WhiteCoat

Low Grade Fevers

Just found another thing to add to my list of pet peeves.

First, I’ll recap. There are three things that get on my nerves to the point that I have had to rant about them: Cell phones, using the term “emergency room,” and anyone who engages in “baby talk.”

Introducing #4: The “low grade fever”.

This peeve is more about doctors than it is about patients. Most patients don’t and shouldn’t know about medical definitions. I sympathize with patients and families who are inappropriately sent to the emergency department for evaluation of “low grade” fevers. Most of the time, this isn’t your fault. Just don’t go telling everyone else what your doctor said so that the problem gets worse.

The definition of a fever is either a core temperature of more than 100.4 degrees OR an increase of 2.4 degrees or greater above the patient’s basal body temperature. Before you use part B of this definition, you better be showing me some graph paper with temperatures plotted on it. Some experts even state that a temperature isn’t a fever until it hits 101 degrees. Hyperthermia is considered an elevated temperature beyond the body’s normal set points and is generally defined as a temperature of 106 degrees and above. Hyperthermia is bad news and requires immediate medical evaluation.

In 99+% of cases, fever isn’t the enemy. Fever is potentially dangerous in newborns and infants less than 30 days old. Seek immediate medical care. Fever in kids less than 3 months old is still possibly dangerous, but less likely so. Kids older than 3 months are generally safe with fevers. I’ve had several parents come to me concerned that their kid’s brains are going to fry. Your kids aren’t eggs and their skulls aren’t skillets. Brains don’t fry unless you’re in Hannibal Lechter’s kitchen.

If you’re using tympanic thermometers, don’t. There are many studies showing that tympanic thermometers are unreliable or at least less reliable than other methods. Yes, some studies show that tympanic thermometers are reliable. If you had three measuring devices showing that a cup was 8 ounces and six showing that a cup was anywhere between 6 and 12 ounces and couldn’t tell the difference between any of them, which one would you use to bake a cake?

I’m getting off track.

First, don’t try to BS me and tell me that you’ve taken your temperature or your child’s temperature when you haven’t. When parents of an 18 month old bring him in for evaluation of “low grade fever” of “ummmm 99 …. point …. 2 or3,” sorry, but my BS meter has already gone off. No Motrin for you … 1 year!

Second, I don’t care what your doctor told you. Less than 100.4 degrees is not a low grade fever. It isn’t a fever period. I know it’s probably not your fault. I know you’re trying to be a good parent. If your doctor insists that a temperature less than 100.4 degrees requires an emergency department visit, get another doctor.

A temperature of 99.4 is not a low grade fever any more than a blood pressure of 100/60 is low grade hypertension or driving 50 MPH on the highway is low grade speeding.

And no, you don’t need antibiotics for a low grade fever … even if it really is a fever. Amoxicillin doesn’t contain Tylenol and Zithromax isn’t a decongestant. They won’t help.

57 Responses to “Low Grade Fevers”

  1. Suzanne says:

    2 things you should know: every pediatrician I’ve taken my children to (in two different countries!) have used tympanic thermometers. Why do that if they are so inaccurate?

    And 2, where we live now, Switzerland, my ped wouldn’t give my child a vaccine because his fever was elevated–37.2 celsius–99 fahrenheit.

    This is why parents worry and use tympanic thermometers. Their pediatricians have told them to.

  2. Pink says:

    Most excellent post, sir. You had me in stitches this morning!

  3. Gene says:

    And what about the return visit because the Tylenol or Motrin “wore off” and the fever “keeps coming back”? That one is just a huge eye-roll for me.

  4. Kyla says:

    Well said! It doesn’t matter how many times you explain this to some people, though, they still drag their kiddos in for 99.1 “fevers”. These are the kids who are doing cartwheels in the ED waiting area.

    • Emma says:

      I work in daycare and we have to send children home at 100* I’ve yet I have seen a child with a fever of 99 and up EVER do a cartwheel or anything other than stare off pale. And I’ve sent hundreds of ifs home thousands of times over the year. They aren’t fine in fact feverol seizures begin at 100* which I’ve also had happen. Explain that how did those children get feverol seizures If they didn’t have “fevers” at least not by your definition.

