“I don’t care what you do ‘just for the heck of it,’” the mother snapped, refusing to fall for the young doctor’s charms. “As long as I get a prescription.”
Kyle cupped his left hand around the child’s chin, to hold his head steady, while he gently inserted the otoscope into the tiny ear. It took only seconds to record the tinge of pink around the drum and the suggestion of a clear discharge; it wasn’t much but it did put forward the possibility that the cold might be moving into the ears, and he might in fact assuage the woman with a scrip for Zithromax without completely compromising his principles. Even as the thought passed through his consciousness, he regretted the impulse. There was no question that antibiotics were still rampantly overprescribed in children, they rarely did any good, and the consequences both immediately, in terms of diarrhea and other digestive disorders, and in the long run—ever more refined strains of bacterial infection which increasingly resisted these previously effective treatments—were not insubstantial.
“Has he been pulling at his ears?” Kyle asked, hoping the hideous mother might provide him with more reason to just do what she wanted, so that he could be done with this.
“I don’t know. Maybe. Why can’t you tell if he even has an ear infection? Isn’t that what that thing is for?”
The woman was awful, no question. That didn’t mean he could do something his medical training warned him would be potentially damaging to her child.
“There’s some indication of a slight infection but honestly I’m not convinced this is bacterial,” he started, cautious. “Unless it develops further there’s really no indication that an antibiotic is going to do anything more than give him a stomachache, on top of the cold. I’m inclined to agree with Dr. Grisholm; it’s probably viral. In a couple of days I think you’ll start to see some improvement.”
The horrible mother didn’t go for it. He had known she wouldn’t. “I came down here,” she informed him, her voice rising. “I came all the way down here and all you can do is tell me he’s sick? That’s ludicrous. And you know I’m going to be charged for this, there will be a copay, or a deductible, and I didn’t want to come anyway, I said, ‘Just give me the prescription!’ And your nurse—whatever her name is, on the phone, she was the one who insisted he had to be seen by a doctor and now I came all the way down here to be charged for nothing? Are you kidding me? I mean, seriously, are you kidding me?”
“I’m giving you my best advice,” Kyle began again.
“Your best advice is not what I want,” she informed him. She took a step forward, reaching out to snatch her child back from Kyle’s now-suspect care. Startled by the suddenness of her move, he took a step backward and relinquished the boy without argument. “I want to see another doctor,” the woman announced. “I want another doctor!”
She had not yet made it out the door, but her voice was loud and had already breached the privacy of the examination room. Kyle knew that she was well within her rights to ask for a third or even fourth opinion on this matter, and that as soon as she had stepped out into the hallway with her impatience and her complaints, the nurses and aides on shift would scurry about and do her bidding, avoiding his gaze as they bowed to the patient’s right to usurp his authority. He also knew there were two other doctors present in the building who would have little trouble issuing a scrip for Zithromax, which is the easiest thing in the world, without even examining the child.
“Could someone help me here?” she yelled. It was excruciating, watching her swing that kid to her shoulder just roughly enough to startle tears and a wail of anxiety out of him. She tossed a contemptuous gaze back at Kyle, as if to accuse him of making her child cry, and turned the doorknob uselessly, while she struggled to bend over and pick up her purse, a brown-and-black designer sack which clearly cost a fortune while simultaneously looking like knocked-off sophomoric junk. He had known girls in college who carried bags like that, from which experience he also knew that women who carried designer bags were not to be messed with. In addition, he was aware that if he didn’t issue the prescription and someone else did, the office manager, Linda, would make note of it in the daily report she emailed to the local headquarters of the HMO which administrated their practice. And then that report would worm its way through seventeen levels of health care bureaucracy, before winding up as a reprimand in the file they kept on him and examined every six months when his performance came up for review.