Urgent scare

For the past two years, the majority of my clinical work has focused on the treatment of sick hospitalized children. When a patient is in shock, it is pretty easy to determine that they need immediate treatment. There is no hemming or hawing about diagnostic and treatment plans.

Things are different in the urgent care clinic. Many children come in with the same complaint of fever, pain, difficulty breathing, vomiting or abdominal pain. Most of them will do fine without treatment, but a few will do poorly if you choose the incorrect plan. I must determine which ones are truly sick.

When I see most patients, I initially assume they are extremely ill and need aggressive treatment. As I do the history and physical exam, I proceed through a mental checklist ruling-out the most serious disease. In the end, I tell most patients that they are going to be fine with no treatment.

Unfortunately, at the end of the day, I always second guess a few of my decisions and fear that I missed something like sepsis, a severe pneumonia or appendicitis. Trying to find that needle in a hay stack is scary.

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