While next day follow-up by the PCP may sound like a laudable goal in a
febrile child who had no laboratory evaluation, we may be missing a
golden opportunity to make a diagnosis that might be missed the
following day. How many of those children will be placed on an
antibiotic for a red throat, a runny nose, a slightly pink ear in a
screaming, febrile toddler, or for some other weak excuse? The answer is
a lot. That number rises if the PCP in an FP. The approach is quick,
easy, and widespread and is not limited to FP's (which, by the way, are
the preferred provider along with PNP's and PA's in the brave new
world). I have suspected on a number of occasions that recurrent pyelo's
have been repeatedly missed in children with recurrent "red throats".
These children, after appropriate evaluation, are found to have
significant VUR. Similarly, without the abnormal CBC to raise the index
of suspicion how many times are pneumococcal pneumonia's, OB, earl;y
meningitides inappropriately treated? If it were my son or daughter, I
would want to know what was wrong and have it treated appropriately.
Additionally, I sleep better and worry less when I gather all the
information I think is appropriate and treat accordingly. A dose of
Vitamin R or oral megastompakillamycin is a poor substitute for good
data. I always feel more comfortable calling the next day and finding
the child playing at home after an appropriate evaluation and treatment
than trying to catch up the next day with pressors and fluid boluses.
Just my thoughts.
Scott Nau MD
Cedar Rapids, IA
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