Pediatrician Gripe: Phoning in for Diagnoses and Prescriptions

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The Offending Statement

“We don’t have time to come by your office. My child has experienced these symptoms before, so I know what's wrong; can’t you just phone in the prescription?”

I get it. Parents are extremely busy, so why waste time? Little Johnny had these same exact symptoms last month—and the month before that! After lugging your child into the office and lolling around the waiting room, your pediatrician will just scribble off a prescription and send you on your way, and your baby will feel better within 24 hours. So why can't doctors make this process quicker and more convenient for you?

Why We Don’t Want to Hear It

Unfortunately, diagnosing and treating illnesses and infections is not quite as easy as it seems. For example, if your child is experiencing ear pain, you may recognize this as an indication that he has the same infection he had last time, but in fact, ear pain can be indicative of a number of problems. It may be a sign of otitis media (an ear infection), but it can also mean a swimmer’s ear (you don’t have to swim to get one), a scratched ear canal, a foreign body, or congestion build-up behind the eardrum. If your doctor were to make a diagnosis over the phone, your child could be treated for an infection he doesn’t have, and unnecessary exposure to antibiotics is bad for any child—plus it's a serious national health concern. The same is true for any number of illnesses. Pain and discomfort just are not conclusive symptoms. A child in distress should be examined by a medical professional.

If your doctor makes a diagnosis over the phone, the actual cause of your child's pain could go unrecognized and untreated. Even if your suspicions are confirmed, and your baby actually is experiencing a flare-up of a previous illness, waiting to make an accurate diagnosis has been shown to improve the effectiveness of antibiotics. In other words, “jumping on” an infection with prescription treatment may decrease the usefulness of that treatment and may be a therapeutic disadvantage. That may sound strange, but it has been shown that strep throat, for example, is less likely to be remedied by antibiotic therapy if treated within the first 12 hours of symptom onset, rather than if treated a day or two after.

What You Should Say

So, what is an appropriate call to the doctor? Regardless of the diagnosis, a parent's priority should be pain control. Tell your pediatrician exactly what's happening and what steps you have taken: “My child is miserable with pain. I have tried a therapeutic dose of ibuprofen and Tylenol, waited 45 minutes, and he is still significantly uncomfortable. How do I keep him comfortable until I can bring him into the office?”

No doctor or parent wants a child to suffer, but jumping the gun by making a diagnosis without an examination is not the answer. Even if you could start administering antibiotics immediately, your child might still experience significant discomfort for the next 48 hours or more, so focus on addressing the key issue: pain management.

Helping Parents Deal

Keep your cool and keep your focus. Make sure you are using the correct dose of pain reliever for your child’s weight. Many calls to the doctor simply end in a scheduled appointment and a suggestion to increase the Tylenol dose to the correct amount (based on weight, not age) or to give a first dose and wait the 45 minutes it takes for the medicine to kick in.

Also, sometimes infections just aren't treated with anibiotics anymore. Many ear infections in children older than six months are resolved with pain management and time. Prescriptions are now (appropriately) reserved for the sickest children and the ugliest looking eardrums (the ones bulging with pus behind them). This is how European doctors have been successfully treating ear infections for years, and Americans are finally catching on.