Second Guessing

My dad is in the next room, and I think he has pneumonia.

I listened to his lungs, and it sounds like a pneumonia. He was coughing like there's no tomorrow, but the anti-cough medicines I've given him seem to have calmed him down. His respiratory rate is less than 30, and he says he's not having a hard time breathing. I've already started him on oral antibiotics with good coverage for a wide range of possible bugs.

So why am I still awake at 2:30 AM trying to decide whether I should bring him to the ER or not?

You'd think that after 3 years of training in Internal Medicine, I'd be sure of what to do next. After all, I've seen already so many cases of pneumonia, seen patients falling into the full range of the disease. As part of my training, I've evaluated these patients in the ER and in the out-patient clinic and have made quick rational clinical decisions about who can be treated at home and who should be admitted.

I've just finished reading the chapter on pneumonia as part of my review, and I don't think Dad needs to be admitted. Sure, he's a diabetic and hypertensive, but those two conditions are stable anyway. I guess he'll be okay here at home. I haven't even confirmed it's really pneumonia. Maybe I didn't really hear anything.

Or maybe I'm just in denial.

I'm bringing my dad to his doctor as soon as the sun is up. His doctor can decide whether to admit him or treat him out-patient basis.

This plan of action is sure to get my parents' goat yet again. We've had this argument too many times to count. They will play the "what's-the-point-of-your-medical-degree-
if-you-can't-treat-us-anyway" card. I will come out looking like their useless child but I will drag them to a doctor's office anyway.

What most people, especially my parents, cannot understand is that once you're dealing with diagnosing and managing your close family members, all that medical training goes out the window.

Objectivity, an essential element in the clinical decision-making process, is all but impossible. It's easy enough to make treatment decisions for people who you can hold at a certain distance, thinking in terms of likelihoods and probabilities. When you're this close to the ones you are treating, this second guessing simply cannot be helped. It doesn't matter that you're supposed to know better - in that moment, you don't.

So while I think my dad doesn't need to go to the ER right now, I still won't be able to sleep - because I could be wrong.

These are the moments when I have to say it really sucks to be the only doctor in my family.