Why is it so hard for outpatient Ped's to provide good information?

[gamerEMdoc]

I hate to complain about other specialties, I really do. But if I hear one more time from a parent that they were told by their Pediatrician who saw a child (not an infant) less than 48hrs ago to go immediately to the ED for a fever > 102, I'm going to lose my mind. It is not 1992. We can stop practicing like the era before Hib and prevnar eradicated nearly all bacteremia in kids, and almost all bacterial meningitis. I've never seen a Pediatrician bring their own child to the ED for a fever. Not one single time in my career. You know why? Because they know fevers aren't dangerous.

Why is it so hard for doctors to just tell people that fevers aren't dangerous? Between this and telling every parent their kid has an early "double ear infection" when they have go to the office for a cough/URI, I sincerely question at what point a Ped's doc just give up trying to actually do the right thing for children. Ped's is literally one of the LEAST litigious fields in medicine. I just don't get it.

The thing is, I actually like seeing kids. And these are easy patients to see. I give them motrin and discharge them immediately. They get a popsicle. Easy. It's not making my job harder, other than one more chart to do. It's more that it is an incredible waste of time for parents who can sit for hours to be seen, and an incredible waste of money, and at the end the parents are left with questioning why they were told to come for something when another doctor just hands them motrin and discharges them.

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[BJJVP]

You're not wrong and I agree with you completely. But to be fair, I find that parents often call the office and state things that can be difficult to blow off over the phone (lethargic, trouble breathing, hasn't eaten in 3 days, etc). Of course, these things often really mean that the kid just wants to lie down and watch TV, breaths with mouth open due to a stuffy nose, & won't eat anything other than ice cream and gatorade lol

 

[gamerEMdoc]

You're not wrong and I agree with you completely. But to be fair, I find that parents often call the office and state things that can be difficult to blow off over the phone (lethargic, trouble breathing, hasn't eaten in 3 days, etc). Of course, these things often really mean that the kid just wants to lie down and watch TV, breaths with mouth open due to a stuffy nose, & won't eat anything other than ice cream and gatorade lol

Sure, I totally get the bad nursing line advice with the default "go to the ED if concerned" canned response, though IDK why this has to be the canned response instead of saying if you are worried, we can see your child tomorrow, but if you notice XYZ actually concerning symptoms, you should go to the ED. But I'm more referring to kids who were seen in office and given BS diagnoses they don't have or bad advice regarding a specific number for a temp of when it becomes dangerous, which is based on practice from before the Hib/prevnar vaccine era when a fever of 102.5 prompted a bacteremia workup. No one practices this way because its not 40 years ago, and yet many times parents are still told that "low temps are viral" and a fever over 102 = dangerous and it's complete BS and they know it is.

 

[PTPoeny]

Did the doc actually say that? Or did the parents say the doc said that?

In residency I covered ED consults on the same nights that I took the mommy call pager and saw plenty of parents come in claiming I had told them to come when I had told them everything possible to keep them out of the ED.

 

[Birdstrike]

I'd bet 99 out of 100 times it's a receptionist, nurse or medical assistant telling a parent to take a kid with a fever to the ER because of a full schedule, as opposed to a pediatrician seeing a kid with a fever, and forcing you to also see them.

Our system is setup such that anywhere there's a shortfall or weak link, it falls on the ER to bear the load (thank your Congress, for giving us the law EMTALA). It sucks, but that's the way it is. It makes your life Hell in the ED. Every pre-med, medical student should be told of this and the other 1,001 things outside of their control that will torture them while in the ED. They should be told, and told, and told again 10,000 times, before they commit to EM.

 

[RustedFox]

Did the doc actually say that? Or did the parents say the doc said that?

In residency I covered ED consults on the same nights that I took the mommy call pager and saw plenty of parents come in claiming I had told them to come when I had told them everything possible to keep them out of the ED.

THIS guy!

Bro. Haven't seen you post in awhile.
Good to hear from you; you nearly always have something useful to say.

 

[miacomet]

Parents in the US are often uneducated, spoiled, and entitled. They hear what they want to hear and demand what they want. Pediatricians are in a tough spot dealing with such people.

