Emotional Care, Emotionless Decisions

I was a second-year resident in paediatrics when I first noticed it.An experienced, respected, genuinely good at his job senior colleague had just finished a long night shift.The last patient was a four-year-old brought in for fever and ear pain.The tympanic membrane was slightly erythematous but not bulging; there was no effusion, no systemic involvement.Nothing met criteria for antibiotic treatment, but the mother was a little scared and not speaking well our language.My colleague prescribed amoxicillin and sent the family home.When I asked him why, his answer was honest in a way that has stayed with me: 'I couldn't risk sending him home with something that gets worse, and it was too long and complex explaining pro and cos of such a choice.Not at six in the morning.Not after twelve hours'.Some time later, a mother brought her eight-year-old to the same emergency department with a 2-day history of sore throat and low-grade fever.The child was not particularly unwell-no tonsillar exudate, no anterior cervical lymphadenopathy, a Centor score of one.The mother produced a rapid streptococcal antigen test, performed at a pharmacy the previous day: positive.A different senior colleague glanced at the result, did not examine the throat with particular care, and prescribed 10 days of amoxicillin without pausing to consider whether the child might be a streptococcal carrier experiencing an intercurrent viral pharyngitis.It was a Friday afternoon.The waiting room was full.The consultation lasted 4 min.