I generally stay out of politics for the same reason I don’t fly airplanes: I will not mess around with things I don’t fully understand where someone may get hurt.Â Laws, as they apply to medicine, tend to run with a steamroller over problems best attacked with a scalpel, and the fewer of those we have, the fewerÂ patients will suffer the consequences.Â I have a story of a little girl who got better in spite of laws to the contrary.
It was 10 minutes to seven PM.Â The mother ran in, scattering tears, clutching her little 2-year-old daughter, upset beyond words.Â She had just picked her up from day care, and as she started to change her diaper –
she could talk no more.Â Crying, she undressed her child, revealing a huge buttock bruise and bleeding in the diaper area.
Let’s stop for a second.Â The law dictated for me to call the police at that point.Â It is very specific that where a suspicion of child abuse exists, it must be immediately reported.Â That’s not what I did.Â Instead I ordered a CBC, a complete blood count, to be done.
Let’s stop again.Â I have a CBC machine in the office.Â It takes 90 seconds to return a result.Â There is another law, called CLIA, designed to make it very difficult to operate a lab in the office.Â This is actually a law we have been able to follow, at great expense and with considerable difficulty.Â Most pediatricians do not have a lab, and must wait overnight for results from their patients.
90 seconds later I knew I was not going to be calling the police or Child Protective Services.Â The platelet count was extremely low, 10 times less than normal.Â Platelets are the blood cells that stop small bleeds.Â The little girl had ITP, and less than an hour later was in the emergency room getting appropriate treatment (I called ahead and had them ready the immunoglobulin before she even got there, wasting no time on testing).Â She went home to recover completely without further adventures.
Did my brief encounter with illegality save her?Â Maybe.Â I know I saved the day care center people, and I don’t even know who they are.
What brought this back (from ’93 or ’94, quite a while ago) is an entire issue of a respected pediatric journal devoted to “advocacy for children”.Â That means, getting the legislatures to pass laws to help children.Â I just hope they do a better job with these laws than with some of the others…
RE: Mr Chavez comment:
There was nothing to report.Â ITP was responsible for all the bruising and bleeding — without platelets, the force of just sitting down on the floor is enough to produce hemorrhaging.