Inadequate Service from GP's office, WWYD?

[Tinker'n'Fun]

So glad to hear that!!

Would have helped if I had your son's name last night, but I remembered your screen name (which is really unusual), so I ran with that.. I'll say another one tonight - that all remains well - and you find the ability within yourself (I'm sure it's there) to know just the right thing to say tomorrow - as well as making your decision in regards to what you feel comfortable doing (or not) in terms of this particular practice..

Can't hurt to name him specifically, his name is Kevin. Thanks again, I really appreciate it.

 

[Hannathy]

Just keep reminding him to take nice deep breaths and expand his lungs often even if it hurts or makes him cough.

 

[Agri]

I'd shop around for a new doctor.

My mom had whooping cough/pertussis a few years ago. She saw her doctor, he told her to get some cough syrup. She had a coughing fit so bad she passed out so she took herself to the ER (its just a couple of blocks up the street) where she was diagnosed with pertussis. Her doctor still refused to believe the diagnosis and told her she had just had a bad cold that was lingering!

 

[cm8]

This was very poor treatment of a child! As a Primary Care Provider, I can say that I always insisit that parents or patients let me know if they aren't better in a couple of days. If they aren't, I want to see them back. By the way, Levaquin isn't recommended for anyone under 18. It can cause tendon ruptures or slow bone growth. I really hope that you find another Primary Care Provider

. I am shocked......

 

[cm8]

I highly disagree with this statement. Overall, mid-level providers, like PA's typically spend more time with patients that the doctors do. Many clinics are ran by the PA's. The doctor just stops by occassionally while the PA does most of the work. At our pediatricians office, we usually preferred the Nurse Practitioners because they spent more time with us & our children.

 

[Tinker'n'Fun]

[/B]

. I am shocked......

This is in reference to the Levaquin. Can you please explain your feelings more. Upset because it was prescribed, or upset because you disagree. Thank you.


Hannathy: Just reminded him to do deep breathing again. Thanks for the reminder.

 

[heatherwillmom]

Time spent with the patient sounds more like a function of the front office scheduling.

It was the PA's (who are overseen by a Dr. for a few hours each morning) at my dd's college health clinic who almost killed her 3 years ago. They mis-dx what turned out to be mono for over a month. In the end they rushed her by ambulance in the middle of the night due to what they said were breathing difficulties (they even gave her an asthma inhaler earlier in the day even though she told them repeatedly she doesn't have asthma problems). She had trouble breathing because her throat was so swollen from the mono. How did this almost kill her? It turned out her spleen was extremely swollen as well, quite an unknown danger for someone who rides and jumps a horse several times a week (one fall and she could easily have bled to death within minutes).

Added to a couple of other incidents involving PA's and I'm happy to skip over them and go directly to the MD who has more training and knowledge. Never had a problem with lack of time and care during an office visit, they have all been terrific at listening to me if I think something is "off", and when a big issue is at hand, they have no problem suggesting a visit to a specialist (as in, they know their limitations). I do spend time trying to find the best doctors I can, however, and that pays off (and the reason I am a high stage cancer survivor). Honestly, if you were dx with cancer tomorrow, would you want to see a top oncologist personally or a PA in the same office who might spend more time talking to you? I'd prefer to trust my life with the person who has the greater knowledge and schooling.

A few summers ago there was a virus going around our area that started off with virus symptons, then turned into pneumonia. 4 out of 5 members of my family including my dh (but not me!) got it, one after another with a couple of weeks in between. By the time I was in there with my 3rd child the ped said "it's a virus". But she listened to me when I said what my experience had been with the follow-up pneumonia, and since this particular child also had a heart defect, agreed to start the antibiotics sooner rather than later (even though she said she didn't think it would do any good). Indeed, it stopped everything in its tracks, the only child who didn't get way worse before he got better.

More than anything, I'm horrified for the OP that her child was getting worse and the office refused to see her. Every single time I've brought a child in for something like that the ped. ALWAYS tells me that if symptons worsen to come back in asap. It's insane that they wouldn't make an appt. for her.

I'm sorry that you have had such bad experiences. I have some good friends that are PA's & I literally trust them with my life. They spend more time & are more careful that most MD's. Overall, that is common. Most Family practice MD's don't spend much time with their pts. They also don't typically listen as well either

 

[heatherwillmom]

This is in reference to the Levaquin. Can you please explain your feelings more. Upset because it was prescribed, or upset because you disagree. Thank you.


