Ambiguous measurements, or, pediatricians can bite me

One of the unexpected joys of parenting has been the extent to which pediatricians seem to feel comfortable raising all sorts of hellish worries based on scant or flimsy evidence. It’s especially exciting when they do this in front of the kid in question, and the kid is one who listens intently to adults. Three examples:

  • When A was pregnant, the 5-month ultrasound appeared to show that the kid’s cisterna magna was larger than normal values, by a little less than a millimeter. That bought us a trip to the “genetic counseling” room, monthly follow-up ultrasounds, and a series of scheduled post-birth appointments with a pediatric neurologist, because, we were told, the likeliest cause of such an enlargement is a disorder with the misleadingly upbeat name Dandy-Walker Syndrome. The neurologist came to one of our OB-GYN meetings, and the ob-gyn doctor gave us all sorts of pep talks about “you’ll be surprised at how much you will still love your child.”

All the way through, I’d been skeptical, because if Dandy-Walker were really the problem, then it seemed as if the boy’s brain would look worse on the ultrasounds. The proof was going to be a CAT scan after he was born.

Naturally, the scan showed a cisterna magna well within normal bounds, and that there were no brain abnormalities (except for ones indicating awesomeness). The neurologist who interpreted the CAT scan said the problem appeared to be 2-fold: 1) the fact that fetal development isn’t uniform, and the boy was pretty big, and 2) the fact that the ultrasound kept getting his head at a bad angle, and so there was at least some chance that the problem was one of forced perspective, rather than anything actually being enlarged.

On the one hand, that was great news; on the other hand, the plausibility of those two explanations should have occurred to someone earlier on in the process. There was no warrant for gloom-and-doom scenarios based on the extant data.

  • Fast-forward to a couple of weeks ago. One of the boy’s blood pressure readings is, not absolutely high, but a little higher than one might expect. The doctor says–in front of the boy!–“It’s probably nothing, but let’s do some blood work to rule out kidney failure.” Kidney failure! So, naturally, 10 minutes of questions ensue.

We get the blood work (after days of the boy asking worried questions about his heart), and, naturally again, everything comes back fine. The doctor called to update us about the results, and said, “You know, it wasn’t really out of range, and he’s *very* tall for his age, so no worries.”

Now, I’m prepared to admit that abnormal values should be investigated, but, again, tone & presentation matter so much. Rather than lead with “kidney failure,” how about something else? (And thanks, too, for giving “hypertension” as the diagnosis on the lab form, so that some future insurance company can reject him for having a pre-existing condition.)

  • Finally, he had to have the TB test for kindergarten. I knew he would probably have an ambiguous result, because I get them. Sure enough, he had a 9mm red bump, which is within normal range for people outside of high-risk groups. What did the doctor do? Engaged the boy in a discussion of needle-sharing and other practices that might make someone “high-risk.” Remember that he’s 5!

We are actually on balance happy with our doctors, and the boy has had some strange bad luck (“toddler fracture” at 15 months, due to a playground mishap), but I will say this: The next doctor who trots out alarmist rhetoric without attending to 1) the boy’s size for his age and 2) his overall excellent health is going to get punched.  (Well, probably not punched–but I will write another pissy blog post.)  And the next doctor who starts spinning out worst-case scenarios as if the boy doesn’t listen will get rudely interrupted.

We are grateful for the boy’s overall health, and I don’t want to invoke the karmic gods or anything, but it does seem to me that at least 2 of these situations could’ve been handled with a lot more humility and tact.

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5 Responses to Ambiguous measurements, or, pediatricians can bite me

  1. Alex says:

    “(Well, probably not punched–but I will write another pissy blog post.)”

    Ladies and gentlemen; the internet.

  2. Frothy McBaldman says:

    When I was a lad I was diagnosed with Jackanapes-Saucebox Syndrome. That was pretty tough to live down.

  3. I understand your frustration, but do keep in mind the high incidence of malpractice lawsuits, especially against ob/gyns.

  4. melanie deal says:

    Doc,
    My son at two had what was thought to be a seizure…after 2 CAT scans and one mri (he had to be sedated for) the dr’s said undetermined seizure disorder…I did not like that, he had no other sypmtoms so we changed dr’s and *viola* he had Pallid breath holding spells (he basically held his own breath until he passed out) cute right..BUT not seizures (no where near seizures). I feel your pain..but as they get older they can wade through the BS, esp. E he is a smart boy and has the ultimate bulls–t detector as a DAD…

  5. Jason says:

    @Knitting Clio: I do understand that, but there’s a difference between, “hey, we have to raise this, and we’ll keep an eye on it, but you should take some comfort in factors 1, 2, and 3,” (especially when #3 is “we do in fact see a cerebellum.” I mean, that’s a biggie!), and, on the other, raising alarmist hell. There’s a question of tone.

    @Melanie: *Love* the story. I bet that was frightening at first, though!

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