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How to know when your child is really sick

When your child is sick, everything seems to crowd in and collapse on you. It is difficult to cope, let alone sort out what to do.

Recently, my ten month old son pulled a bowl of boiling porridge onto himself. Our lovely family breakfast was shattered by his screams, which cut straight to our hearts. Almost immediately, his sister became distressed, more able to express herself than we were. After a morning in the emergency room, and ten days in silver dressings, the burns to his arm have healed well. At that time, it was a disaster, but we were lucky: we knew that he was sick as soon as it happened. We knew to strip his shirt off and pour water on him. And we knew to seek medical care immediately.

When I was working in the emergency department, we had a patient arrive in the middle of the night by ambulance. He was a two year old boy, and he had a cold. He was unhappy, but not particularly sick. His mother had been investigated by child services in the past and was keen to “prove” that she cared enough. He wasn’t that unwell, but we all understood how she got herself in that situation. I think the junior docs were a lot more understanding than the paramedics, though.

So how do you know when your child is really sick?

Kids can get better very fast, but they can also get very sick very quickly. Unlike adults, they can sometimes seem a lot more settled when they are really sick. This can sometimes trick people into missing the signs, so how do you really know?

Beware of the cuddly child

Children who have accidents or get colds and flus are normally cranky and irritable. They normally have insufficient sleep, and it shows. They often want lots of cuddles, but they are usually pretty unsettled at the same time.

However, when kids get really sick, they can become very flat. “Flat” is a word medical staff use that looks exactly what it sounds like: an infant or child with little facial expression, cuddling their parent, but not really distressed when they are put down. They tend to have no energy, and don’t really react to what is going on around them. Sometimes, it can seem like a sick child has “settled.” But if your child gets sleepy and drowsy, and stops really noticing what goes on around them - call an ambulance. They might be really sick.

Check their nappy or potty

Do you notice when your child goes to the potty? When children are sick they dehydrate rapidly. A lack of wet nappies or wees in the potty is one of the early signs that they are not doing well. If you pick it up early, you can prevent disaster. A common example of this is gastro. Gastro isn’t usually life-threatening and usually only needs hospitalization if the child gets dehydrated. If you think your child might be dehydrated, give them water or diluted juice, or anything they like and can keep down. If you can’t fix it, see a doctor immediately.

Believe your child

My two year old is currently learning how to manipulate her parents. She often tells us she “has a sore tummy,” but if we ask further questions, she explains that she “needs choc to fix it.” Last Thursday, she spent the day telling me she had a sore tummy and needed cuddles to fix it, so I gave her lots of cuddles and reassurance. When I got to the end of the day, I realised she had emptied her bowels four times over the course of the day. In retrospect, she probably was having cramps and was feeling pretty rotten.

Sometimes it is easy to take our kids verbal skills for granted. Often they can tell us when things are wrong and they feel awful: they are not always trying it on. While we deal with their manipulations, it is important to realize they might be telling the truth.

Believe yourself

The truth is, almost all parents know when their child is really sick. Unfortunately, we feel so much pressure to do the right thing and be good parents that we fail to believe our own judgement. It is ok to get it wrong. It is ok to feel stupid. If you think your child is sick, then call an ambulance, beat down doors and wring necks until you can get someone to pay attention to you. You might be wrong, but there is an excellent chance you are right, and that is the only important thing.

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2008 06 13 Children
Emergencies Comments (2) Permalink

How to find a quality family doctor

With a quality GP you can “play” the healthcare system

A good primary care doctor, or general practitioner is the key to “playing” the health care system. They can be your passport to skipping queues, finding the best specialist, getting timely appointments, getting the best after hours care, and attention to the things you worry about.

I have written more about the need for a good GP previously. Now I would like to give explain one way to find the right doctor.

How to find your new family doctor

It is totally in our control to find a better doctor. There are very few people that are limited to only one family doctor in their town. Most of us have the luxury of 3 or 5 or 15. However, we get stuck going to a doctor we aren’t happy with, which is silly – patients are the consumers. You wouldn’t go to a bad restaurant every week, so don’t continue going to a bad or even average doctor.

Recognizing that you are the consumer is vital – you are not limited to one provider, and you have no obligation to continue to use a service that you are not happy with.

I always knew these principles in theory, but it took having a family to realise their importance. I had been seeing a doctor for many years, one that I was “putting up with”. I had not been happy with the referrals she made and was not thrilled with her manner, but it was good enough. But when my daughter was born, I realised I needed someone better. My daughter was too precious to entrust to half-rate, “good enough” medical care. So I started looking around all the doctors in my area, and after a few visits, found someone I was really happy with, who continues to care for my family today.

I feel really happy with that decision – it is one of the most important things I ever did to care for my family.

Here is one process for finding a good doctor:

  1. Look at your relationship with your current doctor

    2. Are you happy? Do you feel you can trust them, and talk to them about embarrassing problems. Can you get an appointment when you need one? Do you have good conversations. Do you like them as a person, and respect their knowledge? Do they know you and your family and what is important to you? Would you trust them to make decisions about what medication to give you, or what treatment to offer, if they couldn’t discuss it with you?

    If you answer YES to all of these questions, congratulations, you have the doctor that is right for you. If you answered NO to some questions, then it may be fixable. Trusting your doctor to make your decisions is the basic test of whether they are right for you. Normally good doctors consult with their patients, but as they can’t possibly explain all the variables, then they will have to abbreviate and select and recommend based on what they know of you. Maybe you need to have a conversation about your priorities, so that thy understand you better.

