Random ranting

Every so often I feel the need to do this. I beg your indulgence as I get this out of my system.

To Parents Everywhere:

1) If you reek of cigarette smoke, please do not lie when I ask about it and either deny that you smoke or insist that you do so exclusively "outside." I will not call you a liar to your face, but neither will I credulously take your word for it in defiance of my own sense of smell. I am not an idiot.

First of all, it complicates our relationship when you make it obvious that you are willing to be flagrantly dishonest. Secondly, in cases when the inarguable fact of your children's exposure to your second-hand smoke is complicating their health (eg. recurrent respiratory infections, asthma), it makes it nigh unto impossible to discuss ways of making them healthier. Dancing around the fact of your smoking is uncomfortable for both of us. Be honest about it. I make a point of being respectful, kind and patient when people are forthcoming with information of this nature.

2) There are times when you will have to accept the reality of your child's symptoms. Sometimes there are problems I cannot fix, and which must simply get better with time. As unpleasant as it may be, you may have to tolerate the cough/diarrhea/fussiness for a while. I promise that I will investigate symptoms that are not resolving in the time frame considered normal. But within that time frame, if I have told you that there is nothing I can do about Symptom X, it is because there is nothing I can do about symptom X. I am not withholding the relief you seek. If I did not prescribe anything, it is because no remedy exists. This is frustrating for all of us, but being hostile or rude will not effect the magical appearance of a cure.

3) On that note, if I have spent the time discussing a behavioral approach to your child's behavioral problem, it is because that approach is much better than simply trying to medicate it away. Psychiatric medications are horribly over-prescribed these days (as I have posted before, but am too lazy to look for now) and have lengthy and often unpleasant side effect profiles. Abjectly refusing to attempt the behavioral approach (or a similar alternative) will not break my spirit and force me to write a prescription for the sedative of your choice. Sometimes doing right by your kid (my patient) means saying "no" to you and risking your anger. In the long run, you and your kid will be better off if you can find an alternative to Problem X instead of seeking recourse through pharmaceuticals. See above re: the effectiveness of rudeness and hostility.

Thank you. That is all for today.


  1. bad day at the office? I say prescribe the sedatives, but for the parents. The kids behavior won't improve, but it won't bother them anymore.

    I disagree with one thing, of course a remedy exists, it always exists, just because you don't know it, or it hasn't been invented yet is not my problem, so get with it and cure everything already.

    Seriously though, I understand your frustration but sometimes, rarely, you do have to separate the wheat from the chaff, it might not be as simple as you imagine and you have to carefully listen to the parents. I have heard too many horror stories of symptoms masking the disease. Sometimes the parents instincts are right, and there is something seriously wrong, this differentiation is why being a Doctor is so difficult.


  2. Charo, I do understand that sometimes symptoms are a sign of an underlying illness, and teasing out the distinction is a cardinal skill of medical practice. However, there is a species of parent that is intolerant of any symptoms whatsoever, and becomes incredibly unpleasant when told that modern medicine cannot provide an immediate cure.

    We're not talking "lingering symptom that simply will not go away." We're talking "started yesterday, and is totally consistent with mild viral infection going around."

  3. Dr.dan, I realize you realize it, just putting it out there that sometimes some Doctors get complacent. So this wasn't meant to chide you, it was just an observation directed more at your vast legion of loyal readers.


  4. By the way, according to my page ranking, your blog comes in at number 9 of all webpages (google is 1), or maybe that is the domain of blogspot, but I am going with it is your blog specifically.