Standard of Care?

[SpoiledMilk]

As a MS3 in clinic, intern and I went into the exam room with a very senior male pediatrician (multiple leadership positions at the medschool) after presenting. The 1st time mother was there for 1st WCC. During examination, the newborn started crying. The pediatrician placed their right index finger into the crying baby's mouth. The sucking calmed the baby. The doc continued asking the mother questions as he held the newborn and the child continued sucking away on the tip of the finger.

But I noticed something that made me cringe. I also saw the expression on the 1st time mother's face which I do not believe the pediatrician noticed. The pediatrician did not wash their hands, did not glove up, and the fingernails were relatively long and unclean. Maybe it was just me, but I could tell the mother was unnerved by her newborn sucking away on a dirty fingertip. She did not say anything about it though.

Is this appropriate standard of care or am I being ridiculous?

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[GoSpursGo]

I guess both. When I was in residency we would definitely use a finger to sooth a crying baby during an exam, it was surprisingly effective. At the same time, this was before a global pandemic, and I definitely would at least wash my hands before doing that. If you're routinely doing this then you should probably mind your nails.

And obviously, read social cues--if they parent is not comfortable with it then stop.

 

[Cuthbert]

You are not being ridiculous. There are a couple of things that will hit wrong with certain people: I certainly would not welcome an ungloved and unwashed finger in my child's mouth - from anyone, let alone a healthcare provider. There are also people who take breastfeeding very, very seriously and may be adverse to any use of a pacifier - finger or otherwise.

His age likely has something to do with it; I doubt his gender does. I'm sure he doesn't mean anything by it (probably not worth it to call him out on it - but it's up to you). Take the good habits and mannerisms that you can learn from him and leave the rest.

 

[SpoiledMilk]

As a MS, I was not in a position to say anything to the doctor unfortunately. I kept silent, but did seek confidential counsel from a trusted pediatrician in the department. They were aghast at what I told them. She was insistent that taking universal precautions were vital and necessary, more so now than ever.

 

[charleydogmom]

Working as a postpartum nurse I would always 1. Ask permission from parent/s to put my finger in the baby’s mouth 2. Wash hands 3. Glove hands 4. Wash hands again afterwards. It is very useful especially when you need to listen to the chest but always follow these steps. I also used to clean the stethoscope with a alcohol pad before I put it on the baby too.

 

[SurfingDoctor]

There’s no “standard of care” for soothing a crying baby. The poor man’s pacifier is one way (it also can be an exam finding to assess strength/tone). But not gloving/washing hands is poor hygiene. That’s about as far as it goes though.

 

[DO2015CA]

Def isn’t a standard of care. I would lean more towards using a finger to pacify being the standard of if there was one. I always use a gloved finger. I’m a germaphobe even prior to covid. Ofc as said above, this is if parents are okay with it