I had a particularly unpleasant consult with an unwell child the other day and I would appreciate your opinions on it:
A mum brought her 3 year old boy to our family clinic the other day. I had never met either of them before. As they walked in I could see that the child appeared well (good color, no shortness of breath, walked in normally and sat down, said 'hi' and was smiling). Because of how well he seemed I relaxed.
Mum opens by saying that the kid has "croup" and needs prednisolone.
Ok I thought. What does the "cough sound like?"
"It's a seal-like barking cough", she states.
I thought that was a bit odd and that she must have heard it from a doctor at some point. I got the rest of the history from them. In summary he had a runny nose for a few days and then starting with a dry "seal-like barking cough" had started infrequently over the last 24 hours. No stridor or shortness of breath. No fevers and was eating and drinking well.
I then examined the child and apart from a runny nose everything was normal: Appears well, no stridor, good hydration, vitals normal including temperature, no meningism, ears and throat looked normal, chest clear. The only thing was a bit of a runny nose. I did not witness a single cough during the 20 minutes they were there.
I then spent about 15 minutes discussing about how I thought there was a possibility that this wasn't croup and that maybe she was interpreting a regular cough as a croupy cough. My plan was to treat this conservatively with rest, fluids and acetaminophen and have them return or go to emergency if he was starting to get worse – particularly if he developed shortness of breath/stridor. She didn't take this too well and in the end we agreed on a backpocket script for pred that she could take home and give him if he started to get worse.
The next day I received a formal complaint from her about me with all kinds of accusations like I was putting her child in harm's way by not giving the pred, not knowing what croup was, by seeming that I made her feel unwelcome that she was even there (in reality I was stunned at how she yelled at this kid to sit down when they arrived). During the consult she also punched the kid in the arm hard with a closed fist because he wriggled in his chair a bit (ADHD) – but that is not the topic of this post.
During my time writing a response to the complaint, I went back through all of the notes that we had on this child. In his 3 years of life he had been brought to our clinic almost 50 times with some variation of viral illnesses – runny noses, AOM, viral induced wheeze etc and had received approximately 20 courses of antibiotics. Looking through the notes I also found that the child has also been given 12 courses of prednisolone for croup. Every single instance was the same: mum brought in child saying he has a "seal-like barking cough", he looks completely well to the doctors, sometimes a mild non-croupy cough was heard but never any stridor and vitals and examination always normal except for sometimes a mild fever. However, each time he was prescribed prednisolone seemed to have been due to mum reporting a "seal-like barking cough."
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