Shortly after I started as the telehealth nurse practitioner I encountered a “repeat offender”, a child who often visited through our broadband link only a week or two after completing a course of antibiotics. Often there was an infection, and sometimes it was a middle ear effusion (fluid behind the ear drum without infection) causing pain. At first I wrote notes for the mother saying, "Schedule appointment with your Primary Care Physician (PCP) to discuss treatment options for frequent ear infections”. Then I spoke with the mom through the telehealth link about the need to see her PCP to discuss treatment options. Finally, I demanded that she see her PCP because of my increasing concern about the child’s (1) discomfort, (2) diminished hearing because of the middle ear effusion, and (3) potential for the persistent effusion to impair speech development.

The Certified Telehealth Assistant in the child care center (CTA) and I worked together to make sure the child was going to get the care that was needed. Every day we would print one of "ear boy’s” photos. By the end of the week mom had eight dated pictures in sequence that showed her son's ears in different stages of effusion or new infection. With the pictures in hand, it now all made sense to her and she was comfortable talking about her options for treatment with her PCP. By now, we had frequently discussed the different approaches.

Mom scheduled the visit armed with her pictures and some specific questions. Low and behold, the PCP visit led directly to an ENT referral, and placement of PE tubes occurred 2 weeks later.

I guess the childcare center staff is a little miffed, because now he never stops talking, understands everything they say to him, and still ignores them 1/2 the time - only now it’s on purpose!

Jeanne Caudle, PNP
Health-e-Access Telehealth Network