Monday, March 27, 2006

Over-using the hospital system

I had a scary night last night. D (aged 2 and three quarters) woke up at 2 am needing to go to the toilet, was trying to yell out to get help, and discovered that he couldn't talk, and could barely breathe. So I heard some strange barking noises, went to investigate, and discovered a terrified child who was trying to simultaneously breathe and pull his shorts down. I was pretty sure (from the barking) that it was croup, but two years ago, when D had croup, I got a pretty severe lecture from the nurse treating him that if he had trouble breathing, I should take it very seriously.

After a brief confab with E, I called 000, and an ambulance came and took them both to hospital. He was absolutely fine - by the time the ambulance came, he was just wheezing a bit, and after some drugs at hospital, and an hour or so of observation, they were sent home in a taxi.

I'm now wondering whether to feel guilty about over-using our wonderful health system (all completely free, by the way). Should I have waited the extra two minutes it would have taken to make it clear that a drive to hospital would have been adequate (rather than an ambulance)? Should I have then given him some ventolin (from previous wheezing episodes), and put him to sleep in our room and listened to his breathing all night instead of using getting the hospital to check him out?

Certainly any parent of a child with asthma would deal with that kind of breathing trouble pretty regularly, I imagine. They would probably laugh at my alarm. But they would also have strategies to deal with the little episodes, that I don't have. I also know that asthma, left untreated, can kill a child (it put one of my cousins in intensive care for a few days at age 20), and D has shown wheezing tendencies in the past.

Upper-middle class parents like me are more likely to have the sense of entitlement that leads them to just call the ambulance, rather than feeling a burden on the system and waiting until it's clearly a matter of life and death.

So which is right? The over-use of the hospital system to make sure nothing terrible happens, or rationing yourself to make absolutely sure it's necessary?

Most studies of the rationing of health care that happens when patients are charged for it show that patients don't have enough understanding to decide which treatments are necessary, and which are not. The trouble is that charging for it is unlikely to change the use. I would still have called the ambulance, even if it cost me a fair bit of money, and the parent who is already worried about being a burden on the system would be even less likely to, as they would have the added worry about being able to afford it.


At 9:04 am, Blogger Elizabeth said...

Well, as the parent of a kid with (mild) asthma, the only strategy I have for dealing with that is to give him albuterol (ventolin) and see what happens. If he doesn't get better after a round or two of albuterol, it's off to the doctor's we go.

The other drugs we have are long-term controllers, but don't do anything in the midst of an attack.

At 4:36 pm, Blogger Jennifer (ponderosa) said...

How scary for you -- and your child too. Glad that everything's all right now.

I don't think you should feel guilty. As a parent you have to make choices, who knows if you're right or not? But you choose with the best information you have at the time.

At 11:46 am, Blogger Phantom Scribbler said...

I don't think you should feel guilty. Your nurse made you feel that sort of situation required immediate intervention, and you listened. If there are any guilt feelings to go around, they should belong to the nurse!

At 12:44 pm, Blogger Susoz said...

I also don't feel you should feel guilty about using health resources in this way. That's what they're there for. A great many people sit in emergency wards when they have a cold.
Perhaps you're wondering if you could have spared your child and partner the time at the hospital, which is a slightly different issue. Croup apparently responds well to steam, or is it dry cold air?

At 8:23 pm, Blogger Jennifer said...

Thanks for the reassurance. D's totally better now, and totally attached to the teddy bear the nice paramedics in the ambulance gave him. As an aside, E found it quite annoying the way at every step of the way the medical staff assumed he knew little about D's idiosyncrasies (e.g. his weight and history of respiratory illness)


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