Friday, July 10, 2015

Life in the ER - When diplomacy fails.

Dealing with ER patients is mostly straightforward.  Be polite.  Remember that most of them are having a Bad Day.  Practice good medicine.  You will generally do fine even with what some would regard as challenging patients.

But one category requires special from about age 2 to 10.  This is a demographic that is too old to fool and too young to reason with.  They are often quite frightened, especially so if they have had previous difficult encounters with the medical system.

Dealing with parents is the topic of another post entirely, but I will mention in passing that you have to always remember, even if the reason for bringing the kid in looks rather silly objectively, that they are motivated by concern for their child.  This is always worthy even if practiced to excess.

But back to the suspicious toddler types.

Always move slowly.  You can do things gently or you can do them quickly.  Unless you have a genuinely life threatening situation on your hands, or if the ER is collapsing under the burden of multiple messes, you just have to take your time with things.

I always try to sit down when dealing with patients.  If you tower over them you just make them more nervous.  This is especially true of children.  Of course I have to talk to the parents, but I keep watching the child out of the corner of my eye.  Usually I catch the kid doing the same thing.  It helps if they think of you as more of a "co-conspirator".

You never want to have to use brute force.  I for instance will not restrain a child for stitches. You use whatever pain control measures are necessary, hopefully in a good tasting oral form, then wait for it to work.  Tell stories while you work.  I have some excellent ones.

It helps to distract them when necessary.  There are a few minor magic tricks that can be done with tape measures, tongue blades and reflex hammers....

And if diplomacy and trickery fall short, well, there is always BribERy.

We have child sized containers of ice cream.  We have stickers.  Combine the two.  "Hey, want some Spiderman/Princess Ice Cream?".  I will usually offer either one and can say that the gender predictable choice is opted for about 95% of the time.

And if that does not work....

This is Coban, a dressing material sometimes called "Vet Wrap".  It is stretchy stuff that sticks to itself but not other stuff.

"Would you like a Ninja Turtle Head Band?".  Usually the answer is yes.  I could show you some really cute examples but, hey, privacy rules and all.  I sometimes put one on in solidarity with my young patient and I have no qualms on this point.

Having extensive kid experience raising my three boys, I consider this my comfort zone. Little girls are something of an enigma to me.  So I am always asking them about stuff.  It came to my attention that almost all of them have seen the movie "Frozen", and that the average number of tiaras that they own is about 2.5.  Well, since they went on sale at Target recently I just stocked up on them.  Can a gal, or I suppose to be fair, a guy, ever have too many tiaras?

I suppose the average reader still thinks of physicians as being August, somewhat Aloof professionals.  Thinks perhaps that the dignity of the Healing Arts precludes me modeling ER bribery Princess swag.

Happy to disprove that theory for you!

Hey, one never knows.  The Next Generation may include one or more little girls.  Gotta work on my Tea Party skills!

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