Wednesday, 23 November 2011

Don't just do something, stand there!

Examining a 6 month old with bronchiolitis the other evening reminded more just how important observation is in the practice of medicine. By that I mean that in practical terms  there is very little the general practitioner can offer in this situation, other than careful assessment of the degree of respiratory distress and careful advice to the parent of the signs to watch closely for.

Prescription medicines just don't make any difference, whether it be steroids, antibiotics or bronchodilators. The only thing I have up my sleeve is admission to hospital with all the facilities of close supervision, oxygen and the option of iv fluids.

It was just good traditional GP. I arranged for a partner to review the infant again the next morning. There was a slight reduction in respiratory rate and the fluid intake had improved. I'm sure recovery will be steady from now. OK we didn't do anything, but close observation and parental education was crucial.

Non flashy, 'inexpensive', effective medicine.

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