Hannathy: Just reminded him to do deep breathing again. Thanks for the reminder.

Levaquin is in a class of antibiotics called Quinolones. They aren't approved for use in anyone under 18 due to problems with spontaneous tendon ruptures & problems with bone growth.

 

[Pea-n-Me]

Levaquin isn't recommended for anyone under 18. It can cause tendon ruptures or slow bone growth.

Levaquin is in a class of antibiotics called Quinolones. They aren't approved for use in anyone under 18 due to problems with spontaneous tendon ruptures & problems with bone growth.

This is unclear to me. From what I'm reading (and the literature is confusing), it looks like it's approved by the FDA for pediatric use (for anthrax and community aquired pneumonias) but not recommended by some medical groups due to the issues you mentioned, and it looks as if these recommendations for the pediatric population were based primarily on studies in immature animals.

http://www.fda.gov/Drugs/DrugSafety...ormationforPatientsandProviders/ucm126085.htm

http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088619.pdf

http://www.articlesbase.com/health-...-makes-headlines-for-severe-risks-451552.html

Just want to clear this up so the OP has her facts straight when discussing this with her doctor. (Nothing worse than having the wind taken out of your sails right off the bat when you're arguing a point, lol.)

It also looks as if they started off using amoxicillin, then moved to levaquin after fever increased on amoxicillin.

DS15 went to the doctors Monday night, he had a stuffy nose and sore throat for a few weeks, but no fever. On Monday morning, he started with a severe cough that hurt him enough to beg to go to the doctors.

They gave him a cough pearl to take and said Motrin for the fever (102.4). He saw the PA and she also gave DH an antibiotic and said if he wasn't better by Thursday to start him on it.

Tuesday: Couldn't keep his fever under control even with piggy-backing Motrin and Tylenol.

Wednesday: Cough worse, fever still high, started antibiotic. This is the LONGEST DS has ever had a fever, he is very healthy.

Thursday: 4 doses of antibiotic, and fever is now higher. Contacted Dr.s office, they said I was jumping the gun. Tried to tell them that I never am wrong and this was not normal. They would only call in Cough syrup with Codeine, would not see him.

Friday: Still high fever, we even tried sweating it out. Now he is really feeling crappy and the cough syrup is almost gone. (They gave a small amount). The poor child has gone through a huge bottle of Motrin (he takes liquid) and still no improvement. They would not see him. I insisted on coming in on Saturday, said I would sit there until they saw him....

Today: Went to the office. They said, could be viral, etc. They heard some wheezing in his lungs, but thought it was nothing. Asked me if I wanted a flu test, I insisted. Negative by the way. Got a lecture about not getting the flu shot even though he tested negative. Asked if I wanted a chest Xray for the wheezing, I said YES. This PA said his amoxicillin would not treat bronchitis and ordered Levaquin and more cough syrup, but still said we should wait it out.

So we go get the Xray. DS has pneumonia in the total left lower lobe and is considered at least moderate.

I am calling the office to see his Doctor on Monday and get more answers as to his meds, any other treatments we should be doing and the mis-care we received.

How would you handle it, and do you think they were in error not seeing him? I am really close to the situation.. I am his Mom afterall!!

Not sticking up for the PA, but sort of thinking out loud here. My question to your doc would be what he or she would have used in place of levaquin under the same circumstances, and does he or she think it was appropriate to prescribe levaquin to your son - as a teenager. See what he or she says. If, in his or her opininon it was inappropriate, then I might be rather upset with this particular provider (PA). But remember, with use of any medication you always weigh the pros and cons of both the illness and the drug. In other words, do the pros outweigh the cons? This is what you discuss with your doctor, and then you'll have at least part of your answer (the issues with the office staff being the other part).

 

[Tinker'n'Fun]

DS's appt is at 2pm. I am going to have the doctor examine my son, ask about when he can go back to school, if he can use anything to help with the wheezing that is bothering him, and also as about his school retreat this coming weekend, talk about bad timing!

Then I will ask DS to leave the room. He tends to get very nervous and upset with confrontation with his Mom (he is a good kid) and gets scared when he is ill.

