Middleman

Besides employers placing ER doctors in the middle of decisions about a patient’s return to work, we also get caught between divorced parents and between parents and their children. This includes parents with minor children as well as parents of adult children. I can tell you that no ER doctor wants to be in the middle of these situations.

In high-conflict situations, it’s tempting to want someone else to solve the problem for you. In high-conflict divorce cases, this often involves one parent bringing the child to the ER for a very minor complaint. The story typically begins with, “Well, they just came back from their dad’s…” or “Mom had them for the weekend…” When I hear that, I know where this is going. The child usually has a minor issue, such as a cough, a stomach bug, a bug bite, mild upper respiratory infection (URI) symptoms, or vague pain. Almost never does the child have a significant medical complaint that warrants an ER visit.

The parent’s reasoning (although left unspoken) is that they’ll face criticism from their ex if they don’t take the child to the ER. They don’t want to be blamed if a minor issue worsens. When the complaint involves mild URI or gastrointestinal symptoms, this logic doesn’t hold up. Viruses have an incubation period, so just because a child returns from one parent’s house after the weekend doesn’t mean the illness developed in the last one or two days. It certainly could have, but it’s just as likely the illness was brewing from the days prior, when the child was with the parent now bringing them to the ER to avoid conflict with the other parent.

ER doctors also don’t want to be the middleman between parents and their minor children. I’ve seen plenty of kids who reportedly complained to their parent about some symptom, often in the context of not wanting to go to school. When asked specifically about their symptoms in the ER, the teenage child often can’t describe anything in definite terms. Their answers are vague about whatever is supposedly bothering them. My conclusion is usually that nothing is actually wrong. Yet, they may complain of symptoms like chest pain or shortness of breath, even though they look perfectly well, their vital signs are normal, and they’re so bored with talking to me that they can’t even take their eyes off their phone.

Then the truth usually comes out. The parent will say, “You told me this was bothering you and you couldn’t go to school, so tell the doctor what’s going on.” The reality is that the child doesn’t want to go to school, but the parent lacks the resolve to make them. So, I become the middleman because the parent isn’t doing their job.