October 17th, 2022
In general, I try to avoid paying attention to internet criticism of our practice unless the critique is actionable, realistic and not just someone's frustration with their own experience based on a choice to be late, rude or non compliant. Critiques are highly useful when we can use the information to learn and adapt to be the best care provider for a child.
Recently, a parent critiqued us twice under two different names using similar information on the same day. While I may disagree with the review and even find them frustrating at times, there is often a teaching point hidden among the vitriol. Here is a portion of the review as copied word for word for a little context:
"The actually doctors are decent for the most part, but rarely prescribe any medicine to sick children other than recommending "natural" ingredients from grocery stores. One time they prescribed my daughter eye drops that caused her to have an allergic reaction and almost end up in the hospital." "Not to mention they never prescribe antibiotics to help the kids get better."
Clearly, there is a disconnect between this parent's understanding of how medicine helps, how it does not and ultimately can harm as stated with the allergic reaction that occurred. The critique is a shot across the bow for us to work even harder to educate parents regarding why a medicine is necessary and also when we need to avoid it.
Medication errors are a major risk for morbidity and mortality nationally. The number affected skyrockets into the hundreds of thousands when we look at the countless side effects that do not cause death but leave us miserable and harmed.
When it comes to the children that we treat, physicians and care providers should refuse to give a medicine unless it is absolutely necessary to the point of the above review. We have no desire to add to the statistics of medication induced negative outcomes. Over the years of writing, I have tried to make it transparent that medicines are causing a lot of harm, especially antibiotics. The onus is ours to convince parents that drugs can be necessary but only rarely. This weekend, I experienced the same anger from a parent demanding steroids for a cough because the cough had not abated over a few days. It is a tricky dance to take the anger and reflect back calm measured reasoning as to why the choice to not prescribe the medicine is made. I would not give the medicine to my own child in the same situation so therefore I have to honor your child's health and do the same. The parent walked out asking which way she can leave this place that doesn't help her children.
Educating patients and parents is therefore the only and key way to fixing the problem of over medicalization for a given problem. Thinking about the best way to avoid medicine is to go back to root causes of disease and mitigate them.
God had a plan for us to survive in this beautiful world. It involves healthy lifestyle choices that keeps our immune system strong. The body is protected through breastfeeding, movement, healthy food and spiritual happiness. When this system fails, which it will at times, we then have medicine to correct the issue and allow the body to heal the imbalance where possible.
Here inlies the key. Your body wants to heal! It wants to return to homeostasis. It just requests that you feed it the inputs that it needs to be right. This is the reason that I love to treat children. They want to heal. They desire to run, play and love.
Antibiotics, steroids and other commonly prescribed medicines have consequences when chronically used and also rarely when used acutely. Antibiotics, steroids and antacid medicines will go down in history as the the best medicines when appropriately used but also the worst in the over use realm.
It is profoundly clear that we need not eschew medicine nor embrace it solely. We need to use a medicine only when truly needed and not to make us feel better by doing something for a virus or other temporarily uncomfortable illness or symptom that can resolve without medication management. This is not an absolute so much as a conversation of pluses and minuses in a calculus of health.
For the reader, know that we try very hard to provide medicine appropriately every time based on the current science, symptoms and pattern of disease.
Stay warm and healthy but play outside this winter,
Dr. M
Allen Scientific American
Jha Scientific American
Part II: Buyer beware of the health system's pushing patients towards the emergency room for high cost care. From a Medscape article: "Frankie Cook remembers last year's car crash only in flashes.
She was driving a friend home from high school on a winding road outside Rome, Georgia. She saw standing water from a recent rain. She tried to slow down but lost control of her car on a big curve. "The car flipped about three times," Frankie said. "We spun around and went off the side of this hill. My car was on its side, and the back end was crushed up into a tree." Frankie said the air bags deployed and both passengers were wearing seat belts, so she was left with just a headache when her father, Russell Cook, came to pick her up from the crash site. Frankie, then a high school junior, worried she might have a concussion that could affect her performance on an upcoming Advanced Placement exam, so she and her father decided to stop by an urgent care center near their house to get her checked out. They didn't make it past the front desk." Article site link. The moral to the story was a massive bill for a possible concussion. These issues can bankrupt you if you are not aware of the outcome risk. Total Bill: $17,005 for an emergency room visit; it was later adjusted to $11,805 after a duplicate charge was removed.
Knowing the risk of immediate post injury consequences can help avoid an ER visit and the back breaking bill.
"The Takeaway: It's important to remember that urgent care centers aren't governed by the same laws as emergency rooms and that they can be more selective about who they treat. Sometimes their reasons are financial, not clinical. It's not uncommon for urgent care centers — even ones in large health systems — to turn away people who have been in car wrecks because of the complications that car insurance settlements create.
Although urgent care visits are less expensive than going to an emergency room, the clinics often can't offer the same level of care. And you might have to pay the cost of an urgent care visit just to find out you need follow-up care in the emergency room. Then you could be stuck with two bills."
Lots to think about here.
Dr. M
