Dr Daedalus saw a child in hospital recently with quite severe bronchiolitis - she hadn't been eating for about a day and a half, sounded and looked terrible, and a chest X-ray showed she had one entire lung full of muck. So far, so easy - secondary bacterial infection on top of bronchiolitis. Treatment - iv antibiotics.
So we told mum this was what we needed to do - this mother who'd obviously noticed her child was sick, struggling for breath, and getting dehydrated, and had been worried enough to bring her to A&E. Her response? She wanted to talk to her homeopath instead.
Difficult situation, in that you don't want to terrify the parents but at the same time you can't let the child go home to take water - so you mention the severity of the illness, the possibility of lasting damage if it's not treated, and the fact that children do die from this sort of infection.
Outcome? We treated her with high-dose broad-spectrum antibiotics, and she got better.
I was reminded of the Australian homeopaths convicted of manslaughter for their (admittedly much more chronic) neglect of working treatments for their daughter in favour of the woo of homeopathy.
And of Andrew Lansley's comments on his healthcare reform:
"It is time to put patients in charge of their own healthcare. While that may lead initially to some catastrophic misdiagnoses and thousands of easily preventable deaths, it is surely better than some top down, centralised bureaucracy where ordinary patients are constantly told what to do by qualified medical professionals who see them as nothing more than a human being that is displaying a set of symptoms of which they have a high degree of expert knowledge."
When do these things become child protection issues? If you honestly believe the child is at risk of imminent death if they go home untreated, do you treat against the parents' wishes? If so, do you get sued afterwards?
I know what I'd do. But it's a tough call, all the same.
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3 comments:
I think the situation here is similar to blood administration in children of Jehovahs Witnesses. In situations where there is possible threat to life there is a procedure for rapidly getting the child made a ward of court.
And just in case anyone thinks that homeopathy is not a threat to life should see;
http://whatstheharm.net/homeopathy.html
I do agree that there are similarities. In this situation, though, the risk is less, isn't it? The child in shock following trauma with (presumed) active bleeding is overwhelmingly likely to die without resus + blood products.
This girl is a bit trickier, I think - she'd already been ill at home for several days and while clearly had got worse she had a chance of clearing the infection without antibiotics. Hard to say what that would be, but it just feels a little less clear-cut. I wonder if there have been cases of children being made wards of court to receive iv antibiotics against parental wishes - anyone?
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