The One Hundred-and-Twenty-Sixth Chart

April 25, 2014

By Ekta R. Garg

Last week something happened that reiterated for me an important adage when it comes to kids: don’t be afraid to ask questions.

In the early hours of last Thursday morning, Five woke up with a fever. I only found out because in the midst of deep sleep something startled me awake. I saw the bathroom light on and knew right away a child was in there. Given that both kids usually sleep through the night, I knew something was wrong.

I found Five there. She had needed to use the bathroom, but she was also burning up. I came back to our room and told my husband, and we brought her back to our bed where she flopped over. After a few minutes we realized that she wouldn’t throw up or anything; she just had a high fever. So we made her as comfortable as we could in her own bed and then discussed a trip to the doctor’s office in the morning.

I made an appointment for 9:30 and took Five to the doctor’s clinic. The nurse who called us in mispronounced Five’s name, and when I corrected her politely she gave me a wan smile that seemed to say, “Not really that important to me right now.” She didn’t apologize, instead giving us the obligatory, “Right this way.”

I found out later that this particular nurse had just joined the clinic a month ago, so that may have had something to do with her behavior. She never spoke rudely to either Five or me, but she seemed to just go through the motions. I almost wanted to tell her, “If it’s this bad at 9:30 in the morning, you’ve got a long day ahead of you.”

Nevertheless, she asked all the right questions and then we met the doctor. He asked some questions too and then did a rapid strep test on Five. Five didn’t cry, didn’t even gag much, and I hugged her later and told her how proud I was of how she handled herself. When the test came back negative, a different nurse came to let us know and told us the clinic would hold on to the test for a couple of days to see if anything developed.

I took Five home and tried to make her comfortable. I even managed to convince her to take a nap. When she didn’t protest too much at the suggestion, I knew she really didn’t feel well at all. If she’d had any fight in her, she would have used it.

Things got a little strange that evening around 5:15 when I got a call from the pharmacy. The pharmacist said our antibiotic was ready to be picked up. I asked her what antibiotic, and when she said amoxicillin I identified it immediately as the medication prescribed for strep.

But Five didn’t have strep…did she?

Fortunately my husband came home early that day. I asked him to check on Five’s labs in the computer system, and we saw the bright yellow highlighted note that the strep test had come back positive. But why hadn’t anyone told us about this?

We went that night to the pharmacy and picked up the medication, but I felt miffed. The nurses at the clinic had an obligation to call and tell us that Five had strep. So I knew I would call the clinic the next day.

That night I gave Five the first dose of the medication, and she accepted it without saying much. The next morning I waited for a few hours, giving the nurses the benefit of the doubt. Because I’m married to a physician I know about the circumstances on this side of the desk and know that a lot of stuff goes on in a clinic that patients never see. So I thought I’d give the clinic some time to get back to me.

When I hadn’t heard from them by 11 a.m., though, I picked up the phone and started dialing.

Many years ago I read an article about the most effective way to express a complaint. The writer targeted complaints related to customer service issues—your cell phone or a problem with lost baggage—but the principles apply to anything. If you want people to consider your complaints and actually do something about them, you really have to present the complaints in a non-combative way. In other words, don’t yell and scream like a maniac at the person on the other end of the phone.

In order to do this, you have to control your anger. Which takes a supreme effort, depending on the situation. And when it comes to your child…well, you can imagine what it takes to control anger. But, as I said, I’m a physician’s wife, and because we’re in a small town with a fairly tight-knit medical community, I knew I had to be careful.

Besides, screaming like a maniac usually only yields one result: two unhappy people.

I told the receptionist who answered that I wanted to talk to a nurse who works with the pediatrician and explained why as succinctly as possible. She transferred me to a nurse who listened with an open mind and apologized right away for the breakdown in communication. She even went as far as to call it that, and she promised that she would report the situation to the clinic’s nurse manager who oversees the nurses. The nurse also encouraged me to call the practice’s action line, which was instituted to address these types of issues.

The nurse sounded genuinely surprised and concerned that I had received a call from the pharmacy for antibiotics when I’d received absolutely no instruction from the doctor’s office on the fact that Five needed the medicine. I told her that because my husband has access to the information we had the opportunity to check on it and act upon it. What about the people who don’t have that access, I asked. They would have ended up being confused and maybe even unsure as to whether they needed the medication. Some would probably have ignored the pharmacy, calling it a mistake and missing out on treatment.

She agreed, and I felt better after calling. What did she do? In effect, nothing. But she listened to my concerns, acknowledged them, suggested another step I could take to voice my concerns, and let me know I had a valid point.

This entire situation reminded me of a crucial point that we often overlook: don’t be afraid to ask questions, particularly when it comes to healthcare. Especially when it comes to our kids. Children don’t always know how to articulate what’s wrong, and they need advocates who can act on their behalf. Those advocates should do exactly that: stand up for the kids and continue to press an issue until all the questions are answered or an action plan is offered.

That’s not to say a parent has carte blanche to be obnoxious. My husband tells stories about many patients who come into the office armed with the entire compendium Google has to offer on the most minor of ailments. These patients spend a lot of time talking and not enough time listening. They also spend a lot of time working themselves into a frenzy because they’ve already figured out their diagnoses.

These patients drive my husband nuts.

He fully appreciates, however, the patient who does some reading and comes up with thoughtful questions and then listens. The patient who isn’t afraid to challenge, with the utmost of respect, what he has to say and then accept or reject his decision based on his subsequent explanation. More often than not the patient accepts his decision because it makes sense given what they’ve already read.

Those patients aren’t afraid to ask questions, and we as parents shouldn’t be either. It’s our duty, our obligation, and our right as the first line of advocacy for our kids. And it teaches them to stay educated and informed about their own health and carry that responsibility forward in the best way possible when they become adults too.

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