So I would like to take a moment to talk about normal progression of illness and parental expectation.
I had a patient come in last week with two night history of cough and congestion. No fever was reported and the child came into see me after the second night.
At that time we found they fever and the child was alert, agitated, and crying. Prior to starting my exam we gave the child Tylenol and instructed the caregiver in the proper dose. During the exam I checked the lungs and found no lower respiratory issues at that time. The nose was congested and runny, and the throat was visualized without needing a tongue depressor (during the time I was getting a nasal swab for Covid/flu). By the end of the visit the Tylenol had kicked in and the temperature dropped 2 degrees.
Both the covid and flu were negative, and so swabbed again for a PCR respiratory panel. This of course caused the child to scream and again was able to see down the throat.
Instructions were given for fever and respiratory management, and the caregiver was advised to call for worsening symptoms.
Over the weekend the symptoms worsened and went to the ER and was treated for croup. The caregiver did not call me beforehand, perhaps due to rapidly worsening symptoms.
The caregiver has since expressed their displeasure, without giving me a chance to speak, claiming I did not look down the throat and missed the diagnosis of croup
I wish I could have had the opportunity to speak so I could explain that I understood their frustration. It was obvious that they did not realize that I had indeed looked at the throat.
I also wish that they had let me tell them the test results and the virus responsible.
I wish that they could understand that seeing the presentation of an illness at one point does not mean that we can perfectly predict the course of the illness.
The child was safely discharged that day without any medications being prescribed for at home use. I have read the ER physician’s note, and the presentation only had fever in common with the prior day’s office visit.
I encourage all my patients and their caregivers to be aware that a definitive diagnosis may not be evident early in the illness, and to communicate their concerns if the illness does change. Chronic illnesses may also change over time and it is this history that helps physicians make more accurate diagnosis.
Hindsight is 20/20, and I hope that my kids caregivers can appreciate this.