A Missed Observation

One of my really good friends in medical school invited me over to his parent's house this weekend. His girlfriend was going to be in and his brother (with newborn baby)was also visiting. I thought it would be a good opportunity to get away from the books, the lonliness of living in solitude and also a perfect opportunity to eat a home cooked meal. I haven't seen his brother in about a year and I had only seen pictures of the baby.

When I got to their house, my buddy wasn't home yet. His brother let me and brought his daughter out to see me. He said that she wasn't feeling well and was a little cranky. He asked me if I thought it was because they took her to the mall the previous afternoon, thinking she may have caught something from one of the many strangers around. I asked him what the temperature was and what he had done for her so far. He said the temp was about 100 and that his mother (a physician) had given the baby some baby tylenol. I told him to wait a few hours and then take the temperature again (I've really gotta brush up on my pediatrics--but ask me anything about hypertension).

A few hours later, the baby still had a temperature. However, she was still drinking milk and also pretty active. My buddy told his brother, "if they can still eat/drink, they should be alright". He looked to me for confirmation. Their mother and father still weren't home from some social activity they were attending. I told him that I thought so, that I had heard that as long as the baby remained active and not lethargic, there wasn't anything. I looked at my buddy and asked where his pediatric Blueprints were.

When Grandma came home she asked about the fever--and asked how many times the baby tylenol was given. She then pulled a grandma, pushed a speed-dial button on her cell phone and informed someone on the other line that she would be arriving with her grandchild.

My first thought? I can't believe that I advised my friend that I had thought it was okay--that the fevers weren't too bad.

We got to the E.R. and my friend was interviewed by a somewhat "rude" nurse. She informed my friend that a temp of 99 didn't constitute a fever and then proceeded to say, "next problem--what did you do and any other signs and symtoms that brought you in". My friend and his wife were speechless and stuttering. I was wondering why would you be so rude to people who were obviously nervous because they were new parents.

Anyway to make a long story short, it turns out the baby had a urinary tract infection. The parents were told some further work-up would be done to find the problem.

My buddy and I were talking in the car afterwards and wondering how we could have missed it. We wondered why it wasn't even a differential on our list of possiblities. And instead of a relaxing weekend, we pulled out our books and started reading again. When do I switch over from becoming a student to a physician?