pathways and protocols have created an atmosphere of ‘dys-ownership’ of the patient. Consequently, extenuated physicians are, at times, more concerned about following the ever-changing most recent protocol so as not to be harassed by administrative measures, than they are about the actual well-being of the patient. I should add that the physicians involved in that case are my friends, and I know they are good physicians. The solution to this issue is to have less administration, less protocols, more legal ‘protection’ (which does not mean that one should not be penalized for negligence, but this is another topic) and a return of the ‘moral’ ownership of the patient to the caregivers. We must insist on teaching residents these extremely important basic steps in medicine: take a history and perform a good physical examination. Dr Frank Ford was right; it is still true today and will be true tomorrow: laboratory tests and x-rays are here to confirm the clinical impression – if they don’t, they are wrong. If we do not have a clinical diagnosis before we order them, we won’t have one after. Once again, thank you Dr Haslam.