Wednesday, August 20, 2008

Sore Throats & Minor Emergency Clinics

I absolutely detest minor emergency clinics.

Maybe it's because of the years I worked in a family physicians' office. I witnessed professional, expert care first hand by the doctors I worked for. Perhaps it's because there is a big difference in the attitude of a family physician working with their own patients than a general practitioner working at a walk-in clinic with patients who are not their own. Both have the same education and training, but trust me, they generally do not have the same attitude. The majority of my experience in a walk-in clinic is one of extreme indifference by doctors who want to quickly treat your symptoms, do not have any patience to hear any history, and just want to push you through as quickly as possible.

Therefore, it was with extreme unenthusiasticness (my word) that I took my children to one on Monday night because of their sore throats. I was pleasantly surprised then when I found this to be the best minor emergency clinic I have ever been to, from the receptionist to the doctor. I mean, this doctor actually checked their ears, chest, neck for enlarged lymph nodes AND their throats, ALL IN THE SAME VISIT! ALL FOR THE SAME PAY! I was impressed. And, he was nice! And, he didn't push drugs before the throat swab came back! Unbelievable!

My good impression didn't last.

I was told by the doctor that the throat swab would be back the next day (Tuesday). I called the clinic in the late afternoon and was told, again by a very nice receptionist, that the swabs aren't even cultured until a full 24 hours after the lab has received them. She also told me that the lab always called positive results. Because she seemed very competent and because my experience with this clinic had been positive up to this point, I decided I would worry no longer, and would trust them to call me the next day if the results were positive.

I did not hear from them all day today. I was somewhat surprised as I really believed that Hannah had strep throat, even though I know that viral illnesses can make you just as sick and, in fact, are harder to deal with sometimes because there is nothing you can do but let them run their course. However, when Hannah came to me again at 4:30 crying because her throat hurt so much, I decided that I would just make sure that her throat swab was negative.

I called the clinic and again got a very nice receptionist. She asked me for my childrens' names.

I always spell my last name because usually people have no clue how to spell it. She then asked for the first names.

"That's Seth?" she asked.

"Yes." I answered.

"What's the other name?" she asked.

"Hannah." I replied.

"Hmm. I'm going to have to get the doctor to call you. I'm not allowed to give any results out over the phone."

Translated: The results are positive, but I can't tell you that.

"Okay." I said.

"Before you go, I need to ask you a couple of questions. Do your children have any allergies?" she asks.

"No." I reply.

"If the doctor needs to call in a prescription, which pharmacy do you use?" she asks.

I gave her the name of the pharmacy, the whole time thinking: Can we just skip this little game? However, I know how doctor's offices work and I know receptionists are trained to say certain things and this is not her fault. I'm also thinking that I'm very glad I did call after all and really do wonder if this would have been missed.

"What is your phone number?" she asks.

I give it to her. Then I say, "I would really like to talk to the doctor before he calls in a prescription, if he needs to call one in (going along with the little game, after all). I would like to talk to him about which antibiotic I would prefer."

"Which antibiotic is that? I mean, if you need a prescription?" She gamely continues.

"Zithromax." I reply.

Seth has had this drug a few times over the years for his ears. It really is the wonder drug of antibiotics, because it's given ONCE a day, not 3-4, and only for FIVE days maximum, not 7-10, depending on the illness. AND, there are no side effects! Now, why would I want them to have an antibiotic that causes gastric upset, try to force them to take it three times a day for 7-10 days when I don't have to? I did a bit of research and found out that because this is such a WONDERFUL antibiotic, doctors are more hesitant to give it because the more it's given, the greater chance resistance to it will be built up. Therefore, they tend to want to save this antibiotic for only when the others either don't work or are reacted to.

Since Hannah has never had Zithromax and, in fact, has only ever had Amoxil once when she was one (like I said, she's pretty healthy) and Seth has had it only a few times, with the last time being two years ago, I think - resistance phooey. I think they'll have to take it much more regularly to worry about that.

So, I settle in and wait for the doctor to call. He calls around 5:30. He completely surprises me by telling me that Seth's throat swab is positive for strep, but Hannah's isn't.