  5. Mama On A Budget says:

    Don’t even bother with the basal temperatures and MDs. I have taken my waking temperature with a basal thermometer for over 4.5 years (with the exception of a pregnancy thrown in there). I’ve brought my records with me to every doctor’s appointment. I can prove with data and graphs that my highest temp is 98 even and my average temp is about 97 even – and they all say I’m crazy.

    Which is why when I get a fever, I drink more water, take some vitamin C, and let it burn off whatever it is that is making me sick. And yet I (as well as my 3 and 4.5 year olds) were able to survive the “Swine Flu” and 104-105 temps last year without being told to take antibiotics (that weren’t necessary) or get a vaccine for the same damn thing after the fact.

    A fever is just the body’s way of killing off the virus. If it doesn’t last more than a couple days, everyone needs to just chill the heck out. Bringing your snot-nosed febrile kid to the doctor’s office and letting them sneeze all over the toys is just your way of sharing the bug with everyone else. Then going to the grocery store to fill the unnecessary Amoxicillin Rx just gets the little old people waiting for their blood pressure meds and insulin refills sick, too. Stay home, feed them (and yourself) some chicken soup and orange juice, and get some rest – for everyone’s sake!

    • Nurse K says:

      Um, why are you randomly checking your temp? That’s a bit bizarre…

      • Gene says:

        Likely for fertility reasons. Natural family planning techniques use basal body temps (among other things) to track fertility. A woman’s body temp increases right around ovulation a few tenths of a degree (F). Women who are either trying to conceive or trying to avoid pregnancy often track BBT to assist in their endeavors. I personally know several couples using this technique. It is not uncommon.

      • Nurse K says:

        Hm…Nuva-Ring vs. “checking your temp”…I’m going Nuva-Ring.

      • Felix Kasza says:

        Nurse K — there are folks who measure BBT to _increase_ their chances of getting pregnant. You seem blissfully unaware of anything fertility-related beyond the Nuva-Ring.

      • Mama On A Budget says:

        Yes – to GET pregnant. Thanks.

        Some of us prefer to trust our bodies over big pharma. Nuva ring… around for 5-10 years. Temperature rising at/after ovulation and changes in cervical position and discharge… since the dawn of man.

  6. Nurse K says:

    I think this was intended for children and worrisome young adults with fevers, although it doesn’t really say.

    However, I’d like to give a little shout-out to the fact that very elderly people with serious infections often have no fever…20-30% in fact.

  7. Nick says:

    The low-grade fever is rant-worthy, to be sure. Maybe not as frustrating as allergies (which you covered very well last year) but pretty bad.

    My fever peeve regards decimals. The nursing home tells the family the patient’s temp was 100.6, but when they’re telling me in the ED, it becomes 106. At least in that case there are records I can fall back on.

  8. DefendUSA says:

    Off topic, sort of. I never had trouble getting pregnant…but I did do the BBT as part of a paper for college. I actually discovered over 3 months of measuring that I ovulated twice a month!! I spent a ton of money to confirm it with those predictor tests, too. I got pregnant on the 7th day, 23rd day, 19th day and 14th day respectively with my four kids. I still find that amazing and I did document it!

    As for my kids and fevers…I used the tympanic thermometer, but many times felt it was wrong and did a rectal to confirm a high fever.

  9. midwest woman says:

    Body Heat..if anybody remembers that movie…Kathleen Turner was always a sizzlin’ 100 degrees or somethihg like that.

  10. SeaSpray says:

    Both community hospitals I am familiar with use tympanic thermometers ..both in the ED and on the floors. I often guide them to put it all the way in and nurses say it doesn’t matter..which doesn’t make any sense to me because when I guide them in they kind of have to go around the bend and I can definitely tell a difference. I would think it would be warmer all the way in then just on a ledge in the outer ear. ?? Does the depth matter?