 

[cyanide12345678]

I’ve started teasing out the difference. If someone says their doctor sent them here, often that means a nurse or receptionist told them to go and they didn’t even see the doctor. Sometimes even if they went to the office, sometimes the staff would just tell them to go to the ER for something simple and unnecessary - usually it’s almost always after 2-3 pm. They just don’t like to add people on after that time. Unlike us, their office closes they picked a better specialty where there isn’t an open door at all times.

Since i practice in rural America, almost always if a doctor or even a nurse practitioner sends a patient that they have seen in clinic, they call the ER and tell me what they are sending. Usually it’s something reasonable that ends up getting admitted.

 

[cyanide12345678]

Parents in the US are often uneducated, spoiled, and entitled. They hear what they want to hear and demand what they want. Pediatricians are in a tough spot dealing with such people.

Mostly uneducated i feel. Also it doesn’t help that the box for ibuprofen and tylenol usually under doses medications. So sometimes they just come in freaking out that the fever isn’t going away -_-

All fevers go away if you dose appropriately lol.

 

[gamerEMdoc]

Its easy to blame the parents and I agree they probably hear what they want to hear and probably are getting bad advice from a nursing line more often than from a doc. But parents arent putting every kid with a cold on amoxicillin for a double ear infection either, so the prescribers share some blame. Magically when I look at the kids ears 12 hours later they’re tympanic membranes are always completely normal. Its easy to blame parents but I also think the Peds outpt folks (many of which are likely midlevels) fuel the fear that something more serious is going on by overmedicating young children unnecessarily for viral infections. Not every kid needs to be on Cefdinir and prednisolone for nasal congestion and have a BS diagnosis like “double ear infection” or “clinical pneumonia” to justify giving them abx. Maybe this is just regional practice, but I feel like over the past decade the amount of rampant abx use for clearly viral illnesses has gotten so much worse. And it fuels parental fear that everytime their child has a fever they must get seen right away bc everytime they get a fever they get put on all these medications for diagnoses they really dont have.

 

[miacomet]

Its easy to blame the parents and I agree they probably hear what they want to hear and probably are getting bad advice from a nursing line more often than from a doc. But parents arent putting every kid with a cold on amoxicillin for a double ear infection either, so the prescribers share some blame. Magically when I look at the kids ears 12 hours later they’re tympanic membranes are always completely normal. Its easy to blame parents but I also think the Peds outpt folks (many of which are likely midlevels) fuel the fear that something more serious is going on by overmedicating young children unnecessarily for viral infections. Not every kid needs to be on Cefdinir and prednisolone for nasal congestion and have a BS diagnosis like “double ear infection” or “clinical pneumonia” to justify giving them abx. Maybe this is just regional practice, but I feel like over the past decade the amount of rampant abx use for clearly viral illnesses has gotten so much worse. And it fuels parental fear that everytime their child has a fever they must get seen right away bc everytime they get a fever they get put on all these medications for diagnoses they really dont have.

Peds is still private practice. When it's not, it's employed and pt satisfaction oriented as a loss leader for hospitals. You think parents are coming back if Chad and Kayleigh don't get amoxicillin for otitis and a z-pack for a cold? Nope, and they just head over to the urgent care or kidscare or telehealth where midlevels dole out antibiotics like candy, getting great pt satisfaction scores for "caring" and further eroding our jobs.

 

[GonnaBeADoc2222]

I've never heard of a pediatrician (physician) sending a patient to the ED for a fever. It's always a midlevel or a nursing line. Fever education is central to the lecture pediatricians give the parents of their patients. Usually the ones showing up in the ED for fever aren't paying anything for the visit.

 

[Mount Asclepius]

I agree that a majority of the time parents are instructed to bring kids into the ED by nurse advice lines or office secretaries.

However, I've seen a decent number of kids sent unnessicarily to the ED with fevers by pediatricians (physicians not midlevels). The degree of fever doesn't matter and pediatricians need to stop telling parents it does. I've also seen a lot of kids with viral URIs diagnosed with bilateral OM (really!?) and then treated with unnecessary antibiotics.

