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Those magic words and well children

Posted Aug 26 2008 4:35pm
In this case by magic word I don't mean "please". Some of those magic words to a doctor are, "it's like an elephant is sitting on my chest" and "this is the worst headache of my life." They are lines from medical school textbooks and frequently appear on board exams. They are the epitome of the classic presentation. Unfortunately, it seems as though I'm amidst a rash of people walking into the office with complaints such as this.

If done in the middle of a decent size Emergency Room, this is a fairly simple work up. At a small doctor's office in a small town some 35 miles from a CT scan is another story. Certainly one's history and physicals need to be somewhat honed to sort through what really sounds like an emergency and requires transport and what can be managed as an outpatient. Even then, however, I get very nervous about these cases.

On another note, our office is doing a little experiment today. Modeled somewhat after a sports physical mass screening, we're going to be doing a couple of Well Child Fairs. In August we're usually swamped with parents walking in the door with their child and without an appointment requesting immunizations that are typically given before kindergarten and before sixth grade. It ends up being very labor intensive for the nurses which throws a wrench into the doctors' day as well. This year we've decided to be a little more proactive.

We pulled the chart of all of the kids around these ages and reviewed their immunizations and well child visits. Those who needed updating were offered an appointment for one of the two Well Child Fairs we'll hold this summer. We've had a pretty good response and will be doing about a dozen of the exams this afternoon. Since we'll just be focused the well child issues, theoretically at least, we should be more efficient at this than during a typical day when adult and obstetrical patients are roaming the halls as well. If this goes well I'd certainly like to expand it to even more of a group visit where anticipatory guidance could be given to all of the parents at once and the parents can learn from each other as well.

I'm not totally sure how today will go, but I'm fairly certain the volume of our waiting room will be higher than usual. Some prophylactic Tylenol for that impending headache may be warranted. At least I don't think any of the kids will be saying they have an elephant sitting on their chest.

The Country Doctor
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