    And ..if no one should use these tympanic thermometers ..then *WHY* do hospitals use them …and does it matter ..does the temp accuracy matter?
    ************************
    I used to take my basal body temp for about a year. I had infertility concern with first child. However ..when you’re afraid you may never conceive ..you become a *slave* to the chart and it can get mechanical. You get so obsessed with timing.
    **********************
    The Soup Nazi – My FAVORITE Seinfeld episode! Ha ha! When I think of all the scenes in that episode ..but the Soup Nazi – EXCELLENT! :)

    Another favorite – Scrubs – My Machines!

    http://www.positivemedicalblog.com/2010/08/doctor-didnt-yell-at-me.html

    I can watch that over and over and over and over again and now will before signing off. :(

    That actor is just PERFECT playing the extremely irate radiologist! :)

  11. SeaSpray says:

    “I can watch that over and over and over and over again and now will before signing off. :(”

    That was supposed to be a HAPPY smile face. :)

  12. hannah says:

    We had a guy that kept coming in with lowish “real” fevers (101 or so); finally got diagnosed with malaria. That was kinda cool.

  13. ERP says:

    I get irritated with that too. Just last night I had “Oh, I checked my temp and it was 99.0 so I have a fever since I usually run at 96.5″. Yeah right, prove it to me.

  14. SeaSpray says:

    One more thing …my normal temp was always 98.6 …until I had sepsis, etc back in 06.

    But ever since then ..my norm seems to be in the 97s.

    I did ask a doc about it and I don’t recall his explanation ..but an illness like that can cause the normal temp to reset to a lower norm.

    Can anyone explain that?

  15. doc99 says:

    Truly a pity that hit TV show was called ER.

  16. Roberto says:

    According to this article the gold standard for temperature measurement in the clinical practice should be RECTAL temperature. Oral temp outperformed tympanic temp measurement. All patients seeking help in the ED for ‘low grade fever’ should be alerted about these facts, and thus all need to have their temp measured up their ass.

  17. Mandy says:

    Peds do not always send fevers to the ER. When my son had a fever of 106 and we couldn’t get it go down with Motrin, I called my pediatrician (middle of the night) and he told me to just give him Tylenol with the Motrin–it worked–got it down to 103 and my son was able to sleep.

  18. Blacksails says:

    Nurse K, when are you going to reopen your blog?

  19. jb says:

    Of course, the urgency in which moms think their child needs immediate medical attention is directly correlated to whether or not they are on medicaid. It is only going to get worse now that more people are about to get “free” care…

  20. Stalwart Hospitalist says:

    “Low grade speeding.”

    HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

  21. abi says:

    in no way do i find that a fair statement. i am a mother on medicaid. i dont rush my son in for everything because its free. i took ny son to the er last night because his fever kept spiking to 104.4 despite the tylenol and motrin i had been rotating in four hour intervals. you must be the kind of know it all nasty nurse i put in there place last night. i am finishing my training as an ma now so im not an idiot, im just poor hence the medicaid. i would suggest if ypu dont enjoy working with cranky people without adopting there attitude, you should probably find another career.

  22. pet peeve…

    [...]Low Grade Fevers | WhiteCoat's Call Room[...]…

  23. Concernedmother says:

    When you have a child with a fever that pretty much does not break down regardless of following the instructions (Tylenol every 4 hr), crying with headache, tummy ache, does not want to eat anything, lost almost 10lbs in 5 days, what a mother should do then? I have insurance and not on Medicaid. I don’t think it is any doctor’s business for being cautious with my child. You are getting paid so what do you care how frantic a parent feels. Doctors attend medical school to put parents and children’s mind at ease and to get paid comfortably. But I may be wrong. Maybe their main focus is the almighty dollars. Those same doctors are the ones who will quickly contact child services to state that the parent was negligent and if he or she had reached out immediate medical attention, this or that would not happen. So you know what, maybe some of the doctors in here chose the wrong profession and need to return to school for something else. This is a person-approach type of career just like Sales or Customer Service. If you (doctors) are grouchy all the times and start taking everything personal, then you will always need to post frustrating comments in similar sites to release your nerves. So chill and do your JOB!!!!

