Tessalon

For the second time in a week, I took my 7-year-old daughter to the pediatric hospital s emergency room. She couldn't stop coughing. It was so excessive, a nurse asked us to move to a more isolated area of the ER waiting room.

The ER was busy that night. No physician was available, so a nurse examined my daughter. She brought no record of the prior emergency room visit at the same hospital. Thinking my daughter's problem was respiratory, she handed us a prescription for Tessalon Perles.

Four days earlier, at the same hospital, the ER physician had suspected croup, but he had no record of my daughter's medical history. He ordered a mist treatment and a chest X-ray. The former didn't help and the latter was negative, so he prescribed Orapred and Phenergan VC with Codeine.

But back at home, my daughter's constant cough went unalleviated, in spite of the multiplying prescriptions. A week earlier, we had visited her regular pediatrician. At that time, my daughter had a persistent low-grade fever and her coughing was only periodic. He put her on Zithromax and prescribed albuterol. The fever subsided, but the cough lingered and worsened.

After the second ER visit brought no relief, we returned to the pediatrician, but this time our primary pediatrician was not available. My daughter saw a younger pediatrician in the group who had no record of the two prior visits to the ER. She didn't have the X-ray results or previous medications prescribed. She thought it might be whooping cough and gave us a prescription for erythromycin.

At this point, my daughter had been home from school for about two weeks. The irritation developed into a dry, repetitive cough with intermittent bouts of congested hacking. Although she could drink and eat, her appetite was suppressed and she was weak. She said her stomach muscles were tired from coughing.

Versed in the Drill

Frustrated, we called the most recent attending pediatrician who suggested my daughter's problem might be psychological. Even so, she recommended seeing a pediatric pulmonologist. With the two main groups of pulmonologists in town booked for months, we called the pediatrician back and she contacted a pediatric allergist for a next-day appointment.

By now, nay husband and I were versed in the drill. We carried with us a shoebox of prescribed medications and a typed sheet noting each visit, physician, diagnosis and outcome. Based on experience, we were sure the next physician would have none of this documentation to consider beforehand.

I know from my career in a company that manages physician practices that most practices book appointments in 15-minute increments. Some studies suggest that out of 15 minutes, less than three minutes are spent on the actual exam, about eight are spent talking with the patient, one is taken up on the assessment or diagnosis, and the recommended treatment plan takes about three minutes.

Can a physician diagnose in 15 minutes without documentation from previous visits and encounters? "A Preliminary Taxonomy of Medical Errors in Family Practice," published last year in the journal Quality and Safety in Health Care, found that more than 86 percent of mistakes in family care offices are administrative or process errors such as filing patient information in the wrong place, ordering the wrong tests or prescribing the wrong medication.

According to the report, paper-based records "create a huge burden for a small practice." But doctors must have immediate access to relevant and updated patient information so that they can make more informed diagnoses.

The Right Combination

In my daughter's case, and without any recent medical history to go by, the pediatric allergist gave her a mist treatment to numb her throat. He suggested seeing a pediatric ear, nose and throat (ENT) physician and prescribed Tussionex Pennkinetic.

We contacted several offices, but couldn't get an appointment with a pediatric ENT physician for several weeks. Armed with our shoebox and a longer record of my daughter's recent medical information, I brought her to see an adult ENT specialist. I was disheartened. The receptionist even managed to lose my typed medication and encounter history before finally locating it and giving it to the nurse.

As the doctor entered the exam room, I noticed he held the typed medical history I supplied and had even underlined several sections. He spoke briefly to me but directed most of his attention to my daughter.

She had brought with her a stuffed bunny. The doctor took out his stethoscope and asked if he could listen to bunny's cough, and my daughter agreed. She told him that bunny coughs a lot and sometimes her stomach hurts. The physician examined my daughter. He pressed on the sinus area around her nose and she jerked her head back.

Then this physician told me my daughter had a sinus infection and acid reflux--yet another, different diagnosis and more medications. Feeling desperate, I reluctantly filled the two prescriptions for Prilosec and Biaxin. But within 36 hours, my daughter's cough began to diminish, and within 72 hours, the coughing had all but stopped.

My daughter has returned to school and has followed up with her primary pediatrician. But nothing has changed the conditions under which physicians practice. Serious attention must be paid to information management within and between medical practices and hospitals.

Technologies such as electronic medical records and the Internet can help physicians manage information, improve documentation and access the medical data they need at the point of care. But until there are more incentives in place for physicians and healthcare organizations to change, the bottom line is that consumers must carefully manage their own medical information and assume more responsibility for their own healthcare.

I never thought I would experience so personally what I hope to alleviate professionally. I hope that families experiencing life-threatening illnesses are never put to the same test.

Debra Williams is employed by Lanier Worldwide Inc., in market development, in the greater Atlanta area.

COPYRIGHT 2003 Nelson Publishing
COPYRIGHT 2004 Gale Group