  2. Figure out what you need from your doctor.

    3. Is the gender of your doctor important to you? Do you have to be able to get an appointment at the last minute, or is after hours service more important? Is it more important to have a free service, or are you willing to pay out of pocket to go to the right doctor? Should the practice be close to home or work? Do you need a doctor who is right for all your family, or are you willing to go somewhere else to find someone that suits you personally?

  3. Try someone new.

    4. It doesn’t really matter who you try, but feel free to try as many doctors as you like. You have an opportunity every time you get sick. You can try recommendations from friends or family, or you can just work you way around the different practices. It is ok to try someone out. You are not obligated to continue seeing the same person. Remember, you are the consumer, and they are providing the service. You will probably have to fill in new forms at every place you go to, but that doesn’t oblige you to keep going.

  4. When you find someone you like, tell them all your secrets

    5. The best way to form a relationship with someone is to share your trust. Doctors need to know all the background to your health to help you make decisions in the future. Let them know about all the little things about your health, and your relationship will develop so that you can trust them when you need to.

  5. If you get disatisfied again, repeat this process

    6. Most importantly, never give up. Your needs change over time, as mine did when I had kids. If you retire, you will probably be less demanding about after hours appointments. If you develop a chronic illness, you may prefer a different style of practitioner.

In today’s “ehealth” environment, we are not stuck with the same doctor for life, so claim your right to upgrade. Find the right doctor, and start to take more control of your healthcare.

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2008 06 10 Primary Care Comments (1) Permalink

Six Myths and Legends: How to reduce your wait in the Emergency Room

I had a great day today talking to a group of Mums about how to access the health system effectively. Out of the six in the group, five claimed they or someone close to them had waited far too long in their local emergency department (ED). I thought I would share some of my tips and debunk some of the myths about accessing the ED. This post is written from my experience in the Australian Healthcare industry, so be aware that some of these methods may not work in other countries.

Myths and Legends:

If you travel by ambulance, you will be seen by a doctor more quickly.

No. Unfortunately, this is urban myth, and can even slow things down (if you get a triage nurse in a bad mood). This myth probably comes about because most really sick people get taken to hospital by ambulance and really sick people get seen pretty fast in emergency. Also, the paramedics are experts at communicating how sick their patients are, so sick patients usually don’t get delayed, as can sometimes happen with less experienced patients. But this skill can be learnt.

If your local doctor is closed, there are no other options but to go to the Emergency Department.

If you have the sort of condition that is well-treated by a local doctor, there are much better ways of being seen in an emergency than by visiting the emergency department. Both “24 hour clinics” and locum services offer GPs after hours. The doctors can be extremely experienced practitioners and the wait can be a lot less than going to the emergency department. With locum doctors, you even have the advantage of getting to wait in your own home, which is fantastic if you have kids asleep in another room. Although you have to pay for these services, they will normally offer better care, faster than you will get by going to the ED.

It is a waste of time to go to a private Emergency Department!

Not true either. It can be expensive to visit an emergency department in a private hospital, but you get rapid treatment by experienced professionals. If you have an injured child who just wants to go to sleep, then a private hospital emergency may be the fastest way to get them checked out and fixed in time to go home. If you are going to be admitted, and are willing to be treated as a private patient, this may be one of the fastest ways to get into hospital. Be aware that not all private hospitals have an emergency department and not all will treat public patients who agree to pay up front.

If a kid is sick, then they need to go the the Childrens’ Hospital.

The Children’s Hospital is specialized for the care of sick children. They can deal with any condition that presents itself. However, almost all other hospitals look after sick children, too. But they can deal with only run-of the-mill problems like asthma, croup, accidents, cuts, broken bones, gastro, simple infections…. the sort of things that are the most common. So, if you have a sick child, who is normally well, and you think they need to go to hospital, your local hospital is normally well-equipped to look after them. There is another advantage of visiting an “adult” hospital - most nurses can’t bear to see a sick or sad child wait, so they will send you into a room as soon as they possibly can, prioritizing you over an adult patient if possible. Triage Nurses at children’s hospital usually don’t have this luxury, as none of their patients are adult.

You always have to wait in the emergency department.

Emergency Departments are busy at predictable times, as emergencies tend to happen at about the same time. You can’t make yourself sick on a schedule, but you can change your behaviour to access the ED at quiet times. Quiet times tend to be first thing in the morning (especially on weekdays) and in the early hours (from about 3am until 6am). EDs are usually very busy in the evenings from close of business until midnight (later on weekends), and weekend afternoons. They also don’t see many patients at shift-change between 6:30 and 9am in the morning. So if you feel unwell in the middle of the night, it is not alway worth waiting until morning. If you get sick in the evening, it is worth looking for another solution.

There is nothing you can do to be seen quickly.

If you are at the emergency department because you or your family member is very sick, you can make sure you let the triage staff on the front desk see the situation clearly. These staff are nurses and are keen to figure otu quickly who is most sick, but we sometimes make it harder. Carry your screaming baby to the desk with you. Interrupt the nurse to say your father has been burnt. Take your sick mother up to the desk, so that the staff can see how sick she is (this is much more effective than simply telling them). This is the way that ambulance staff get their patients seen quickly if they are sick.

We patients sometimes get caught up in “being polite” and avoiding “annoying other patients,” and make it more difficult for the staff to know what is going on. Eventually all patients will be seen by the nurse and examined, but if you or your family-member have severe pain, or can’t breathe, or are very distressed, you sometimes don’t have to wait to be assessed. It is up to you to make sure the nurse knows what is happening.

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2008 06 02 Emergencies
Hospitals Comments (1) Permalink