I don't agree with the premise that becoming a pill mill with antibiotics and steroids is what it takes in this day and age of patient satisfaction. People are often happy with just receiving testing. Because who cares about a physician's expertise when there is a test for something Step 1: VRP results with random virus. Step 2: Counseling that it is viral, has to run it's course, and antibiotics won't help. My patient population also isn't very well educated. My satisfaction scores for whatever they're worth aren't in the tank. If they were, I nor my group would care. The answer isn't to positively reinforce that wimpy viral URIs need lots of medications. People feel crummy for a little bit occasionally. That's life. Or it is at least in my idealized view of a world "where all the women are strong, the men are good looking and all the children are above average."

 

[VA Hopeful Dr]

I agree that a majority of the time parents are instructed to bring kids into the ED by nurse advice lines or office secretaries.

However, I've seen a decent number of kids sent unnessicarily to the ED with fevers by pediatricians (physicians not midlevels). The degree of fever doesn't matter and pediatricians need to stop telling parents it does. I've also seen a lot of kids with viral URIs diagnosed with bilateral OM (really!?) and then treated with unnecessary antibiotics.

I don't agree with the premise that becoming a pill mill with antibiotics and steroids is what it takes in this day and age of patient satisfaction. People are often happy with just receiving testing. Because who cares about a physician's expertise when there is a test for something Step 1: VRP results with random virus. Step 2: Counseling that it is viral, has to run it's course, and antibiotics won't help. My patient population also isn't very well educated. My satisfaction scores for whatever they're worth aren't in the tank. If they were, I nor my group would care. The answer isn't to positively reinforce that wimpy viral URIs need lots of medications. People feel crummy for a little bit occasionally. That's life. Or it is at least in my idealized view of it in a world "where all the women are strong, the men are good looking and all the children are above average."

Peds is the one place that I still hold the line against unneeded antibiotics. Most of the time if you do a solid exam and spend time educating them on everything (and really play up the possible problems with antibiotics), parents are OK with it.

That said, I think you underestimate how much patient satisfaction matters in certain jobs. At my current job I have to have 85% or better 5 star ratings from patients. I'm always on the borderline with that. I haven't had any 1, 2, or 3 star reviews in 8+ months but if I get 100 reviews in a month, all it takes are 16 of those saying I'm only a 4 star doctor and at the end of the year I'm out around 12k.

I got called to the principals office earlier this year not because of my scores but because in 1 month I had more than the system average of patients requesting to switch providers. In a completely unrelated coincidence that month was the same one where I posted an official policy saying that I didn't prescribe controlled substances to new patients.

 

[Mount Asclepius]

Peds is the one place that I still hold the line against unneeded antibiotics. Most of the time if you do a solid exam and spend time educating them on everything (and really play up the possible problems with antibiotics), parents are OK with it.

That said, I think you underestimate how much patient satisfaction matters in certain jobs. At my current job I have to have 85% or better 5 star ratings from patients. I'm always on the borderline with that. I haven't had any 1, 2, or 3 star reviews in 8+ months but if I get 100 reviews in a month, all it takes are 16 of those saying I'm only a 4 star doctor and at the end of the year I'm out around 12k.

I got called to the principals office earlier this year not because of my scores but because in 1 month I had more than the system average of patients requesting to switch providers. In a completely unrelated coincidence that month was the same one where I posted an official policy saying that I didn't prescribe controlled substances to new patients.

I commend you on your first and third points in the outpatient world.

On the second point, I have no doubt that it matters in some jobs. It shouldn't. Patient satisfaction leads to worse medical care. We all know that. At my job it doesn't matter. I think its worthwhile to try to find an EM position where there isn't much emphasis on patient satisfaction. I also think you can have decent patient satisfaction without turning yourself into an antibiotic/steroid pill mill.

 

[RustedFox]

I commend you on your first and third points in the outpatient world.

On the second point, I have no doubt that it matters in some jobs. It shouldn't. Patient satisfaction leads to worse medical care. We all know that. At my job it doesn't matter. I think its worthwhile to try to find an EM position where there isn't much emphasis on patient satisfaction. I also think you can have decent patient satisfaction without turning yourself into an antibiotic/steroid pill mill.

Bruh; you realize what you wrote... correct?
Forgive me while I scoff and say that we call just can't up-and-find-unicorn-jobs.

 

[Rekt]

I agree it's usually some braindead person on the other end of the phone, but this should not be an acceptable excuse anymore whatsoever.

