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.
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.
Most excellent post, sir. You had me in stitches this morning!
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.
Bravo!
Here, here!
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.
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!
Um, why are you randomly checking your temp? That’s a bit bizarre…
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.
Hm…Nuva-Ring vs. “checking your temp”…I’m going Nuva-Ring.
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.
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.
http://www.tcoyf.com/
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.
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.
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.
Body Heat..if anybody remembers that movie…Kathleen Turner was always a sizzlin’ 100 degrees or somethihg like that.
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?
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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.
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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!
“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.
We had a guy that kept coming in with lowish “real” fevers (101 or so); finally got diagnosed with malaria. That was kinda cool.
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.
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?
Truly a pity that hit TV show was called ER.
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.
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.
Nurse K, when are you going to reopen your blog?
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…
“Low grade speeding.”
HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!
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.
pet peeve…
[...]Low Grade Fevers | WhiteCoat's Call Room[...]…
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!!!!
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?
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.
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?
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?