Our previous paediatrician (who sadly retired last year) had a rather dramatic way of giving us news.
He would sit down, look us in the eye, and after a pregnant pause, convey the information to us. Since he usually had a number of students trailing after him, my husband called them ‘teaching moments’ – it felt a bit like he was showing his students how to break bad news to parents. Ironically, if his students were paying attention, they learned a valuable lesson in communication. Because despite the hint of drama surrounding his declarations, he was actually very good at communicating what he thought was going on with Miss Z. And he then sat there, face to face with us, explained things clearly and didn’t leave until he’d answered all our questions.
The doctors I encountered during our last hospital admission could learn from him.
We were admitted to hospital through the Emergency Department on Monday with Miss Z vomiting, non-responsive and dehydrated. Tests showed an infection, but the doctors were unable to pinpoint where the infection was occurring. Rehydration by IV fluids was expected to wake her up, but on Wednesday morning she was still largely non-responsive, so they did an EEG – mainly to be able to definitively remove status seizures from the list of possible causes.
On Wednesday afternoon, one of the paediatric doctors came to see Miss Z. She asked me about how Miss Z had been that day – if she was any more awake, if she had vomited, how many wet nappies she had, how her feeds were going. She also gave me the results of Miss Z’s latest blood tests and said that the results from the EEG had come back and – good news – she wasn’t having seizures.
But the EEG had shown signs that there was an infection in her brain, so they were going to have to try to do another lumbar puncture. And they were going to start her on some potassium supplements because her potassium levels were still a bit low and would also aim to increase her feeds since more food would help boost the levels too.
Wait – what?! I suggested we go back to the part about the infection in her brain.
The doctor then gave me an explanation using a number of acronyms and big words that I didn’t understand. Finally, probably due to the alarmed look on my face, the doctor suggested she get the senior consultant, who could explain it better. When she left, I looked at the nurse who had been in the room for most of the conversation and said “that didn’t sound good. How worried should I be?”
The nurse explained to me – in simpler terms - what the doctor was saying, which helped me calm down and get a grip on the sudden turn of events, so that by the time the consultant appeared, I was ready to ask lots of questions. Fortunately, it turned out that Miss Z did not have an infection in her brain.
But here’s a lesson for that doctor: if you have something potentially big to reveal, please start the conversation with it. Brain infections trump feeding routines in order of importance, so lets discuss that first - especially if you are planning to stick a big needle in my daughter’s spine. We’ll talk numbers of wet nappies later, thanks very much.
Unfortunately, that wasn’t the only incident of miscommunication during our stay.
Late on Friday afternoon, the Respiratory team arrived at Miss Z’s room. After taking a case history for nearly an hour, explaining how they believed she has bronchiectasis (which I already knew), and telling me there are a number of treatment options (which I also knew), the consultant then said that she wanted Miss Z to have a two-week course of antibiotics – if the paediatrician would approve it. I was puzzled because I didn’t know why the paediatrician wouldn’t approve it – there was already a plan to send us home on a course of antibiotics after all. The conversation continued for a while longer and at one point the consultant said that it would also allow them to run a few other tests as Miss Z would already be in the hospital.
Wait – what?! It suddenly dawned on me that the consultant wanted Miss Z on intravenous antibiotics, given as a hospital inpatient.
Since the paediatric team had already switched her to oral antibiotics and had a plan for her to go home, it had never occurred to me, and the consultant had never specifically said IV antibiotics, just ‘antibiotics’. She left, saying she’d “talk” to Miss Z’s paediatrician to see what they thought would be best. Talking to the paediatrician turned out to be sending him an email at 5.30pm on a Friday evening, which wasn’t seen until Monday, leaving us in limbo for a whole weekend, not knowing if we’d go home on Monday or be confined to our hospital room for another two weeks.
So, here’s a lesson for that consultant: be clear and specific in your medical plans for my daughter. ‘A course of antibiotics’ might mean in-patient IV antibiotics to you, but that isn’t what it means to me.
And by the way, everyone knows that work emails sent at 5.30pm on a Friday don’t get read until Monday. Everyone.
Communication is essential for my daughter’s well-being and care.
Let’s all work on it.
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