The next chapter in Flea’s saga with the ER. Again, I side with the ER on this. Unless you’re physically at the hospital and assuming liability, there is no place for a PCP to dictate care over the phone to the ER. If you don’t agree with the disposition plan, it’s your responsibility go to the hospital at 3am and do what you want. Until then, let the ER handle it. GruntDoc responds:
Any you wonder why they don’t want to call you.The ED doc got an interpreter, got a history, evaluated the patient and called you. Your hangup? Not that a patient you’d seen earlier in the day was getting worse, it’s about a change from hours to days in the history, or historical alternans, the rule in medicine, not the exception.
Your “Sure” indicates more about your interaction with the ED docs and opinion of them than the rest of the piece. Certainly it wasn’t a translation error or a misunderstanding, no, it was a Poor History.
I’m not the least bit surprised they called you back to tell you of a change in referral centers; you’ve obviously made quite an issue of being notified, and no ED doc now wants to get the ‘you know, Flea thought you were sending them to X when you sent them to Y’ chat. And that’s on you.
It’s an odd dynamic you’ve chosen to have there. Hope it’s working out like you foresaw.
Related posts:
- Gawande on US malpractice: "It’s a disaster"
- Flea on retail-health clinics
- Demanding X-rays
- My take: Payment, work-life balance, demanding scans
- Dr. Flea speaks
- Flea to the AAP: Suck it up
- Terminal extubation
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“He was wheezing all right, but wasn’t terribly distressed. He didn’t seem ill enough for steroids, so I gave him a couple of hits of Albuterol”
He was wheezing because of bronchial wall edema. Most ER docs would have started this patient on steroids because we have only one chance to do it right. Almighty Dr. Flea relied on his vast experience and screwed up.
To be fair, there is a significant difference between the two scenarios:
A physician who knows the patient and who is in the 0.1% of PCPs who would make a home visit at all (not to mention on a weekend) coming to the house as a courtesy
vs.
A physician who doesn’t know the patient who is treating him because his condition worsened enough to cause the mother to seek emergency care in the ED.
Of course we would be more likely to give steroids in the
ED….that doesn’t mean Flea “screwed up.” Those are two completely different types of visits.
A physician that is making home visits is clearly way too “unbusy”. That is why he has to occupy his time ranting about how someone else got the story wrong.
sorry, I looked away after “pediatrician, solo practice, northeast”…
Trench, I’m just curious.
Why do you “look away”?
with an N of around two dozen, I know of ONE solo practitioner that does not have a personality or prior substance abuse disorder.
Granted the ONE is one of my favorite people on the planet.
Throw in “pediatrics and northeast” and I am the water to their oil.
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