  24. Victoria says:

    OP
    Who the hell are you? You sound like an imbecile. Is this post supposed to be amusing? You seem hung up on semantics. You may not like referring to a borderline fever as “low grade” but it is a valid way to describe it. Also, as the first commenter said, there are physicians out there who will consider a 37.7 temperature to be above normal. But even if you don’t, it strikes me as ridiculous that you would waste time ranting about concerned parents. It seems that someone wants (needs?) to feel important. Were you not given enough attention growing up?

  25. AA Surgeon says:

    First World Problem. Be thankful for the compassionate parents that bring in a child for a “low grade temp” instead of the ones whose neighbors have to bring in their battered children.

  26. Alyssa says:

    So I care for a little one, I’m the nanny, anyway…the boys that I watch have a body temp of 97.4 when they are healthy. I’ve checked, many times while they are healthy. The mom is the same way. Anyway for the last 4+ months now, the baby, who is 16months has had fevers, almost daily…they usually brake with “Tylenol” and run from 99.4 (according to you not a fever) to 102. A few times 103 to 104. He has also been exteamly fussy these past months, and has at least 3+ movements of diarrhea per day. His doctor says not to worry unless he has like 5+ movements a day. He’s just not himself. His appetite comes and goes. I know that’s normal but this isn’t. I know you can’t diagnose, but does this sound like anything..? At what point do we take him back to the doctor?

  27. Lolo says:

    Err…Here’s a story about why “low grade” or non-febrile “fever”, or maybe “subjective fever” is a better terms, is an important piece of the puzzle, even and perhaps especially when it disappears by the time the patient is triaged. I seem, it first glance, like the kind of neurotic somatosizing attention seeker that clot ERs and inspire frustration, disdain, and belligerent blogs: Anxious, wan, complaining of “low-grade fever” and headache that improve miraculously by the time the disgruntled resident who drew the short straw arrives to examine me. In Dec 2011, I presented to the ER of a nationally prominent teaching hospital with all the vague symptoms you might reasonably hate at 3 am on a Friday-Sunday shift. I was told by a smirking resident I had no fever. When I quoted his hospital’s own outreach pamphlet he threatened to call security (clearly my supine position and crushing headache belied murderous intent…) I demanded to see his attending, and we discussed Dr. Smirking’s education. I was then discharged without any treatment or test.

    I subsequently discovered, ten days later, that I was suffering chronic CO poisoning within my home.

    There is no excuse for this in the NW, where “flu-like symtpoms” beset residents as soon as it gets cold and gas heaters are turned on. The CDC, the news media, public service announcements all warn that CO poisoning is the most common missed ER diagnosis, because CO poisoning mimics the flu, allergies, a cold…causes headaches, malaise and elevated body temperature. Some studies have suggested more than half of “flu” Dx in cooler months are, in fact, CO poisonings. CO poisoning often “resolves” in the wait for ER attention: Carboxyhemoglobin’s half life is only a few hours.

    And before you whinge about the impracticality of running a carboxyhemoglobin blood test on every fluish patient, please remember there are now portable pulse spectrometers that can distinguish serum Osat from carboxyhemoglobin saturations. Your hospital probably has one. If it doesn’t, go straight to risk management and demand one. Sound like too much trouble for a pain in the ass subset of patients? You might want to consider the cost-benefit analysis of a $45 blood test versus a malpractice suit for failure to Dx.

    And yet, I think I still hear the resentful teeth-grinding of ignorant curmudgeons. Still, there is NO EXCUSE for missing a CO poisoning. Even without a portable COhb enabled P-spect, even before the bloodtest(which ought to be routine during winter months in cold climates) comes back, ONE SIMPLE HISTORY QUESTION CAN SAVE YOUR ASS AND SPARE YOUR PATIENT A WORLD OF HURT:

    “Have you recently turned on or started using a different gas heater/ woodstove/ fireplace/ boiler/ old water heater/unvented gas cooking stove?”

    Are you really to busy to ask that one question? Or is it that you’ve become so hardened to ignorance you fail to recognize it in yourself?

