A15-year-old girl was referred to a pediatric endocrinologist for evaluation of hyperthyroidism. Her primary concerns were intermittent increases in heart rate and appetite (with a weight gain of 7 kg within the past year), feeling hot at night even in winter, persistent lower extremity edema that had been present since age 4 years, and difficulty in concentrating. She denied having diarrhea, sweating, fatigue, breathing difficulties, hair loss, or changes in hair texture.
For 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.
The rash on this 4-week-old girl had appeared 5 days earlier on her face as thickened scales on an erythematous base and subsequently spread to the scalp, shoulder, chest, abdomen, and extremities. A few bullae were noted on the neck and hands. Initial treatment with cephalexin failed to control the rash, and the infant was admitted to the hospital for further evaluation.
In many instances, our patients receive invasive and aggressive subspecialty care at or near the end of life. Such care can become burdensome and painful without a favorable outcome. As advocates for our patients, we must ensure that their pain, shortness of breath, and other bothersome symptoms are alleviated, thus leading to a “good death.”
For the past several years, I’ve listed “difficult parents” on my department’s conference evaluation form as my answer to the question, “What do you consider to be the single biggest problem that you face in your practice?” At times, I have to admit that difficult parents have made me dread my decision to become a pediatrician. 
Avoidance of guidelines because they are “cookbook” is no longer an adequate excuse—especially when we are doing things incorrectly and expensively, while adding to potential complications.
Thoughts of my summer vacation are on the back burner now as I prepare to welcome the incoming pediatric residents. July 1st has a special meaning to all of us who have survived the grind of an internship. Fear was probably my main emotion at the start of my residency, while I’m sure for others it was excitement and anticipation. On July 8, I have to give a talk to the newcomers at our institution.- Primary Care Procedures: Trephination of Subungual Hematoma
- Genital Herpes and HPV Infection: Latest Treatment Guidelines From the CDC
- Necrotic Skin Lesions:
Spider Bite—or Something Else? - Aged Man With Disfigured Tip of Penis
- Latest Guidelines on Community-Acquired Pneumonia: Part 2, Empirical Therapy
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PHOTOCLINIC
Graves Disease
August 9, 2010
Henoch-Schönlein purpura with gastric wall thickening
August 9, 2010
Atopic dermatitis superinfection caused by Staphylococcus sciuri and Enterobacter asburiae
August 9, 2010
CONFERENCE COVERAGE
ACP 2010 
Editors from Consultant magazine bring you daily news reports, podcasts, and commentary from the annual American College of Physicians Internal Medicine meeting in Toronto. |
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