Its not a simple benign process "just go to the ED". They're leaving someone in charge with zero medical training to potentially cost a famiy hundreds to thousands of dollars, potentially multiple attempts at IV sticks, inappropriate testing or imaging etc (usually all by non physicians because these all get sent to fast track and NPPs are about as clueless as the person that sent them here).

If a pediatrician/FM cannot appropriately educate their staff on how to handle this simple phone call, then they need to take these calls themselves The sheer volume of well kids with simple URI, fever presenting to the ED "by our pediatrician" is completely unacceptable.

 

[RustedFox]

I agree it's usually some braindead person on the other end of the phone, but this should not be an acceptable excuse anymore whatsoever.

Its not a simple benign process "just go to the ED". You're leaving someone in charge with zero medical training to potentially cost a famiy hundreds to thousands of dollars, potentially multiple attempts at IV sticks, inappropriate testing or imaging etc (usually all by non physicians because these all get sent to fast track and NPPs are about as clueless as the person that sent them here).

If you cannot appropriately educate your staff on how to handle this simple phone call, then you need to take these calls yourself. The sheer volume of well kids with simple URI, fever presenting to the ED "by our pediatrician" is completely unacceptable.

Bro, I'm reading and signing the PLP notes from yesterday's shift. They're freaking awful.

WARNING, TANGENTIAL: The PLPs complain about how they have such a charting burden and that as a result, the quality of their notes suffer; but reading them now - they truly have no idea what is relevant vs. irrelevant (versus just downright freaking silly) data to include. No idea.

It was absolute murder of a shift yesterday. I walked in and there were 10+ to be seen, with wait times of 2+ hours. DocBeforeMe was relieved to see me. First thing I did was dispo patients within :30 minutes who "could get the eff out of here" while starting workups on those who needed them.

What killed me is that people were waiting for 2+ hours when they could have been seen and dispo'd within minutes.

Discussion held with DocBeforeMe revealed that we (and other Docs) feel the same way; the PLPs need to be told to "play your position", as they bumble around with workups that they don't understand, get into murky waters, then say to themselves: "Uh-oh. I need to slow down. Looks like those low-acuity patients will have to wait and stack-up".

We're getting pissed off with starting a shift and playing "sweeper", THEN having to un-ostrich the PLP patients after the PLPs ostriched them all up.

 

[alpinism]

Agree with everyone and will even go a step further in these cases: stop giving children meds for their fevers.

There is a large body of evidence that shows fevers act to reduce duration of illness and transmission of viruses.

 

[VA Hopeful Dr]

I commend you on your first and third points in the outpatient world.

On the second point, I have no doubt that it matters in some jobs. It shouldn't. Patient satisfaction leads to worse medical care. We all know that. At my job it doesn't matter. I think its worthwhile to try to find an EM position where there isn't much emphasis on patient satisfaction. I also think you can have decent patient satisfaction without turning yourself into an antibiotic/steroid pill mill.

That's unfortunately not a universal truth.

 

[VA Hopeful Dr]

Agree with everyone and will even go a step further in these cases: stop giving children meds for their fevers.

There is a large body of evidence that shows fevers act to reduce duration of illness and transmission of viruses.

The compromise that pretty much everyone I know in the PCP world makes is to tell parents to treat the kid not the number. If they are acting OK with a 101 temp, do nothing. If they are miserable and not eating/drinking with a 101 temp, give them some motrin.

 

[Mount Asclepius]

Bruh; you realize what you wrote... correct?
Forgive me while I scoff and say that we call just can't up-and-find-unicorn-jobs.

I have several friends from residency at different SDG jobs in various different states within the western half of the country where patient satisfaction isn't emphasized. We all have been intermittently hiring over the past 5 years. I know there isn't a large number of these jobs available, but they are out there. Your sanity will appreciate the practice environment.

 

[RustedFox]

I have several friends from residency at different SDG jobs in various different states within the western half of the country where patient satisfaction isn't emphasized. We all have been intermittently hiring over the past 5 years. I know there isn't a large number of these jobs available, but they are out there. Your sanity will appreciate the practice environment.

[Sarcastic, but friendly tone]
Sure, amigo - just let me up and move to Nebraska.

