Flea chastises an ER doc for overtreatment

Flea must be quite the intimidator to make an ER doc cry.

I’m going to side with the ER doc on this. Over the phone, you can’t make an accurate assessment of the patient and thus, it’s tough to call the shots on what tests should and shouldn’t be ordered. If something happens to the patient, it’s the ER physician’s responsibility (and liability exposure), not the pediatrician on the phone.

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  • Anonymous

    I saw this as well. Flea mentions that the ER doc told him she is afraid to call him, was quickly brought to tears.

    Flea is full of himself. There is no reason an ER doc should be afraid to contact a patient’s outpatient physician.

    At least he sent her a somewhat apologetic card.

  • Flea

    Full of himself?

    Anon 12:32, if the blog offends you so, do us both a favor and stop friggin’ reading it!

    best,

    Flea

  • Flea

    Now Kevin, with respect,

    If you are in possession of the facts, decision-making regarding appropriate testing is not as hard as you think.

    best,

    Flea

  • Kevin

    Flea,
    I understand where you’re coming from. We both know that ERs overtest and practice defensive medicine like crazy – well documented on this blog.

    However, I’m not sure about dictating care over the phone when you don’t have the benefit of seeing the patient. When a patient is in the ER, it’s the ER’s responsibility/liability – thus, they should call the shots.

    If you don’t agree with what they do, you are certainly welcome to drive to the ER, evaluate and take over responsibility/liability for the patient. I’d be miffed too if a primary told me what to do over the phone while I was in charge of an ER patient. After all, it’s my butt on the line.

    Respectfully,
    Kevin

  • Anonymous

    Thanks for weighing in, Flea.

    Your hair-trigger, self-serving comments prove the point that you are, indeed, full of yourself.

  • Anonymous

    I completely agree with you Kevin, and I just love the blog world b/c it is much more of an open forum. I can’t even remember a time when I’ve seen doctors openly disagree, I guess because that all happens behind closed doors or it is commonly avoided. Although I am sure all medical staff do disagree at certain points (that’s why getting 2nd opinions are common), it is especially hard for them to admit that they could have been wrong. Flea, for instance was probably in a dicey area with this and he can not and will not see that. He wrote an apology for making the girl cry not because he understands her perspective. I enjoy a lot of what Dr. Flea has to say but I definitely agree that he is a bit full of himself and he really is on a completely different playing field. The one step he needs to take to become a truly outstanding doctor, is to come down to the patients level.

    Thanks Kevin for keeping me updated on medical news!

  • Anonymous

    Okay, I started the “Full of Himself” line, and I’m going to clarify my thoughts.

    First, Flea, your blog is thought-provoking, and I mostly enjoy it. Isn’t the point to have other docs read it and think?

    Your mission, however, seems to be to express outrage at the way other docs waste money or treat unnecessarily: point in case being yesterday’s outrage that a pediatric neurologist wanted to treat a strep infection in a child newly diagnosed with multiple tics (probably tourette’s) despite no h/o strep. You complain a lot about people going straight to the ER and sidestepping you. Is it appropriate, no clue– I remember a lot of kiddies with ear infections from my days as a med student. As a parent, I’ve only been in an ER once, and there was a lot of blood involved (and yes, as I registered, I left a message at my child’s pediatrician’s home so she would know we were there, and she called back, mostly to soothe me (what was she going to say to the ER doc: yup, sew the kid up–?).
    You may well be right, so perhaps it’s not your message, but your tone, which leans towards condescending, and you know better. It’s a blog, it’s fun to be extreme and provoke folks. I’m surprised that your readers so much agree with you.

    What irks me though is the message to go for the obvious, to not look too hard– it’s not just the tone, it’s the dismissive, angry nature. If my child developed tics, I would want someone thinking about PANDAs and everything else, even if it was just to consider. My kid’s pediatrician has had to talk me out of more testing for what she’s deemed “just a virus”, but it’s always with a gentle tone, and reassurance that if it persists, she will do more, and she has referred to a specialist for my continued concerns. When it’s my kid, I don’t care about the world’s finances, I care that she get the best possible care, that nothing be over-looked.

    Plenty of people have been sent out of ER’s after being told their chest pain wasn’t cardiac. Some of them die shortly thereafter, and children have left ER’s to die of menningitis after being told it’s just the flu.

    The ER doc knows you want to be called. She doesn’t call you because you are Rude (her words on your post). She doesn’t want to have to deal with your dismissive nature with a patient you aren’t there to see, and the struggle she’ll have if her best judgement, with the patient and parents there is different than your best judgement over the phone. The patient left your practice not because you gave the wrong vaccine, but because of your tone– they didn’t feel considered, the vaccine was the last straw.

    And fortunately, my kids don’t need breast implants.

    Thanks for the outlet, Kevin

  • Anonymous

    Anonymous 4:35 p.m.:

    “Girl”???

    This is a female ED physician, for cryin’ out loud.

    If this had been a male doctor, you wouldn’t have referred to him as a “boy”, would you?

    Chauvinism. Sheesh.

  • Flea

    Sorry, I should just let this pass, but I cannot.

