When a baby is sick, parents are often anxious and can’t replace the baby’s pain with their own sickness, especially when the baby needs to undergo some scary-looking tests, emotional parents often can’t judge calmly, and may even refuse some necessary tests, sometimes resulting in tragedies that could have been avoided, because of this situation caused by doctor-patient disputes repeatedly seen in the media. After the emergence of microblogging, this new era of self-media has also become an effective means for parents of affected children to “complain” about “unscrupulous hospitals” to the public, such as a dispute at a hospital in Zhuhai, which was a typical example of the furore on the Internet a while ago. The mother of the child said in microblogging that the hospital was irresponsible misdiagnosis and mistreatment led to the death of the child, a time that led to tens of thousands of netizens vocal criticism, but when the hospital also issued a voice in microblogging, showing evidence that it was precisely the mother’s refusal of lumbar puncture is the most critical factor leading to the tragedy, things have reversed …… then lumbar puncture What’s the deal with lumbar puncture? Why do some parents refuse? There are similar scary looking tests that are actually useful, let’s take a look. The actual situation is not every time the diagnosis and treatment activities can be smoothly hand to the disease, the condition is very variable, in order to get a good treatment effect, the most important premise is to have an accurate diagnosis, otherwise the treatment effect is not guaranteed, the so-called “cure The so-called “cure” can only be a blind cat touching a dead mouse. For that kind of disease with a very typical clinical manifestation, diagnosis is often not difficult, but the problem is that not every patient is so typical, otherwise, as long as you can memorize the textbook (the textbook description of the typical situation) can become a doctor. Relatively speaking, the more typical the onset of the disease is, the less auxiliary tests the doctor may use; the more atypical the onset of the disease is, the more evidence the doctor needs, and many families do not understand why they do more tests than others, in fact, in most cases because of this, in order to clarify the diagnosis and catch the “culprit”. In fact, in most cases it is because of this, in order to clarify the diagnosis and catch the “culprit”. Due to China’s national conditions, most parents’ acceptance of ancillary tests depends on two factors: first, the economic factor, whether the test is expensive and whether the medical insurance covers it; second, the pain caused by the test to the child. It is not necessary to mention that tests such as urine and stool retention and venous blood collection can cause babies to bawl, but most parents can readily accept them because they are too common, but many parents are easily confused by tests that look scary, even though some invasive tests are indispensable for diagnosing certain diseases. Cerebrospinal fluid testing is essential for central nervous system infections such as septic meningitis (also known as bacterial meningitis) and viral encephalitis. The doctor will recommend cerebrospinal fluid testing when there is fever, headache, vomiting, or even impaired consciousness, when there are signs of meningeal irritation on physical examination (e.g., the doctor will move the child’s neck to check for this sign), or when the fundus examination reveals optic papillary edema. Cerebrospinal fluid specimens are usually obtained by lumbar puncture (in very special cases, live ventriculocentesis of the cerebellar medullary pool is used). This test has a more frightening name among the Taiwanese folk in China – pumping keel water, which is unsettling to the ear and can easily give rise to extremely painful associations. The cerebrospinal fluid is just a colorless, transparent liquid that circulates on the surface of the brain and spinal cord, and a few milliliters are taken to have little effect on the human body, so I don’t understand why my Taiwanese compatriots call the cerebrospinal fluid keel water, as if there is much mystery. In fact, most people worry about this test, probably related to a misconception, the vast majority of people will think that the long lumbar puncture needle will be stuck to the spinal cord, in fact, in the human development process, the spinal cord and the length of the spinal column is different, the latter is longer, and the lumbar puncture area happens to be located in the area without the spinal cord, can only be penetrated to the cerebrospinal fluid inside, it is impossible to hurt the spinal cord. But in practice, the operation consent form that requires the family to sign does list too many possible dangerous situations, but this is not to excuse the doctor from responsibility, in fact, if there is a problem in the treatment process, no matter what word is signed the family can be held responsible, the signature process is only to meet the family’s need to be informed, not the doctor’s shield. It is extremely rare that a lumbar puncture performed by a qualified physician will result in adverse consequences for the child, and more critically, the risk of lumbar puncture itself is negligible compared to the potential dangers associated with refusal. However, there is a problem with the positive rate of any test, and it cannot be expected that any lumbar puncture will bring definitive results; sometimes, a lumbar puncture will simply rule out a portion of the aggressive disease. Typically, a successful lumbar puncture requires a pressure measurement followed by the collection of three tubes of cerebrospinal fluid, 1 to 2 ml each, the first for bacteriology, the second for biochemistry and immunology, and the third for cell counting and classification (a separate tube is left for exfoliative cytology when malignancy is suspected, which is rarely involved in pediatrics). Through this examination, with ancillary tests including cerebrospinal fluid examination, combined with physical examination, the physician will make a diagnosis and assign a treatment plan. In the case of septic meningitis, for example, early diagnosis and timely treatment are critical to the prognosis of the child, and missed opportunities for diagnosis and treatment can have worrying consequences. Therefore, in febrile children, once abnormal neurological signs and symptoms appear, lumbar puncture cerebrospinal fluid examination should be performed as soon as possible to clarify the diagnosis. Some parents may wonder why this test was done yesterday and why it is being done today! That is because sometimes in the early stage of the disease, the routine cerebrospinal fluid examination may not have obvious abnormalities, while other clues are highly suspicious of septic meningitis, and then it has to be rechecked after 24 hours …… Clinical workload is extremely heavy, and if there is poor communication at this time, and it so happens that the parents are in the mindset of suspicious neighbors stealing the axe to examine the doctor’s disposition. I am afraid that everywhere will be full of doubts and conflicts will be inevitable. Similarly, bone marrow aspiration for leukemia and thoracentesis for pleural effusion are essential invasive tests, and when parents refuse these tests, they are actually putting the child in a very dangerous situation. We must admit that it is almost impossible to achieve perfection in the process of diagnosis and treatment, so the two most likely cases are “too” and “not”. Usually doctors mainly make judgments based on the general rules of disease, the probability of occurrence and the results of clinical experience, this process may not always have the so-called “gold standard”, quite often is doing multiple-choice questions, excluding the ABC then choose D, but sometimes there are more than 4 options, and this process of elimination is easy to put doctors in an awkward dilemma. Too many tests, there is the problem of over-medication; too few tests, it is likely to miss small probability events, endangering patient safety. As a parent, of course, you want the best treatment for the least amount of money, so I can only suggest that you trust your doctor and let him or her feel your trust. Only when a doctor is fully trusted is he likely to take appropriate risks himself and thus use less medical resources to make judgments, after all, the result of using less medical resources is less revenue for the hospital and more risk for themselves, if the doctor and patient do not have full mutual trust, which fool will do so?