While on call recently I received a call from the mother of a child who was nearly 4 years old and complaining of fever and a rash. Anyone who cares for children knows that when you get called about fever and a rash, you want to make sure that it’s not something catastrophic — such as meningococcemia.
There are, of course, a number of other illnesses that can present with fever and a rash. However, being on the telephone and not in the room with the child makes diagnosing challenging. In the past, I have tried to determine over the phone if the rash is “blanchable.”
I also try to figure out hydration status, as well as patient history in order to decide whether this is a child who needs to go to the emergency room, needs to be seen by us the following day, or just needs reassurance.
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The mother also told me that her child had begun to complain of a sore throat that day, was still febrile and was much more fatigued than normal — he had even taken a nap, which was out of character.
Given liability concerns, in the past, many providers would have referred the child to an emergency room or possibly a local walk-in clinic — and appropriately so.
Instead, here’s where modern technology enters.
I had the mother text me over the phone some photos of the child, including the pharynx and the rash. From the photos she sent I was able to assess his hydration status based on the moistness of his mucous membranes. The photos of the pharynx were of remarkable quality and revealed obvious visible palatal petechiae. In the last couple of photos, it showed diffuse papular erythematous rash.
Given that I now had a child who had fever, sore throat and a papular diffuse rash, I was able to inform the mother that this was most likely streptococcal pharyngitis — the rash indicating that it was the form known most commonly as “scarlet fever.”
I sent an electronic prescription to the pharmacy for an antibiotic, and encouraged the mother to push fluids, use some acetaminophen or ibuprofen and to bring the child in to their physician the next day. And, of course, I reviewed what to watch for regarding signs and symptoms of worsening illness — which would require a visit to the ER.
This simple use of technology not only averted the inconvenience and discomfort for the child of a trip to the ER, it avoided exposing him to additional illnesses and avoided exposing others to what he had. It is also likely that I was able to get him started on treatment faster than would have happened had he been seen in the ER. Plus, he would be able to follow up the next day with his own physician and continue treatment.
All went very smoothly with a lot of positive benefits.
Now what we need to do as physicians and providers is to continue to lobby the insurance companies to be reimbursed for providing our care and expertise for this form of treatment. We are, after all, assuming liability.
