23 February 2009

Sub-standard medical service

There are two things in life that I am extremely allergic to: being patronised and - somewhat related - being treated like an overprotective or paranoid or hysterical parent.

I got an unhealthy dose of both insults over the weekend.

It all started with the immunisations. All seemed well, Ella was fine that afternoon and night.

Then the next morning she woke up complaining about pain in her right thigh. It looked a bit red and felt a bit hard around the injection point, but I didn't think too much of it. So we went out to the library and the mall, but Ella's complaints got louder and it was obvious by then that her leg caused her considerable discomfort when she moved around.

I gave her some paracetamol and said goodbye to her when her dad picked her up.

That night, I had another good look at the leg and now noticed - by comparing it to the other leg - that is was quite significantly swollen from the crotch right down to the top of the knee and was quite red too. I still wasn't overly worried, so put Ella to bed, without offering pain relief as my judgement was that she'd be fine without it.

The next morning the thigh was a tad worse rather than better. So I called the Health Advice line. A nurse took me through some questions, listened to my description of the symptoms and then advised me to see a doctor within 4 hours.

I got an appointment with the after hours doctor soon after. When it was our turn, I walked in with Ella, got her to hike up her skirt as I explained the course of events and the doctor took one look at her leg - from about a metre away - and said: "allergic reaction" and proceeded to prescribe anti-histamines and a cream. He advised me to see our GP within 2 days and send us on our way. My estimate is that the consultation had lasted no longer than 3 minutes.

I gave the anti-histamine to Ella that day and the next. I failed to read the label and the doctor had not warned me about it causing drowsiness. The teachers at school noticed though, but apart from not being her usual bubbly self, she'd been ok.

(Some of this next bit is a slightly altered version of the letter I ended up sending to the Medical Board, so excuse the dry style)

After school I visited our GP (the same one who gave the immunisation). The GP noticed me in the waiting room and enquired why we were there. I explained that Ella had had an allergic reaction to the vaccine. The doctor asked me to go have a chat to the medical student at his practice while he tended to his next patient.

A bit later he entered the room where the medical student, Ella and me were, walked over to Ella who was playing on the floor and said: "Does this look like a sick child to you?" He then turned to the medical student and said: "That's what I advise parents to do. To step away from their child and ask themselves 'Does this look like a sick child to me?'"

I managed to hide my annoyance at this most patronising comment and briefly gave him my version of events since we saw him last. He said he doubted that it was an allergic reaction, and that it could be a bleeding in the muscle. He did not explain this any further. Nor did he examine Ella. He then proceeded to look up info about the specific vaccine on the computer, explaining how to do this to the medical student. He was preoccupied doing this for a while and only very briefly answered when I asked relevant questions. I found out he had not made a note of which thigh he administered which vaccine in. When I asked him if it was likely or possible that this reaction could be repeated, he said he was sure it was a one off. He did not explain this comment. When I expressed a concern about not knowing the real reason for the reaction, he assured me he made a note of it and that that was enough. He then instructed me to go get Ella's health record which I had left in the car.

When I returned and was waiting in the waiting room I realised that I did not get any advice on whether or not to continue the anti-histamine treatment.

So, when the doctor returned for the health record book, I asked him if I should continue administering the anti-histamines. He only shook his head as if I had asked a silly question. I asked if he thought she needed any further treatment and I got a similar response.

I left the practice feeling extremely patronised and as if I'd been treated like an ignorant, over-protective hypochondriac parent. On top of that, I did not obtain any useful advice nor an explanation of the diagnosis or the treatment. Treatment advice wasn't even offered voluntarily.

I was fuming! I muttered about it (might have used a few profanities in front of Ella too) the whole way from the doctor to the take-away place and home. Poor Ella had to listen to a few tirades about the unfair treatment that night.

And what made things worse was that I was faced with the treatment dilemma. I'd seen two doctors in 28 hours. Neither of them had explained how they came to their diagnosis, in one case a final diagnosis was not given, neither did explain the rationale behind their treatment advice. Neither of them had examined Ella, other than looking at the swollen leg from a one meter distance. Neither of them had asked me any questions about the patient and all they knew was what I managed to tell them in the 30 second introduction when I walked into their consultation room. And both had given me completely contradictory advice.

I ended up calling the Health advice line again to explain what happened and to ask advice on how to solve my dilemma: should I or should I not continue the anti-histamines treatment? I do not have any knowledge about medical issues and do not feel fit to make such decisions about my daughter's physical health without medical advice. The very nice nurse's advice was to follow our GP's advice but to monitor her condition closely and see a doctor if it got worse. I also managed to mention that I'd been treated like an over-protective hysterical mother and the nurse said something about it becoming a trend but that I should never let any doctor make me feel like that. That I, as a parent, knew my child best and knew when a trip to the doctor was justified. It was nice to get that reassurance.

Today I called the Immunisation Section of the Health Department. They confirmed that localised swelling and inflammation is a known side effect of both vaccines in question. They also told me that the symptoms usually resolve without treatment within a few days of the injections. I found out that the doctor should've given me information about possible side effects at the time of the immunisation. If he would've, it would've saved me all the trouble and lost time this caused me, not to mention the $145 for 2 unnecessary doctor's visits. The nurse said she would call the practice to check if they had the info sheets that they were supposed to hand out to parents.

I wrote a detailed and well-considered letter of complaint to the Medical Board, which made me feel better. My next step will be to find a new GP. How could I trust someone, who seems to base his medical strategy on my perceived level of paranoia or hysteria, to look after my child's health?

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