The practice of family medicine can be compared to that of a commercial aviation pilot-- long periods of normalcy and routine interrupted by brief moments of extreme danger.
Daniel, age 3, is the son of Salvadoran parents, and was brought in today with a history of fever for two days, headache not relieved by Motrin, and a purplish rash on the face. Initially, his exam was fairly typical of any child with an upper respiratory infection, but I pulled out a magnifying glass to examine the rash more closely. It was purplish and the outlines were irregular, of different sizes and shapes. This was not a rash that I am accustomed to see..strep, Fifth disease, chickenpox. Somewhere from deep in the mists of medical training I began to wonder.... could he have dreaded meningococcemia, a life-threatening illness that can rapidly progress to sepsis and death. Though it didn't seem overly likely, this was worth a trip to DeVos children's ER to consult with the emergency specialists and, if necessary, with infectious disease specialists.
Later I was called by the emergency room physician...Daniel would have tests drawn and be treated with antibiotics while observing closely for any signs of worsening disease. This is a case where it is better to send in several false alarms than to miss one child who perishes.
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