physician responsibility

Today, I was reading Dr. Rob's blog, Musings of a Distractable Mind (http://distractible.org/2008/07/30/do-you-trust-your-doctor/) concerning the doctor-patient relationship and trust. I agree that there are many components to this relationship, it is definitely not as simple as I think it used to be! We, as physicians, are under time and insurance constraints, we worry about malpractice, and we worry about keeping up with the most recent advances. As patients, we look up information on the internet, we worry about costs of our visits (co-pays, deductibles, etc.), we worry about our illness of course, and we often have to wait to be seen which can make us grumpy. Doctors no longer are the all-knowing father or mother figure. I think this is a positive change! I like to get input from families when I come up with a plan, of course, only if they agree with me! No, seriously speaking, I do try to review my plan of action with the parent(s), especially when I don't know what illness I am dealing with. I also make it clear that I don't know, I don't try to hide that fact.

All this aside, it still hits me when I realize the trust that parents do place in me. I had young parents in this week with their two year old who they worried had west nile virus. After carefully listening to their concerns (she had vomited a few times the previous day and had a decreased appetite) and carefully examining the child, I reassured them that it was unlikely that she had this disease; they left my office clearly relieved. The little girl was happy, playful, afebrile with a completely normal physical exam, and did have a few mosquito bites. I am very grateful that her parents trust me, but as usual, I worry at 3 am about my conclusion that she was OK. What gives me the "power" to say, "I think your child is fine, I think she has the same viral illness that many of her friends have right now, and she has a few mosquito bites on top of this?" Yes, I know, four years of medical school, three years of residency, and a few years of practical experience. But, wow, that's a big responsibility we have as physicians! It's just something I didn't really think about during residency because there was always an attending backing me up or correcting me, now I'm it! It's a tremendous honor to do this work, yet it's also a burden/challenge/constant worry. Perhaps I can relax with a few more years of experience under my belt....we'll see!