    And why should you “be nice” to “difficult patients” like me? After all, haven’t you been taught that we’re litigious, and that your chances of being sued increase with contact time? Maybe. And maybe not. The prestigious teaching hospital failed me, and the attending missed my Dx. I suffered substantial harm as a result. But because the attending treated me with respect and kindness, I could not fault him for his mistake and have no desire to litigate.

    Believe it or not, I actually do know how hard your job is even without “difficult” patients like me. Indeed, the reason I and others like me often give you too much, largely irrelevant information is because WE WANT TO HELP YOU HELP US.

    And in case you’re wondering: When you took your CPx to get your license, your “history” segment was one I helped beta-test and standardize during the initial development of the CPx. To be a doctor, you must have credentials. But it is seeming to me that increasingly, to be a “successful” patient one must be bland as store-bought pudding.

    Hippocrates has left the building–but wasn’t that Freud I saw in the lounge?

  28. holyroar6 says:

    Hmm… All of my children suffer from genetic autoinflammatory disease ( HIDS/ TRAPS). When they flare they will run temps as high as 106. Now that being said they will run what we call low grade fevers between 99.5- 101 we call they low grade because they are taking maintenance NSAIDS daily so who knows what the temp would be if they were not on the NSAID. It may not be an “actual” fever to you but one can still feel pretty lousy with 99.5- 100.4. Just a not Dr.Kastner at the NIH you know what the NIH is right? the National Institute of Health recommends treating these flares at 99 degrees because if you don’t they temps rage and the flares are harder to control. We HATE going to the ER and only go if we can’t get a fever to drop…because I Hate running into healthcare “professional” who don’t know what they’re talking about…we’ve been battling this for 17+ years please don’t treat me like I’m an idoit.

    • WhiteCoat says:

      Hmmmm.
      Hmmmmm.
      That’s it. You’re getting a slapdown.

      OK my punctuation-challenged commenter, show me where “Dr.Kastner at the NIH you know what the NIH is right” says every person in the emergency department with a temperature of 99.5 requires aggressive “fever” management.
      Yeah. Didn’t think you’d find anything.

      But, while we’re at it, maybe we should change standard medical treatment for every patient in the United States whose parent thinks he or she feels “warm” because you’ve got a chip on your shoulder over your kids’ genetic disease. My kids have a genetic disease, too. Maybe I could impose all of their medical restrictions on your family while we’re at it.

      If you’ve been battling healthcare professionals who don’t know what they’re talking about for the past 17 years, then why don’t you go see Dr. Kastner next time your kids have a “fever”? Get his cell phone so you have a direct line at all times to his competent care. See how well that works for you — HE DOESN’T TREAT PATIENTS.
      You expect “ER” physicians to have an in-depth knowledge of every possible disease and genetic syndrome on Earth then be at your beck and call when you snap your fingers and walk into the emergency department spouting off run-on sentences about how your kid needs STAT ibuprofen with a normal temperature? Get a clue.

      If you don’t want to be treated like an idiot, don’t act like one.

      • holyroar6 says:

        Yes my punctuation and grammer isn’t the best when I’m tired or my spelling for that matter. You are taking my post as a personal attack, which it was never meant to be. I don’t expect my ER docs to know every possible genetic disease and we don’t go to the Er for ibuprofen. Actuaally I can email Dr.Kastner and my pediatric rheumatologist.
        The point of my post was not everybody with temp under 100.4 is normal and maybe just maybe you could show some kidness and understanding to some weary parents who may be struggling with something your not familar with? By the way I don’t have a chip on my shoulder. let me give you a case senerio. 16 year old son spikes a 106 degree fever and we are sent by our pcp to ER. By the time we get there and sit through triage temp has gone down to 101. We are then told by the ER personel there is no possible way your son has had a 106 temp he wouldn’t have been able to walk in here !??? He way more tachacardic(sp?) then he should have been with 101 temp but because I’m just his parent and they are the professionals what could I possibly know? Those are the battles I was talking about. We are ever so thankful for the wonderful healthcare professionals that we deal with on a regular basis it would be nice to encounter that in the ER whenwe have to go in also.