I have decided to approach him re:

- the lack of communication from the front of the office to the doctors/nurses
- I want him to know that I called 4 times, who I spoke to, the attitudes they gave me and the flat out refusal to come in. I will explain the symptoms my son had and that I was extremely concerned, but how I felt my concerns were ignored. Also, I will tell him how the office handles his day off which is Wednesday.
- I want to go over the Xray, the degree of his pneumonia, and the treatment. So far the treatment went from do nothing to take some cough syrup, then it went to cough pearls and amoxicillin and the following day went to Robitussin w/codeine, and finally it went to Levaquin but no explanation of the meds or information re: what else to do for pneumonia. Levaquin is not normally prescribed for teenagers with diagnosis's of ear infections or lower grade stuff, but can be for pneumonia because of the severity of the illness is higher than the side effects at that point (spoke with another pharmacist, but I am still very concerned).

- Depending on his answers, I may ask him if he is trying to reduce his clients and if he really understands how it appears to his patients. If he is not concerned with any of the above, I will put all this incident in a report and have our charts moved to a new doctor. I dread this as in our area, it's hard to find that physician who still is a "family" physician. I am hoping he will do his best to make things right.

 

[Pea-n-Me]

Levaquin is not normally prescribed for teenagers with diagnosis's of ear infections or lower grade stuff, but can be for pneumonia because of the severity of the illness is higher than the side effects at that point (spoke with another pharmacist, but I am still very concerned).

This is the point I was trying to get at. It wasn't prescribed as a first line drug, it was prescribed after the illness became more serious. And even though these side effects are reported, it doesn't mean that everyone will get them. (Although I'm not going to rush out to get levaquin anytime soon myself however DH has had it before without any problems and we give it in the hospital a lot and I've never seen any adverse effects from it either, fwiw.)

Depending on his answers, I may ask him if he is trying to reduce his clients and if he really understands how it appears to his patients.

I'd seriously consider leaving this out. It sounds condascending. Just say what you want to say above, ie factual, and then give him a chance to respond.

 

[Hannathy]

I would add that unless you are sure you are leaving I wouldn't be confrontational either, stay informative and "I just want you to know" manner".

If you put him on the defensive right away it isn't gong to go well and you are probably going to have to leave the practice.

 

[Disney Doll]

See bolded

DS15 went to the doctors Monday night, he had a stuffy nose and sore throat for a few weeks, but no fever. On Monday morning, he started with a severe cough that hurt him enough to beg to go to the doctors.

They gave him a cough pearl to take and said Motrin for the fever (102.4). Seems logical thus far. You don't want to jump the gun with starting antibiotics for all the reasons others have posted. He saw the PA and she also gave DH an antibiotic and said if he wasn't better by Thursday to start him on it. I don't love this. I think the instructions should have been "if he doesn't seem better by Wednesday or Thursday, come back to see us".Tuesday: Couldn't keep his fever under control even with piggy-backing Motrin and Tylenol.

Wednesday: Cough worse, fever still high, started antibiotic. This is the LONGEST DS has ever had a fever, he is very healthy. I'd be getting concerned with a realitvely high fever for 4 days duration.

Thursday: 4 doses of antibiotic, and fever is now higher. Contacted Dr.s office, they said I was jumping the gun. Tried to tell them that I never am wrong and this was not normal. They would only call in Cough syrup with Codeine, would not see him. This concerns me. I think that they should have seen him that day. It has been MY experience that 48 hours of antibiotic usually begins to show some signs of improvement if it is the correct antibiotic treating the correct diagnosis.

Friday: Still high fever, we even tried sweating it out. Now he is really feeling crappy and the cough syrup is almost gone. (They gave a small amount). The poor child has gone through a huge bottle of Motrin (he takes liquid) and still no improvement. They would not see him. I insisted on coming in on Saturday, said I would sit there until they saw him.... Again, day 5 and they were still not willing to see him concerns me.

Today: Went to the office. They said, could be viral, etc. They heard some wheezing in his lungs, but thought it was nothing. Asked me if I wanted a flu test, I insisted. Negative by the way. Got a lecture about not getting the flu shot even though he tested negative. Asked if I wanted a chest Xray for the wheezing, I said YES. This PA said his amoxicillin would not treat bronchitis and ordered Levaquin and more cough syrup, but still said we should wait it out. The waiting it out concerns me. This has been a fairly sick kid for now 6 days. Ordering the Levaquin isn't necessarily a problem..."it shouldn't be given to people under age 18" is too blanket of a statement. It should be given with care to people under age 18 and they should be monitored closely. Of course, with this experience, monitoring closely isn't necessarily being done by your ZMD's office.
So we go get the Xray. DS has pneumonia in the total left lower lobe and is considered at least moderate.

