Every parent of young kids in Ottawa has a story about the ER at CHEO, here is mine.
The Children’s Hospital for Eastern Ontario, CHEO is the reference hospital for the National Capital Region and surrounding areas. They do a great job, they are always there, for parents and children in need of medical attention. It is also a reflection on the health care system as a whole; long wait times, in my experience at least 6 hours, and my latest 11 hours; but access to the best technology and professionals.
Many parents turn to CHEO as their only source for a doctor, the crisis for general practitioners and family doctors is palpable at CHEO’s ER everyday.
In our particular case, we are lucky enough to have a family doctor, and we went there first, around noon, to ask her opinion on our daughter, aged 2, with fever, vomit and diarrhea since Sunday, not eating much since Monday, constant fever and cough that doesn’t let her (and us) sleep at night. I am not a medical professional, nor pretend to be one, but my gut instinct as a parent tells me that we have a sick kid.
Our family doctor coudn’t see us without an appointment, but pointed us to the walk in clinic at the same place, under 30 minutes later, a doctor saw my daughter and told us the dreaded words “Take her to CHEO, we could do the same tests here, but it will take at least three days, there you will get them faster”. He gives us a remittance to the ER, stating his observations.
When we got to CHEO, at the triage nursing station, we hand her the remittance from our doctor, and tried to explain our case; she didn’t listen to us and quickly ignored our doctor’s observations, and stated the obvious, “Your kid has a fever, you should have given her Tylenol” …
I know who a triage nurse is. Generally the most experienced nurse on the floor makes the first triage, she can quickly determine who is sick, and who isn’t, and based on her input, the case gets its priority on the queue. From the other side of the counter, the side of the anxious parents and sick kids, one of the unwritten rules when going to the ER is not to give any tylenol or advil before, because when you get into the ER, the effect of the medicine is on, and your kid seems better than he really is, therefore, you get further down in the priority line.
Do you think that we go to CHEO as a past time, or as a sport? Don’t you think that we have tried for three days to manage a fever giving Tylenol or Advil every 8 hours? Don’t you think that we know the difference between real vomiting and vomiting because of a cough? As a responsible parent of two, we have been there, done that, and got the t-shirt, we know when our kids are sick, we know what is normal, what is not. Please don’t quickly dismiss our concerns telling us to give the kid an analgesic.
Anyway, we get in the waiting room, registration, second triage, Tylenol gets in and we start the long wait, around 4 hours until we are in a room in the ER, and another hour until we see the first resident in pediatrics.
She attempts to make a diagnosis, asking all the pertinent questions, and trying to decide a course of action, and as she said “I don’t need a thermometer to tell that your daughter has a fever …”, first possibility is an urinary infection, so to discard or confirm it, we need to hydrate her and get an urine sample. Sounds as a good plan and reasonable, We waited and waited, the re-hydration formula never arrived (fortunately we had our own, as I said, we have been here before), but no one showed up to put the bag for the urine sample. You never realize how valuable is your child’s urine, until you see a diaper full of it, because no one came to put on a bag for catching a sample. My wife goes and complains with the nurse, now the bag is in place, and we have to wait more … second dose of tylenol goes in, and we wait … until we catch a urine sample, but it cannot be tested since its contaminated.
Now another pediatric resident switches tactics, a catheter, uncomfortable but effective; we wait some more, and we have some more pee to test, an hour later, the results come, negative, it’s not an urinary infection.
Later the doctor comes to tell us the result and say “its a viral, there is nothing we can do, go home”, but we are lucky, with good timing, my daughter vomits, and seeing this, the doctor reconsiders and goes for the next test, an x-ray. Half an hour later, we have the image, and confirms the suspicion of our General Practitioner 12 hours before. Pneumonia.
In our case we came to CHEO for quicker access to a lab test and diagnostic imagery, and to confirm the suspicions of our doctor.
How many cases get misdiagnosed initially as a viral infection, just to get worse and return for a second time to the ER? Should a doctor’s remittance to the ER have some value? Triage has been done already, and there is a baseline to assess the patient evolution, why to quickly dismiss any outside opinions and restate the obvious?
As residents in the western hemisphere, we like technological solutions, the latest gizmo that gives more information faster, or the latest pharmaceutical to treat a condition, but sometimes I wonder if we need to return to basics of the Greeks philosophers who invented the scientific method and the fathers of modern medicine, treat the cause not the symptoms; do no harm; cure, not treat.