    • Grumpy Old Bastard says:

      Your children all suffer from both HIDS and TRAPS? How unusual for 100% of children in a family to be suffering from two very rare genetic disorders, one autosomal recessive and one autosomal dominant, with defects in both chromosome 12q and chromosome 12p). The geneticists must love studying your family.

      It’s also odd that you say you only take your kids to the ER if you can’t get their fevers to drop, yet as per your second comment, an hour or two in an ED waiting room is all it takes to magically lower their temp from “106” to 101. I hope you gave that ED glowing Press-Ganey scores for having worked such magic.

    • Grumpy Old Bastard says:

      Also: “Just a not Dr.Kastner at the NIH you know what the NIH is right? the National Institute of Health recommends treating these flares at 99 degrees”.

      Every single one of your children suffers from these two rare genetic disorders, and you’ve been dealing with them for 17 years, and your regular doc hasn’t helped you learn how to treat these flares at home so you don’t have to keep rushing off to the ED? What can an ED do for a child with periodic fever syndrome running a 99 degree temp that a parent can’t do at home?

      Don’t subject your kids to hospitals unnecessarily. That’s where all the sick people are.

      • holyroar6 says:

        I have 4 children each have one mutation for HIDS. And two of them have the one mutation for HIDS and Traps. Yes we hit the genetic lottery. We do not go to the ER for 99 temp. Do you guys really read a post before answering or just react to what you don’t like? We treat a temp with prednisone at home when a temp is at 99 because if we don’t treat then it tends to be harder to control the higher the temp. We try not to go to the ED at all they are on immune suppressant meds. There have been occasions when a temp won’t drop no matter the nsaid or prednisone and then we have to go in and yes once we sat in the ED and by the time we were seen med given at home have kicked in other times they have been admitted to peds floor.

        The only reason I responded at all to this post was to point out that sometimes a temp under a 100.4 should be taken seriously. That not all parents just drive into the ED because they have nothing better to do. And it would nice to be met with compassion instead of arrogance and contempt by those we are looking to for answers. A lot of peds docs. have never heard of periodic fever syndrome it took us 9 years to get a diagnosis.

  29. How disgraceful you are to the medical profession. Those of you who think you are high and mighty, and know it all… posting that a temp. of under 100.4 is nothing to be concerned about…. that a temp like that is not a fever and basically nothing to worry about. To concerned parents reading this ridiculous thread, if your child is running frequent temps over 99.5 this should alert you that something may be wrong. Perhaps it doesn’t warrant a trip to the ER but certainly must be brought to the attention of your childs Dr. and should not be blown off. For my daughter a temp over 99.5 is typically related to a Lupus flare. Most often this is accompanied by extreme fatigue and chronic pain. Even on the naproxen she takes for inflammation and the disease modifying medication, plaquenil. And before you snarky @$$holes try the same $h!t you tried with HolyRoar6… Yes Kids get Lupus too. Maybe you should go back to med school and study up about Autoimmune disease. But please, don’t even consider going into ped. rheumatology and try to treat my my child with your condescending, narcissistic attitude.

    • JustADoc says:

      A temperature is but one data point. If the ‘elevated’ temp is the only complaints than I am unlikely to greatly care.
      However if it is accompanied by severe ear pain, abdominal pain, rash, shortness of breath, sinus pressure of 7 days duration, undue fatigue, new joint pain, or something else that suggests possible bacterial infection OR you have a history of some disease where slight changes in temperature have some meaning than this post is not about you.

    • WhiteCoat says:

      Yeah. My kids stop listening to me any time their temperature goes above 97.7 degrees. I keep telling their pediatrician about it and he just says to give them Tylenol, but it never seems to work.

      You’re another one who apparently thinks that medical treatment for the entire universe should be modified to conform to your child’s idiosyncrasies. Let’s give everyone DMARDs for a “fever” of 99.6. Woo hoo.
      So you mean to tell everyone here that your pediatric rheumatologist busts out the immunoglobulin every time your child has a “temperature” of 99.6? Bull.
      When you find any medical articles that suggest testing a child to see if “something is wrong” when the child has a temperature over 99.5, you post them here.