I am calling the office to see his Doctor on Monday and get more answers as to his meds, any other treatments we should be doing and the mis-care we received.

How would you handle it, and do you think they were in error not seeing him? I am really close to the situation.. I am his Mom afterall!!

Thanks for any advice.

My take on your situation is this:

On Thursday, if that kid wasn't better, if I worked ini his MD's office, I would have seen and xrayed him. 4 days of a fairly sick kid with a high fever who is on antibiotics is starting to get to be a bit long of a time...kids usually bounce back relatively quickly, and when they don't, it's usually something more serious.

Generally, Amoxicillin is a good "first line" antibiotic for a lot of resppiratory issues, so I don't have a huge problem with that. And yes, MDs/PAs/NPs/prescribers are not as quick to hand out antibiotics as they used to be because of creating "superbugs" and so forth.

My focus would be the lack of responsiveness and over-the-phone diagnosing. Truthfully, I think it's bad practice to give an antibiotic Rx to someone and tell them "Fill this if it gets worse". What's "worse"?

The MD may not know about all that transpired. I would tell him your story, try and be as calm as possible and let him know what's been going on. See what he says before you make a decision to change MDs.

And FTR, I don't think PA vs. NP Vs. MD has anything to do with it. I have known very good and very bad in all of the professions.

 

[C.Ann]

DS's appt is at 2pm. I am going to have the doctor examine my son, ask about when he can go back to school, if he can use anything to help with the wheezing that is bothering him, and also as about his school retreat this coming weekend, talk about bad timing!

.

Best of luck today!

Disney Doll is a very wise woman with an abundance of knowledge.. I would go with what she has posted below..

See bolded
My take on your situation is this:

On Thursday, if that kid wasn't better, if I worked ini his MD's office, I would have seen and xrayed him. 4 days of a fairly sick kid with a high fever who is on antibiotics is starting to get to be a bit long of a time...kids usually bounce back relatively quickly, and when they don't, it's usually something more serious.

Generally, Amoxicillin is a good "first line" antibiotic for a lot of resppiratory issues, so I don't have a huge problem with that. And yes, MDs/PAs/NPs/prescribers are not as quick to hand out antibiotics as they used to be because of creating "superbugs" and so forth.

My focus would be the lack of responsiveness and over-the-phone diagnosing. Truthfully, I think it's bad practice to give an antibiotic Rx to someone and tell them "Fill this if it gets worse". What's "worse"?

The MD may not know about all that transpired. I would tell him your story, try and be as calm as possible and let him know what's been going on. See what he says before you make a decision to change MDs.

.

 

[phorsenuf]

Just curious, what was his fever range?

 

[mommasita]

Just popping in, albeit early, to see how the Appt went, and to see how Kevin is feeling.

 

[Tinker'n'Fun]

Just home form a 2pm appointment. Boy that was a long one...

I will try to address as much as possible, but first, once again, thanks for all the information, thoughts, and advice. I think I handled everything relatively calm and cool.

I had our dr. first examine Kevin. He knew that I was upset and we agreed Kevin would leave the room after his exam.

He has a bad case of pneumonia. Along with the Levaquin, he is now on a dose of Medrol and an inhaler. He is not allowed to go back to school until at least next Monday. His lungs were still very squeaky and full. He also has to go for a recheck on Friday. The doctor also insisted that I get checked out. I have numerous health issues and he didn't like my color. I didn't have time to stay today and I am fine with that. I have no plans but to stay on my couch until then anyways.

DS left the room. I calmly explained the week with facts from the first phone call to the last. The doctor seemed genuinely concerned and stated that he was not aware of the situation. He even said he had openings on Friday. He asked that I stay and speak with the office manager and explain to her also what was going on.

I re-iterated to the office manager what went on, how sick DS was, and what my main concerns were. I actually made it through almost all the conversation without crying. (You have to remember I am a bit worn down and tired at this point). I told her that while I really wanted to keep him as our dr. we would not be a number and that if messages can not make it to the doctor than the system has a flaw. She agreed. She was very concerned also as DS was very sick.

I am to speak with the office manager and or my doctors nurse to make appointments for the time being. She will be looking into what happened and while I don't like the electronic system she says it will make it easier for her to find out what happened.

She said they would hate to lose our family as patients since we have been with them for a very long time. Everyone was very nice and apologized. I am still not sure where it will end. I will go the appointment on Friday and they may have some answers then.

