or as Prof James McCormick put it once, the price of always being
"right" is far too high to pay.
Admit every kid with fever? The Paeds service would grind to a halt
within 24 hours! Simply not possible to do that, so we do the best we
can. And in this case, arranging a review and having a sensible partner
who did exactly what you would have done, that was all pretty good.
David Haslam wrote something about that once, he of RCGP and before
that medical writers, not the obesity expert. He was talking about his
Sunday evening on call, pre-OOH co-ops. Five or six kids with fevers,
coughs, snuffles, usual minor stuff. Yet sooner or later, he said, one
of those will develop classical meningitis during the night.
The few spots in the otherwise well kid with fever used to bother me a
lot working in a paeds day unit, the main unit was 27 miles away.
Sending the kid for admission always meant several days on antibiotics
until tests came back clear and one of the consultants decided it wasn't
really anything major at all. Yet these interventions are none of them
risk free. At what level of uncertainty do we submit a kid to paeds
interventions, knowing what we know about the rates of infection and
medical/nursing mishaps in acute hospitals?
Declan
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