      Until then, if you’re relying on solely the presence of a 99.6 degree “temperature” to clue you in to your child having a lupus flare, then maybe you should read a little more about your child’s disease rather than running your yap on a medical blog.

    • DefendUSA says:

      Dear SIL: This post is not about patients who are exceptions to the rule. It seems you are taking this quite personal and you shouldn’t be. It appears that with either syndrome that children can go years without a fever and if they do have one often present with multiple symptoms. Hence the term “flare up”.
      For you to become so indignant when WC was clearly referring to people who should wait to see their GP if a fever is the ONLY symptom is just over the top. The attitude is not condescending or narcissist, but a result of frustration that people (and some general practitioners) not using common sense. It amounts to wasted ER resources and money, frankly.

  30. Victoria Ashley says:

    I have to say, I’m kind of surprised by some of the “Dr’s” comments on this thread. There is in fact such a thing as a “low-grade” temp/fever,& no it’s not nearly as serious (obviously)as a regular fever(& usually it doesn’t warrant a trip to the ER,unless the pt has some kind of underlying condition etc.) HOWEVER, with that being said…have some compassion please. This exact attitude is one of the main reason’s for the major lack of respect now for the healthcare professional in the last few years!!

    Not all future patients are up for a Darwin award Doc’s. Trust me, I get it (I’m a nursing student, so I literally see both sides of it, & sometimes the pt can be in the wrong & give the Dr undeserved grief & expect them to be Houdini.)

    Generally speaking though, parents are in fact intuitive(& can be right at times)when it comes to their child (yes,some parents can be overly extra-anal & in you’re head you can’t help but want to scream the word “Munchhausen’s” just so they stop.)However,for the regular half-decent parent, they really are just trying to do what’s right. I highly doubt most parents are thrilled at the prospect of sitting in an ER for all hours of the night, extremely tired,& with a child who isn’t feeling well. All to be told by some Doggie Houser lookalike, that it’s “no big deal” & treated like they are nothing more then over-dramatic idiot’s who wasted the very important Doc’s time.

    Put YOURSELF in their shoes Doc, the “you” BEFORE med school. The “you” before “you” knew everything. Just have a little bit of understanding, it’s not a parent’s or a pt’s fault that their particular case isn’t a runner up to help you get a Lasker Award or the like.

    The good thing is that I’ve recently heard,that med school’s are now starting to teach a little bit more about communication & the importance of it. The sad thing is that with the lay-off’s of most RN’S & LPN’s recently,in favor of “MA’s” and “PA’s”(no,NOT physician assistant’s-the other PA.)Who are just taught the simple “skill” & not the reason & theory behind it. Ma’s/Pa’s who aren’t taught(because it’s simply not in their scope of practice to) advocate for the Pt and be a valuable asset for the Doctor(like Nurse’s are required to!) Compassion is going to be nothing but a long lost English word. All healthcare in the future will undoubtedly suffer because of this, most of all the Patient’s and even the Doctor’s.

  31. picklesticks says:

    Our nephew ran a “non-fever” of 99.4 to 99.8 for for more then a week..only other symptom was some intermit. fatigue otherwise he was acting like a normal 7yr old boy..he was diagnosed with leukemia after my sister in law took him to see his pediatrician…so sorry, as a parent of 4 and an Aunt to a cancer survivor..your blog was way off the mark.

  32. Med Staff Credentialer says:

    Regardless of your medical and personal opinions, it’s obvious that you never learned effective communication skills. You’ve shown how you would (and obviously do) relate to parents and others who come to the ED with their concerns, but you have also shown the same blatant disregard for other people’s opinions that have taken the time to post comments. Whether you agree or not, your delivery and smug responses will no longer be tolerated in U.S. hospitals as they begin to fully implement focused and ongoing professional practice evaluations and sound credentialing practices. When someone treats the hospital’s “customers” with this attitude, they should be addressed immediately by the department chair and not allowed to continue this behavior. It can wreak havoc on relationships of patients and other healthcare providers, and it also has the ability to obstruct good clinical care. There are plenty of doctors out there who can deliver good care along with good customer service, and those that can’t conform will be weeded out, probably to work in outpatient clinics or private practices where there is not as much oversight and accountability for bad behavior and possible missed pathology. I hope you are intelligent enough to recognize your improvement opportunities and take advantage of them soon. Otherwise, I hope the medical staff leadership will accept their responsibilities to assist you into another career path. “First, do no harm.” Words, actions, non-actions, verbal and non-verbal communications all funnel into those powerful four words.

