Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, September 08, 2008

While I'm here...

Twelve-year-old girl with a fever of 102; headache; stomachache; miserable. A careful exam turns up nothing, so in this part of the country at this time of year we do a test for Lyme disease. Draw the blood; comfort the kid. Review symptomatic care with tylenol and ibuprofen. Discuss how long the blood test will take and make arrangements to call once the results are back; etc.

Finally, on the way out the door, the mother says,
Oh! While we're here, can I have a note saying she's ok to play field hockey?
What? The kids is sick as a dog and you want a note for sports?
This way I don't have to come back and bug you next week.
You know what? As a busy parent, I understood. And I gave her the note -- undated. She can fill in the date once the kid is better. (The Lyme test was negative, and she was good to go within the week.)


At Mon Sep 08, 09:15:00 PM, Blogger Irritated said...

Bless you for not making her come back!

At Tue Sep 09, 04:59:00 PM, Anonymous Anonymous said...

Blood testing at the time of the initial, acute febrile stage of Lyme disease is usually negative. Although the absence of one or more erythema migrans lesions usually rules out Lyme disease, I would not rely on blood testing for the diagnosis.

At Tue Sep 09, 09:01:00 PM, Blogger #1 Dinosaur said...

Anon: I'm well aware of the limitations of early antibody testing for Lyme disease. This patient had been sick for several days. I often get positive IgM tests on Western Blot confirmations of ELISA testing unless the patient has only been sick a day or two.

At Tue Sep 09, 10:00:00 PM, Anonymous Anonymous said...

Field hockey? WTF?

At Wed Sep 10, 09:26:00 AM, Anonymous Anonymous said...

"What? The kids is sick as a dog and you want a note for sports?"

Err... so despite this you gave an undated note saying she was fit for sports?

So if the parent were to send her playing while she's unwell, and if something terrible were to happen to her, you would be willing to take the responsibility for having "certified" her fit?

Sounds like a risky thing to do IMHO (and that's a personal view), no matter how much trust you had in the parent.

At Wed Sep 10, 12:22:00 PM, Anonymous Anonymous said...

As a medical examiner, anything that would happen to the child would involve a cardiac arrythmia, (which I assume Dino ruled out, and she didn't have). Anything else would be some weird ass presentation of a long QT or other zebra, which you're not going to diagnose ante-mortem anyway.

William the Coroner

At Wed Sep 10, 02:35:00 PM, Blogger Rogue Medic said...

When I read the part about the mother asking for the note, I knew the reason. Mine is now an adult, but I remember these requirements. The note could easily state that there does not appear to be anything that would keep the child from participating in athletics.

Do they have stage parents in field hockey, who might pressure a sick child to play through the pain, or is this going to be the child's decision?

People get physicals and die of many causes in the next few days. Is that the fault of the physician? Are arrhythmias and other sudden cardiac death causes often predictable in the individual?

And Lyme disease isn't communicable - unless the child is a tick - so it isn't like a note to protect others from infection.

At Wed Sep 10, 05:28:00 PM, Blogger #1 Dinosaur said...

Anon 9:26 -- The kid had just had a well check two months earlier. It really was a paperwork thing for the school.


Post a Comment

<< Home