As for the question from Phors, his temperature ran from 101.8 up to 103. The lowest the meds brought it down was 100.2.

If I missed anyones questions, I am sorry. Thank you for the prayers and please continue. He is still very sick at this point. Lots of fluids, lots of rest, and oh my so many meds!!!

 

[C.Ann]

Just home form a 2pm appointment. Boy that was a long one...

I will try to address as much as possible, but first, once again, thanks for all the information, thoughts, and advice. I think I handled everything relatively calm and cool.

I had our dr. first examine Kevin. He knew that I was upset and we agreed Kevin would leave the room after his exam.

He has a bad case of pneumonia. Along with the Levaquin, he is now on a dose of Medrol and an inhaler. He is not allowed to go back to school until at least next Monday. His lungs were still very squeaky and full. He also has to go for a recheck on Friday. The doctor also insisted that I get checked out. I have numerous health issues and he didn't like my color. I didn't have time to stay today and I am fine with that. I have no plans but to stay on my couch until then anyways.

DS left the room. I calmly explained the week with facts from the first phone call to the last. The doctor seemed genuinely concerned and stated that he was not aware of the situation. He even said he had openings on Friday. He asked that I stay and speak with the office manager and explain to her also what was going on.

I re-iterated to the office manager what went on, how sick DS was, and what my main concerns were. I actually made it through almost all the conversation without crying. (You have to remember I am a bit worn down and tired at this point). I told her that while I really wanted to keep him as our dr. we would not be a number and that if messages can not make it to the doctor than the system has a flaw. She agreed. She was very concerned also as DS was very sick.

I am to speak with the office manager and or my doctors nurse to make appointments for the time being. She will be looking into what happened and while I don't like the electronic system she says it will make it easier for her to find out what happened.

She said they would hate to lose our family as patients since we have been with them for a very long time. Everyone was very nice and apologized. I am still not sure where it will end. I will go the appointment on Friday and they may have some answers then.

As for the question from Phors, his temperature ran from 101.8 up to 103. The lowest the meds brought it down was 100.2.

If I missed anyones questions, I am sorry. Thank you for the prayers and please continue. He is still very sick at this point. Lots of fluids, lots of rest, and oh my so many meds!!!

It sounds like you handled the appointment very well.. Kudos for that..

But I'm NOT happy to hear that Kevin is sicker now - and that you may be sick as well.. I suppose I could scold you for not staying to be checked out, but considering what you have been through - and how long this appointment lasted, I won't..

However, if you start to feel worse, you must see the doctor! Promise?

I will continue to pray for Kevin to get over this illness - and it looks like I'll be including you as well.. Hang in there - and REST!!!!!

 

[Tinker'n'Fun]

It sounds like you handled the appointment very well.. Kudos for that..

But I'm NOT happy to hear that Kevin is sicker now - and that you may be sick as well.. I suppose I could scold you for not staying to be checked out, but considering what you have been through - and how long this appointment lasted, I won't..

However, if you start to feel worse, you must see the doctor! Promise?

I will continue to pray for Kevin to get over this illness - and it looks like I'll be including you as well.. Hang in there - and REST!!!!!

Promise to call if anything changes. DH is very protective of me and has been doing everything for me. It's going to be a soup/sandwich week and he said he will pick up anything else we need. He has been bringing me my meds and actually just handed me a glass of water and said "drink", you are not getting enough fluids. He brought me some PJ's over and said for me to take a nap, it was a long day. He is my best friend. He also told his boss that he may have to leave this week if anything happens at home. And he brought me a piece of Pumpkin bread, my favorite. The best part is he can overlook any mess in the house and does dishes without asking. God was good to me! Kevin is resting also and the school has called 3 times today alone. They are also concerned and told me to tell him to not worry about his school work. (I kept this to myself since if he is feeling a bit better, no reason he can't do a little math or science for a little bit).

I am resting (actually a bit tired right now) and am forever grateful for the laptop that has found a home on my couch with me.

 

[Pea-n-Me]

It sounds like you got a good response. This says a lot about the doctor and the practice, IMO. I hope it made you feel better. Your son should be feeling better pretty soon.

I do not like the sound of him not liking your color. Please keep a low threshold for going back yourself. Your body chemistries can change if your cells aren't getting enough oxygen, etc, and that will need medical attention. Keep us updated if you will so we know you're ok.