    YOU GUYS DON’T KNOW ME.

    If you had the opportunity to see me in my office, you would not say that the family left me because of my tone.

    In fact, if you had read their letter, that I most unwisely copied verbatim for the world to see, you’d see that they did not find me dismissive.

    One thing that I don’t understand about the blogosphere is this pretense that folks know me on the basis of my blog.

    The picture isn’t mine, and the voice is an alter-ego. If I was half the flea I portray in my blog I’d have zero patients. I use the blog to say things that I’d like to say but can’t.

    best,

    Flea

  • Flea

    Sorry, final comment about PANDAS.

    I spoke to the doc on the phone. He in no way suggested that the boy be treated with ABX in the absence of strep.

    His tortured syntax emerged in part because of his incomplete mastery of English.

    After further questioning, he doesn’t much believe in PANDAS either.

    Flea

  • Anonymous

    You seem compelled to argue and get in the last word.

    Take your own advice: LET IT GO.

  • Anonymous

    I’m anon 12:32, told to stop friggin reading the Flea blog, and then the longer post about Flea’s tone (not to be confused with assorted other anon’s or the anon who told him to let it rest):

    I did read the letter…we found a better fit for baby (baby? baby could care less about his doctor) means we never felt comfortable with you.

    Ask the ER physician (I wasn’t the one who called her a girl) what she thinks of your tone, since she knows you.

    Actually, I was fine with your comeback, glad it’s your alterego on the blog (the same alter ego who told me not to friggin read it?) and not a real pediatrician –they always are the nicest people.

    You’ve had a bad day: first a physician calls you Rude, then Kevin calls you on your judgement and refers to you as the intimidator, then some stranger on someone else’s blog calls you dismissive.

    Time for a beer, Flea. Call it a day and start fresh. Maybe borrow Catch 22 from the kid.

  • Anonymous

    Now if this isn’t really who you are Dr. Flea, why get mad at our opinions?

    “Don’t friggin read my blog” – you don’t want anyone who disagrees with you to bother reading your blog?

    Oh boy! That’s very interesting to say the least.

    Lastly, I apologize for referring to the physician as a “girl,” I would have said “boy” if the physician was male, it was just a quick post. I will not do it again.

    -Julianna

  • Anonymous

    I just want to add my two cents- First of all, Flea, Kevin linked a specific issue from your blog to his own. Don’t criticize Kevin’s readers for looking at it because they disagree with you. After your nasty 2:55 remark, and the defensive, argumentative comments thereafter, I’m inclined to agree that you are indeed full of yourself.

    Aren’t you the one who called up another ER doctor in the past and chewed them out over some referrals they made on your patient, only to later find out that the patient’s mother herself had lied to you? You don’t seem to bother getting with getting the full story prior to making judgements about how ER docs handle their patients.

  • Anonymous

    Unless you’re offering to drive to the ER every single time one of your patients goes so you can meet them at the door and care for them yourself, accept that when they make the choice to visit the ER they are putting themselves into the care of another physician (one with just as much medical expertise as yourself). I think its a little rude for you to tell another doctor by phone how to do their job with THEIR patients.

  • Anonymous

    Why does flea care what the er does to his patients? I am glad when they torture mine…

  • Anonymous

    Flea:
    I’ve been working in ER’s since before you were picking your zits for school prom. I have no time for you and your ilk’s sorry shit. If you acted that way to me I would rip you a new a-hole. I have an idea, if every ER doc is an idiot and you are all-knowing then be available for your patient’s 24-7. If not then shut your sorry ass trap.

  • Anonymous

    He apologized and he’s sending a card. Enough already.

  • Anonymous

    Well said 8:02 flea is a jackass.

  • Anonymous

    Well, if this isn’t the pot calling the kettle black. How did it come to be that anyone of you who post on this site can possibly call another physiciasn “full of himself” or an “arrogant asshole?”

    This is the most vile tempered medical blog on the entire internet. Yes, Flea is arrogant and I agree that he is full of himself, but Kevin, SO ARE YOU! As a matter of fact you are like the king of “Arrogance” and “full of himself.”

  • Anonymous

    What kind of ER doc cries when some stupid PCP calls? I’ve been threatened with a gun before in the ER and all I could think was “damn, i’ll never get out of this shift on time”. Any ER Doc who cries (or even gets a little tachycardic) when some jerk yells at you on the phone, needs a new profession. As I always say, if a specialist wants to call me names, threaten me, spit on me, fine, as long as he comes to see the pt. when he’s done.

  • Anonymous

    Hey Flea,
    One of these days, one of the patients you just saw at your clinic one morning might end up in the ER that night with a condition you missed, such as acute appendicitis, intussuception, brain tumor, pancreatitis, airway foreign body, accidental poisoning, or bowel obstruction. If you say, that’s not gonna happen, then you’re really full of yourself.

  • Anonymous

    One of the biggest causes of ever escalating health care cost is the failure of ED “MDs” behaving like doctors. I propose out source ER care to a call center. After all, all ER “doc” do is to call someone else to do his work and take his/her responsibility. It is a disgraceful specialty; it is not doctoring; it is tele-marketing

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