  33. Annie says:

    Picklesticks, thanks for sharing your nephew’s story. So sorry to hear about his diagnosis. Hope he’s doing well with the treatments. I have to agree with the importance of following up a persistent “low grade fever.” I’m not a doctor but I have been seen by a team of specialty doctors, all of whom agree that a temp 99.5-101 over 1-2 weeks and still not resolving warrants some work-up/investigation. It could be autoimmune issues, infectious disease, drug reaction, or malignancy. A normal bacteria or viral infection would have run it’s course and the patient should be well on the road for recovery. It is worth noting that GI tract will slow down significantly when the core body temp is above 99.5. When you can’t eat and digest well, you get sicker. Thus, our body is not built to be dealing with a persistent core temp over 99.5 for a long time.

  34. Kane says:

    This is an Emergency Medicine blog. All the exceptional stories here (leukemia, lupus, HIDS) really have nothing to do with emergency medicine.

    The fact remains that there is almost no circumstance in which it is either necessary or appropriate to go racing into the emergency department of your local hospital, child in tow, simply because your child has a slightly elevated temperature. Your child’s regular pediatrician is far better placed to deal with your concerns.

    And whether you like it or not, it’s not technically called a fever (“low-grade” or otherwise) unless it’s 100.4 °F (measured rectally) or higher. That’s not Dr. Whitecoat being mean, that’s just the definition.

    The emergency department is for emergencies. A temperature of less than 100.4 in a child, unless there is some underlying medical condition, is rarely an “emergency” that needs medical attention right away.

    • Emma says:

      I don’t know where you live but in ont if you don’t have a doc which is most ppl … You go to emerg… I’f you call telehealth they tell you to go emerge. My docs answering machine says to go to emerge if it something that requires attention before 2 weeks which is their booking time…

  35. Matt says:

    I’ve had a body temp of 99.3 to 99.6 for the past 6 months. prior to that it was around 96. I was exposed to black mold for 3 years. I know for a fact I’m fighting about 5 different infections. I’ve seen my blood under a microscope. I’ve seen parasites, lyme like microbial cysts. mycoplasmsa, I have gut dysbosis, Sibo. and fungal infection. I has a very vibrant full of life person a few years ago. Now i’m a shell of my former self. I’ve been on all the protocols for mold and lyme but it’s just not breaking.. In any event. a 99.3 persistent low grade fever is something to take seriously. Maybe if it only happens once in a while no big deal. But if you feel like crap and the fever is constant chances are you have something chronic.

  36. Katie Lemos says:

    You’re kind of a d!@%. I am very lucky to have very healthy kids. My oldest daughter has been on an antibiotic once when she was five and had a temperature of 103.5 due to a kidney infection. My second daughter is 18 months and has yet to be on an anti biotic. I, on the other hand, am not so lucky. I was hospitalized with bacterial pneumonia twice. Both times my temp didn’t get above 99.6. The my symptoms, examination, and xrays said I had pneumonia but the entire time I was in the hospital I never had a ‘fever’. I understand why parents freaking out over the bodies natural response can be annoying but do you really have to be so douchtastic about it.

  37. Christy says:

    I know you will just flame me, and I don’t really expect anything different after reading the posts and comments made here, but the majority of you are in the wrong profession. It is so disheartening to see that doctors and health care professionals are so cold and callus. It is unfortunate that bedside manner is not more important today. Please remember that one day you will be on the receiving end of this one day when your health fails you, and for your sake, I hope your health professionals have just a touch more sympathy and respect than the folks here seem capable of showing.

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