After many years of diagnostic dilemmas, I have learned a few lessons. Two important ones come to mind with the case I am about to share with you. One lesson is that one should always consider simple explanations first and, more importantly, one should never jump to conclusions as a result of panic.
I was on call during a recent holiday weekend when I received a page from an after hours pediatric clinic in our community. The doctor on duty was moonlighting which meant that he was working in unfamiliar surroundings. That always raises one's level of anxiety. The panic in his voice when I returned his page was evident immediately.
He described to me a four year old child with cerebral palsy who had been brought to our city from Central America to undergo an orthopedic procedure common to children with his condition. He was brought to the clinic, however, because of a sudden onset of torticollis. This is an unusual condition where the muscles of the neck spasm causing the head to involuntarily turn in an awkward and sometimes painful fashion. It may also result in a facial grimace which can be, quite frankly, frightening.
This moonlighting physician was convinced that this child was either experiencing an untoward reaction to a medication or was having a stroke. Strokes are rare in children, and usually associated with some other underlying medical condition. This doctor, I suspect, made the somewhat biased conclusion that because this child had CP, he must be a set-up for any other neurologic problem. This could not have been farther from the truth.
Further, the child was on no medications that could precipitate such a condition. But in his haste to get the child to the hospital, and thus out of his clinic, neither a thorough history or physical was obtained. Had it been, the cause for this child's problem would have been obvious. I have no doubt that this physician's heart was in the right place and that he wanted only the best for this child. But his panic, and I dare say his bias toward children with handicaps, got in his way, and prevented him from making a very simple and treatable diagnosis.
When my staff received him, assured themselves that he was stable, and did a thorough examination, they found that he had a severe ear infection ... his ear drum was in fact bright red and bulging. He was started on pain medication and antibiotics and his torticollis miraculously resolved. It turns out that ear infections, and even very bad colds can be explanations for torticollis. The child was discharged the next day in excellent condition, returned to his normal state.
The lesson is simple. Even complicated problems deserve the chance to be explained simply. And we must not let our biases, or our fears, force us to turn simple problems into complicated ones.
In addition to his regular column in Pediatrics for Parents, John Monaco, MD, along with coauthor Judy Mazel, recently published Slim & Fit Kids, Raising Healthy Children in a Fast-Food World. Their book is available in bookstores or from the publisher, Health Communications, Inc. 3201 SW 15th St., Deerfield, Beach, FL 33442 (www.hci-online.com.)
COPYRIGHT 2001 Pediatrics for Parents, Inc.
COPYRIGHT 2002 Gale Group
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