Or mother? Or father? Or husband? That’s a question I think every doctor gets asked a lot. I know I get asked it frequently. It can be a good question, although it can sometimes be a tough question to answer.
Sometimes it’s simple. The doctor is faced with a scenerio where 99% of doctors would do the same thing. The CT scan shows appendicitis…surgery is needed. The baby is very dehydrated…IV fluids are needed. The bone is broken…it needs to be repaired. Those aren’t really the situations I’m talking about.
Sometimes what I would do for my own family might not be what I’d recommend for someone else . Not because I try and treat my family better than other patients but because it’s more complicated in treating your own family. Three times I’ve taken my kids in to specialists for thing I probably wouldn’t have sent a patient in for. Once was when John was a baby and he had a few birthmarks that I knew were probably fine. I knew they could also rarely be associated with a rare genetic disease. If it was another patient, I’d likely have noted it in the chart and kept a close eye on them each time the patient came in. (This particular disorder has no treatment so there isn’t any benefit to earlier diagnosis.) It was driving me nuts though. I knew I was being neurotic, but I couldn’t reassure myself. So I took him to a dermatologist. He knew I was a pediatrician, looked at the birthmarks, immediately knew what I was thinking, laughed and said “It’s not _______.” So in this case, I caused myself an unnecessary visit to a specialist that I wouldn’t have caused a non-family member.
Sometimes, I might recommend different treatment because my kids have a pediatrician at home treating them. The best example of this is John’s asthma. There have definitely been times that he’s had symptoms that would have caused me to send a patient in to the ER or possibly admit him to the hospital. The difference is that I trust myself to treat him at home, where I can’t always do that with a patient. That might sound unfair and it is. But it’s also a perk for all the years of training.
Sometimes parents ask “What if it was your child?” when I’m recommending something that is controversial or painful or has potential side effects. That’s probably the best use of the question. It makes me stop and think what I would do. And if I can honestly say “Yes, I’d do this if it was my child, ” it reassures the patient and me that I’m not just recommending the particular course of action because it’s the thing to do or because I’m being overly cautious and practicing save-my-own-but medicine.
I often ask myself “What if it was John? or David?” when I’m faced with a tough decision. Not to say this is the only way or even the main way I make a medical decision but sometimes when I’m faced with two choices that both have pros and cons it’s a good way for me to gauge what I really think is the best thing to do. This week, I had a 2 yr old patient in the hospital who had possibly aspirated a peanut (meaning the peanut had gone into his lungs instead of into the stomach). He was seen by another doctor and looked terrible with real difficulty breathing and signs of aspiration. By the time he got to the hospital he was better so he was admitted for observation only. By the time I saw him the next morning he looked perfect.
The choice was whether or not to have the surgeons do a bronchoscopy (put a tube down into his lungs looking for the possible peanut and removing it). Against doing it was the invasiveness of the procedure. He’d have to have anesthesia which has it’s own risks, the procedure has some risks and it would mean more time in the hospital. The reason to do it was that it’s entirely possible that there was still a small piece of peanut there. A retained foreign body could cause problems later, including pneumonia.
I was leaning towards not recommending the procedure, although a part of me worried about the small risk of there being something there. Then I thought of David (easy for me to do as he’s the same age as this patient) and I knew that if it was him there was no way I’d agree to putting him through the bronchoscopy.
In the end, it wasn’t simply my decision. I presented the different options to the Mom and told her the risks of doing the procedure vs. not doing it. I told her I would recommend not doing it, but I also told her that there was some risk in that. After discussing the pros and cons, she decided against the procedure. Sometimes, parents make different decisions than I would make for my own kids. That’s ok. A lot of times, my job is to present the information and give guidance in making the decision. I can recommend one way or another and if asked I can answer the “What if it was your child?” question. But ultimately, if their decision is different, that’s ok. Sometimes it’s just not clear that there is one “right” choice.
I can’t know for sure if I made the “right” decision. I’m sure if he ends up with pneumonia caused by retained peanut, I’ll feel that I should have recommended differently. But I know I made the same decision I would have made for my own child. And that’s worth something.