If I had been a betting person, I would have just lost the farm on this one. I was sure that her throat swab would be positive if any, not Seth's. Although his throat has been hoarse, he has not complained once about his throat (and believe me, he would, even if he did it by pointing to his throat complaining of a bellyache!).

I ask the doctor what I should do about Hannah. He tells me she should get her throat swabbed again if she's still complaining because it doesn't mean she won't get it, especially if her brother has it. He does not recommend starting her on antibiotics until she has documented strep. Again, I'm impressed with this doctor - he's not a drug pusher. I must confess, however, that for the first time I actually would have considered giving her a course of antibiotics anyway because I really couldn't see her submitting to another throat swab (not my hyper-gag-reflex daughter) so soon after the last. And she is not getting any better. And I am a little skeptical of these results. I give him the pharmacy information and he tells me he'll fax in a prescription for Zithromax (although Penicillin really is the drug of choice, he sneaks in).

I made the mistake of telling my mother. You know, I really do make this mistake often and should have my head examined. My only excuse is that, well, she's my mother. And she was asking me anyway whether the doctor had called. When I told her that I didn't know if Hannah would submit to another throat swab, she says, "Well, I would just make her!" Now isn't that brilliant? Honestly, I don't know how she managed to parent FOUR children sometimes. Please pardon my disrespect, I know I am being disrespectful, but really. As much as I love her, she frustrates me to no end sometimes. According to her, we were perfect children and she NEVER had any trouble with us. I mean, we ate all our vegetables, never fought, always obeyed, were never sneaky, never sassed. NEVER. I don't know what happened to us now as adults (at least to my brother and two sisters, anyway....ha, ha!) since we had such perfect upbringings. I very impatiently explained to her that I hadn't yet learned the technique of making a child open their mouth if a child refused to. She would be a rich woman if she invented a device or method that did this (and I would inherit some of it), so be my guest - invent away.

I asked Hannah how sore her throat really was. She said it really was. I asked her if it was worse than two days ago, or just as sore. She said that it was just as sore. I asked her if she would be willing to go through another throat swab. She said she didn't know. I told her to think about it, and, if her throat was really sore enough, I would take her again.

Lo and behold, she surprised me. Her throat really must be sore because she told me she would have another one done (even without any invention of grandmas - imagine!).

I took her in to the same clinic because, in spite of the fact that I think they forgot to call us today with Seth's positive result, they really are the best I've been to. Besides, I thought it was the same doctor on. I was wrong. It was his brother. Very, very nice doctor, but totally different philosophy on doctoring. He checked her throat, ears and chest. Not bad so far. Then he called us to his office and offered the kids a sucker while he wrote out a presciption. We went through the whole Zithromax versus Penicillin thing, and he very congenially agreed to give Zithromax. I am quite sure that if I would have told him that she needed Valium to sleep tonight he would have very congenially given me that, as well.

"Are you not going to swab her throat again?" I ask.

"Do you want me to?" he asks.

About as much as I want her to take cod liver oil, I think. However, I've been thrown off guard about this whole visit because I really wasn't expecting a prescription without a confirmed strep.

"I think it's best to have a confirmed strep, don't you?" I ask.

"I'm not one to make a child wait for five (yes, he said five) days suffering when they could have already gotten some relief from the medication." he explains.

He swabs her throat, hands me the prescription, chats with the kids and we leave.

I look at the prescription: Hannah (with her last name), age 6, 53 lbs. Zithromax.

Real good. Real educated. One of those doctors that make the pharmacist earn their pay.

However, after considering everything and discussing it with Dave, I decide to fill the prescription. Yes - I am before the result comes back, which is not my general practice or belief. However, I've had a daughter with a sore throat for a week; she has only had antibiotics ONCE before; I am really not wanting to wait until Friday at the earliest for her to get some relief; and the worst case scenario is that she takes antibiotics unnecessarily this one time - well, it will not kill her. Not a girl who is not over-antibioticed (again, my word).

Now, that's my story. If you don't agree with the antibiotic thing, please don't be too harsh. I think it's just time for the sickness to be gone if it can be.

Have I mentioned how much I detest minor emergency clinics?

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