Canadian Medical Association Journal 1996; 155: 11-20
Squires writes, "another difficult problem is the tendency of those who are knowledgeable about disease to become enured, even deaf, to the concerns of what they interpret to be an over-distraught parent." He should know that the resident spent more than 1 hour examining the child, observing her feed, discussing the symptoms and signs of dehydration (the child had moist mucus membranes and tears), and listening to the mother. These were hardly the actions of an indifferent or deaf physician. In fact, Hunter later wrote of the physician, "I felt reassured that she was finally getting a doctor who was caring and capable."
The editorial goes on to say, "unattended concerns and misunderstood counsel can be fatal." Squires thereby implies that the resident was responsible for Madeleine's death, which occurred more than 24 hours after discharge from the hospital. What Squires did not state was that the mother was given explicit feeding advice and was instructed by the resident to return to the hospital in 6 to 8 hours if the infant failed to urinate or to produce tears on crying. Before leaving the hospital, the mother signed a statement confirming that she had received and understood the instructions.
Madeleine's death was a tragedy, and we all feel enormous sympathy for her parents. But Squires' editorial is misleading and, I fear, does great harm to a young resident who has shown herself to be competent, dedicated and caring.
Robert H.A. Haslam, MD, FRCPC
Professor and chairman
Department of Paediatrics
University of Toronto
Toronto, Ont.
Bruce P. Squires, MD, PhD
Editor-in-chief