 

[Mount Asclepius]

[Sarcastic, but friendly tone]
Sure, amigo - just let me up and move to Nebraska.

Nebraska probably wouldn't be my cup of tea. I like mountains and oceans. Head even further west along the Oregon (or even Santa Fe) trail and you'll find gold.

 

[GonnaBeADoc2222]

Agree with everyone and will even go a step further in these cases: stop giving children meds for their fevers.

There is a large body of evidence that shows fevers act to reduce duration of illness and transmission of viruses.

I'm going to assume you are not a parent that has ever had to deal with a febrile toddler.

 

[Mount Asclepius]

I'm not completely through the toddler stage with my kids, but so far have made it without ever giving an antipyretic. I personally believe that fever is a helpful natural host response to viral infections. We've let the fever burn through and feel like the recovery happens quicker. Toddlers are toddlers, but it can be done.

 

[thegenius]

Agree with everyone and will even go a step further in these cases: stop giving children meds for their fevers.

There is a large body of evidence that shows fevers act to reduce duration of illness and transmission of viruses.

Would love to read that..is there a Cochrane Systematic Review or a resource on this?

 

[Neopolymath]

I think it's completely related that the staff, not the physician, will also block important afternoon appointments without telling the physician or without a real scheduling conflict. I have experienced this multiple times at multiple peds offices. I thought it was funny because I was texting the doc who told me to come in at X time each time this happened. "Oh you can't get the ceftriaxone shot at 4:30 we are closing early." Stuff like that. Absolutely unacceptable behavior. No surprise they send people to the ED without running it by the docs either.

 

[HemorrhagicShock]

Agree with everyone and will even go a step further in these cases: stop giving children meds for their fevers.

There is a large body of evidence that shows fevers act to reduce duration of illness and transmission of viruses.

One of the main reasons I like to treat fevers in the ED (and treat them aggressively i.e. APAP + ibuprofen every single time) is because of the concomitant lowering of heart rate. I want discharge vital signs to look impeccable for discharged febrile pediatric patients. Generally, it also makes the kid feel better, which of course makes parents feel much better.

Evolutionarily you're right, and for my own kids I take the avoid the antipyretic approach.

 

[thegenius]

One of the main reasons I like to treat fevers in the ED (and treat them aggressively i.e. APAP + ibuprofen every single time) is because of the concomitant lowering of heart rate. I want discharge vital signs to look impeccable for discharged febrile pediatric patients. Generally, it also makes the kid feel better, which of course makes parents feel much better.

Evolutionarily you're right, and for my own kids I take the avoid the antipyretic approach.

Oh good lord. So you wait a minimum of 1 hour, sometimes more, to see the 2 yo kid jumping up and down blowing snot bubbles with 103F and HR 160 normalize down to 99.0F and 120?

 

[RustedFox]

Oh good lord. So you wait a minimum of 1 hour, sometimes more, to see the 2 yo kid jumping up and down blowing snot bubbles with 103F and HR 160 normalize down to 99.0F and 120?

I order the dose and discharge them immediately, with a Smartphrase that states the discussion I had, and another Smartphrase indicating the child's obviously well status.

2 minutes.

 

[thegenius]

I order the dose and discharge them immediately, with a Smartphrase that states the discussion I had, and another Smartphrase indicating the child's obviously well status.

2 minutes.

yea I try to get the kid to smile at me. Smile = discharge

 

[alpinism]

Would love to read that..is there a Cochrane Systematic Review or a resource on this?

Dr. Paul Offit at UPenn has an excellent lecture on fevers in children that includes references.

Basically the whole concept that fevers need to be treated comes from pharmaceutical companies.

The benefits of fever lecture series

 

[gamerEMdoc]

Dr. Paul Offit at UPenn has an excellent lecture on fevers in children that includes references.

Basically the whole concept that fevers need to be treated comes from pharmaceutical companies.

The benefits of fever lecture series

Yeah, anytime I try to explain the "fevers aren't dangerous and some ID docs don't believe we should treat them" to parents they think I'm an alien. I do think it makes sense to treat fevers for palliative reasons. One of the reasons in 15 years I've never really taken my own kids temp. If they are sick and feel miserable, I give them motrin. If they are running around and feel fine, there's no need to give them motrin.

