To Treat or Not to Treat: The Pediatrician as a Parent

Howard Markel, MD, PhD

Disclosures

December 21, 2005

With perhaps the singular exception of my 5-year-old daughter, Bess, my 10-month-old daughter Samantha is the greatest child in the world. This is not, however, the mere boast of a proud father. As a professor of pediatrics, I insist to all who will listen to my bragging about either child that such pronouncements are far more substantial than mere observations. No, these statements of their excellence, I believe, can reasonably be elevated to the status of professional opinion.

A few months ago, I was playing with Samantha -- or Sammy, as we call her-- in our living room while my wife, Kate, went out for a much needed break. Usually when I am alone with the baby, I feed her, stall as long as I can before finally changing her diaper, and play a series of silly games that we both enjoy while her mother is out of the house. This week's favorite is one we call "Baby from Outer Space," where I hold her up in the air and we pretend she is flying through the cosmos. But that afternoon was different because no matter what I did for Sammy, she was easily upset – fretful, really -- and prone to crying whenever I attempted to put her down.

Usually when Sammy cries, she has an excellent reason for doing so -- and I was relieved when Kate came home to help me attend to Sammy's distraught state. It was not until a few hours later that it finally occurred to us to take Sammy's temperature. Three minutes later, I understood my daughter's misery: the thermometer registered a whopping 102.4 degrees. As every pediatrician knows, fever in an infant under 6 months of age is usually a cause for concern because these babies are so prone to serious infections. Sammy was precisely 3 months of age at the time of this event.

During my 20 years as a pediatrician, I have admitted dozens of feverish babies Sammy's age to the hospital. So although I didn't articulate my fears aloud, I was plenty worried. Nevertheless, I reassured my wife, and in some sense, myself, by noting that Sammy wasn't all that sick. Her color was good, she continued to feed well, and we could console her with hugs. But I also know my hesitance to call Sammy's pediatrician had a lot to do with pride. After all, I am a pretty good pediatrician -- surely I could handle this situation myself.

Then my mind focused on the problems that can result when a physician treats his family members. I remember a disastrous case of mine several years ago when an orthopedic surgeon treated his 5-year-old son for a serious infection of the thigh bone at home -- even to the extent of starting an IV and administering antibiotics in the boy's bedroom. Unfortunately, the surgeon chose the wrong antibiotic, and by the time the child was admitted to the hospital he was far more ill than he would have been had the doctor-father brought him in when the problem first arose. This surgeon wasn't alone in this approach -- I know many medical colleagues who tell me that when illness pops up in the middle of the night, they often take on the doctoring of their own children.

Although I have long vowed that I would never place myself in such a situation, here I was, in essence, treating my own child by avoiding a call to her doctor. As I looked into Sammy's eyes, I soon realized that this would not do at all. I was not Sammy's pediatrician, I was her father, and it was time to start acting as such. In my state of embarrassment, I waited until Kate left the house to get some Tylenol for the baby before calling Sammy's pediatrician for a consultation.

"Is she eating okay?" he asked.

"Fine," I replied.

"How's her color and breathing?" the kindly pediatrician queried.

"Perfect."

"Does she stop crying when you hold and console her?"

"Yes," I responded, knowing that this is one of the most important signs pediatricians use to evaluate fever in an infant.

"Let's give it a little time and then re-evaluate," he concluded.

Happily, Sammy soon turned the corner and was back to normal by the next day, but her brush with fever reminded me of an important lesson that I continue to struggle with as a father who happens to be a pediatrician. Lawyers have an old saying that the attorney who represents himself in court has a fool for a client. I would argue that a similar adage be adopted among doctors, whether the patient is himself or a loved one. We can be objective when caring for strangers, but it is a very different matter when there is a connection of love or relation. And although my daughter cannot yet articulate herself in words I can readily understand, I have a strong suspicion she is in perfect agreement.

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