The outpatient pediatrics clinic where I was spending the day had fancy electrified exam tables that could be raised and lowered using a foot pedal. Although I was supposed to be seeing patients on my own, the doctor I was paired with would only let me observe her. She would be the one asking the questions and examining the patients.
The doctor finished examining a 4-year-old girl while I watched. The child was perched on the exam table, which was about 4 feet off the ground. The child and parent were to wait where they were until the medical assistant came in to administer the child's flu vaccination. I walked over to the foot pedal and began lowering the table, because I was worried the child might fall. The doctor motioned for me to stop. "You know," she said, "the child still needs to get her vaccinations." I wanted to argue. The assistant might not arrive for 20 minutes. And when the assistant did arrive, it would take her seconds to raise the table back up. But in working with this doctor, it had become clear that she did not want my input. I simply stepped away from the pedal and then followed her out the door.
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An hour later, I watched the doctor finish examining an infant, an active crawler who was perched on the high-up exam table. Again, the patient and her parent were to remain where they were until the medical assistant arrived to administer the infant's vaccinations. This time, I didn't bother making a move for the foot pedal.
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Ten minutes later, while in with another patient, the doctor and I heard a loud CLUNK that seemed to shake the walls of the clinic. There was a piercing wail and some panicked yelling. I headed to the room holding the infant, because I instantly knew what had happened. When I later examined the inconsolable infant, a bump on the scalp indicated to me that she had landed on her head. The exam table was about 40 inches off of the hard ground. The patient's parent was quietly sobbing.
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At a well-child visit, this infant had suffered a potentially life-threatening injury. It was an injury that I had foreseen but had been forbidden from preventing.