 

[RoyBasch]

One of the main reasons I like to treat fevers in the ED (and treat them aggressively i.e. APAP + ibuprofen every single time) is because of the concomitant lowering of heart rate. I want discharge vital signs to look impeccable for discharged febrile pediatric patients. Generally, it also makes the kid feel better, which of course makes parents feel much better.

Evolutionarily you're right, and for my own kids I take the avoid the antipyretic approach.

Early in my career I used to do this, but it just takes too long for the vitals to correct. In flu season we get cluster bombed with pediatric fevers, if the kid is well appearing it’s an immediate dc. I can’t wait 30 mins for nurse to get the orders, go to the Pyxis, give the med, then 90 mins for the kid to defervesce. This is too deleterious to throughput on patients that are otherwise a 10 min dispo.

 

[brabbit2222]

Early in my career I used to do this, but it just takes too long for the vitals to correct. In flu season we get cluster bombed with pediatric fevers, if the kid is well appearing it’s an immediate dc. I can’t wait 30 mins for nurse to get the orders, go to the Pyxis, give the med, then 90 mins for the kid to defervesce. This is too deleterious to throughput on patients that are otherwise a 10 min dispo.

"Doctor, you discharged this child with an undiagnosed terrible pneumonia who died at home a few days later. How do you justify discharging him with fever and such high tachycardia after spending only 10 minutes in the department? Did you not learn to take abnormal vital signs seriously?"

 

[HemorrhagicShock]

Oh good lord. So you wait a minimum of 1 hour, sometimes more, to see the 2 yo kid jumping up and down blowing snot bubbles with 103F and HR 160 normalize down to 99.0F and 120?

Yes absolutely I wait. Of course, there are the kids like you describe where I'll chalk up a discharge tachycardia to the fact that they're chasing their own tail, but honestly that's nowhere near the majority of kids.

Early in my career I used to do this, but it just takes too long for the vitals to correct. In flu season we get cluster bombed with pediatric fevers, if the kid is well appearing it’s an immediate dc. I can’t wait 30 mins for nurse to get the orders, go to the Pyxis, give the med, then 90 mins for the kid to defervesce. This is too deleterious to throughput on patients that are otherwise a 10 min dispo.

Fair, I get that approach for sure. Looks like I might be in the minority here. But all it takes is one of these:

"Doctor, you discharged this child with an undiagnosed terrible pneumonia who died at home a few days later. How do you justify discharging him with fever and such high tachycardia after spending only 10 minutes in the department? Did you not learn to take abnormal vital signs seriously?"

And you're done. Just write the check. I'll be quick about discharging adult low acuity BS all day every day. But for pediatric patients, even for a simple well-appearing URI, I'm making sure there's a reassuring vital trend. It gives parents the sense that they got good care and I truly and genuinely never want to miss anything with my pediatric population. I've caught a handful of viral myocarditis cases this way.

Also a lot of our pediatric patients have trash-tier follow-up and sometimes live 30+ minutes away. There's (a lot of times) no real guarantee they'll have the means to come back quickly.

We're definitely being "cluster bombed" with all the big three right now - RSV, influenza, covid - in addition to the 200+ different viruses out there that cause all these respiratory syndromes. But it's not like I'm taking up a bed or any significant amount of nursing care here. These patients never even make it out of the waiting room where I'm at, so I'm not taking up a bed either.

Just my practice pattern and I'm sticking to it!

 

[thegenius]

"Doctor, you discharged this child with an undiagnosed terrible pneumonia who died at home a few days later. How do you justify discharging him with fever and such high tachycardia after spending only 10 minutes in the department? Did you not learn to take abnormal vital signs seriously?"

Yup you could get that question on the stand.

That's what we all risk discharging fever in a well child. Thankfully that risk is probably on the order of 0.002%

 

[thegenius]

Yes absolutely I wait. Of course, there are the kids like you describe where I'll chalk up a discharge tachycardia to the fact that they're chasing their own tail, but honestly that's nowhere near the majority of kids.

I hear ya man I'm not trying to give you a hard time. We all have quirky ways of practicing medicine. What I'm referring to is the 5 year old with a fever who playfully walks into the room, sits on the chair, is very nice and pleasant and they say "I feel fine". At that point I know I'm going to discharge them and I don't even really care what their temperature is. I just do a perfunctory exam and discharge them. And my conversation with Mom and Dad is largely jibberish about nonsense medical stuff.

 

[gamerEMdoc]

I generally consider waiting for their HR to normalize as well. But I don't have them take up a bed. See them, write them up for DC, then have them sit in the WR. Recheck HR in an hour or two. Give the parents the option not to do this and just go home, and document the abnl HR was appropriate for the tachy and brief obs was offered to the parents to ensure correction etc etc... probably overkill but them taking up a chair in the WR isn't really increasing my cognitive load, its more annoying for the parents.

 

[Dred Pirate]

Mostly uneducated i feel. Also it doesn’t help that the box for ibuprofen and tylenol usually under doses medications. So sometimes they just come in freaking out that the fever isn’t going away -_-

All fevers go away if you dose appropriately lol.

funny you say this- I had this exact discussion with my wife the other day - I was at work and I told her how much tylenol to measure - "but the box says?" - I told her the box is wrong - which is hard convince someone - especially when my daughter is like 25th percentile height and weight- and the box still under-doses her.

 

[HemorrhagicShock]

It's also mind-blowing for 99% of the parent population that you can MaGicALLy take tylenol and ibuprofen together

 

[Birdstrike]

It's also mind-blowing for 99% of the parent population that you can MaGicALLy take tylenol and ibuprofen together

I'm equally amazed how people react to this. They seem like they can't decide if you're sharing a brilliant life hack, or if you're a dangerous hack oblivious to the fact that you can't mix TNT and fire.

"Yes. Two drugs that have no interaction can be taken together. I know it's hard to believe, but it's true."

 

[Dred Pirate]

I'm equally amazed how people react to this. They seem like they can't decide if you're sharing a brilliant life hack, or if you're a dangerous hack oblivious to the fact that you can't mix TNT and fire.

"Yes. Two drugs that have no interaction can be taken together. I know it's hard to believe, but it's true."

I am actually surprised some company hasn't made a combo IBU + apap and jacked up the price

 

[RustedFox]

I am actually surprised some company hasn't made a combo IBU + apap and jacked up the price

Advil makes it; it's called "Advil Dual Action".
I totally would have called it Turboprofen.

 

[WilcoWorld]

[Sarcastic, but friendly tone]
Sure, amigo - just let me up and move to Nebraska.

You like steak, don't you?

 

[WilcoWorld]

funny you say this- I had this exact discussion with my wife the other day - I was at work and I told her how much tylenol to measure - "but the box says?" - I told her the box is wrong - which is hard convince someone - especially when my daughter is like 25th percentile height and weight- and the box still under-doses her.

I ask every parent of a toddler who's in the ED for fever what dose of antipyretic they gave and I can count on one hand the number of times it wasn't underdosed. The box is written that way. Like you say - except for the one moment in time when the child entered that dosing range (right when they hit 10kg) - the box is wrong.

I agree with all of the above who don't care what the precise temp is: as long as it's between 100.4-105 F it's "a fever". The work up for 100.6F and 103.9F are the same, in both cases it depends on the kid. I'll LP a truly lethargic kid with T = 100.6 and I'll promptly discharge a kid with a T = 103 who has a normal work of breathing and would be adorably cute were it not for his snot-stalagtited smile.

So, I also don't treat fevers with antipyretics. I do treat sick kids with ibuprofen though, and I treat myself with it too. It can be a wonderdrug.

 

[BoardingDoc]

Advil makes it; it's called "Advil Dual Action".
I totally would have called it Turboprofen.

I've taken that before. It's weirdly dosed though. 4 pills gives you 1000mg of APAP and 500mg of ibuprofen. I mean, it works, I'm just used to ibuprofen in combos of 200, not 125.

 

[RustedFox]

You like steak, don't you?

I do. Grilled some sweet filet mignon for Thanksgiving.
I eat turkey all the damn time, so we did steaks instead.

 

[WilcoWorld]

I do. Grilled some sweet filet mignon for Thanksgiving.
I eat turkey all the damn time, so we did steaks instead.

Come to the Midwest and let me cook you a thick, well-marbled ribeye.

Please