"Go to the ER, for peace of mind"

David Williams talks about his Christmas Eve ordeal with the healthcare system. I can’t blame the on-call doc for the ER recommendation. Someone over the phone can’t diagnose, and maybe it could have been a serious fracture.

I think Mr. Williams falls into the Monday Morning Quarterback trap. Diagnosis is always 100% when done in hindsight.

Comments

Rich, MD
Interesting about the “tip-toes trick” – the Doctor who relied on it did so only after seeing a negative x-ray. Two out of three pediatricians who examined the child prior to the x-ray were not satisfied.
Would Mr. Williams have felt the same if Dr. Linderman said not to worry, and upon arriving at his foreign destination he learned that the child had a Jones fracture? What is the sensitivity of the “tip-toes trick” for detection of a fracture of the fifth metatarsal (in the absence of an x-ray)? What is the likelihood that a plaintiff’s attorney could find several experts to testify that the “tiptoes trick” is an inadequate test to exclude a Jones fracture?
Hindsight is twenty-twenty. Mr. Williams would not likely have been as grateful to Dr. Linderman if he was incorrect.
Anonymous
I can’t believe this post.
So, your kid comes home after falling with a foot that is not just painful, but actually swollen. It’s a holiday weekend. You’re leaving in 2 days for a foreign destination where, presumably, you would have trouble obtaining medical care. So, you do what any red-blooded American parent would do. You pack the kid up and take him to the ER. Oh, I’m sorry, my mistake. You pack the kid up and take him to a Christmas party where you proceed to attempt to mooch information off of three pediatricians, whom I’m sure appreciated your business.
When you’re not satisfied that two out of three suggest the ER, you finally call your child’s covering pediatrician. So now 3 out of 4 say go to the ER, which you do. You take your child to the premier children’s hospital in New England, where you proceed to spend 5 hours receiving medical care on Christmas Eve. The x-ray is negative, kid’s fine, vacation not ruined! Everyone’s happy, right? Wrong. The wait was too long, those three cautious doctors were too cautious, etc.
So, just to recap, this guy got outstanding medical care in 5 hours, had a good outcome, and jetted off to his foreign destination (and, I’m sure, payed nothing except a copay for the ER visit). This is his medical nightmare???? I hope he never has to walk a day in some of my patients’ shoes.
The scary part? This guy is a health care consultant? How can someone with so little knowledge or insight consult to the medical field?
Anonymous
I agree entirely. I especially like that he was about to take the family out of the country on vacation. Personally, I’d want to know for sure what was going on before leaving the US, to avoid risking having to seek medical care overseas and also having the vacation ruined.
Also, what Mr. Williams doesn’t realize, is that he inadvertently illustrates an important point for MDs: don’t do friendly “curbside consults” for friends or acquaintances (except in the broadest possible terms, with the emphasis that the patient needs to see their regular MD for proper treatment). If the family had followed Dr. Linderman’s advice not to worry, and the outcome had been different, I’m sure most juries would agree that Dr. Linderman had now established a patient-doctor relationship and was liable.
Gasman
So in the end you got great care. Your wait in the ER would likely have been less had you not procrastinated until christmas eve for the proper evaluation. As this was a non-time sensitive injury you were appropriatly triaged to the slow line behind acute and life threatening illnesses. So it took 5 hours. As a health care consultant you at least knew to bring something to read and something to feed and entertain your child. You were far better off in your preparation for the ER visit than the average parent might have been.
David E. Williams
Well I’m really taking a beating on this one. Let me address a few of the issues:
1. My son was essentially back to normal the next day, which is what I thought would happen. It would have been nice if someone could have helped me assess that on the phone. Maybe it’s not possible but I have a suspicion that my regular pediatrician –who knows my kid and me– would have been able to help me a little more.
Is there any threshold of injury that would have obviated the need to visit the ER that day? My regular pediatrician knows me well enough to know I’m not going to sue him. The backup doesn’t and I’m sure that’s one reason she was more conservative.
I don’t fault the pediatricians I asked for an informal opinion. I only did it because I knew the likely consequences of heading to the ER.
2. There were a couple of suggestions that I go to an urgent care center. That sounds like a good idea but I’m not sure how realistic it is. A Google search for “urgent care clinic” and my zip code (02446) turns up junk.
Today I called my health plan, Blue Cross Blue Shield of MA to ask them about urgent care clinics. The rep checked with her supervisor and eventually came back, told me there aren’t any urgent care centers but said there were two Community Health Centers in my area. CHCs are mainly for the uninsured although they also accept insurance. The first referral, Fenway Community Health is renowned for treatment of lesbians and gay men. They are a leader in HIV. I don’t see anything on their site that would have been relevant for my situation. The second referral, Joseph P. Smith Community Health Center doesn’t look appropriate either. It wouldn’t have even been open.
3. I’m troubled by the idea that a 5-hour wait (or longer) is acceptable. My wait was partly due to triage, but largely due to my record getting lost in the shuffle. We got called in when we did because the physician recognized our name and moved us up. ERs could be run more efficiently and it would also be great if they weren’t the first or only recourse for after hours. I’d wait all week, month, or year if that’s what it took to help my son. That’s not the same as saying I should be happy about it.
Anonymous
“My regular pediatrician knows me well enough to know that I’m not going to sue him.”
As a practicing physician, I call bulls**t on this one. Are you telling me that if you had left the country without an evaluation on his advice and then your son got worse, and received sub-standard care elsewhere as a result with a bad outcome, you wouldn’t sue? Or even if you had to cut your vacation short to bring him back here? I know my patients and have a great relationship with them. That doesn’t mean I trust them not to sue me if I screw up.
Actually, I would question the judgement of any physician who tried to diagnose this kid over the phone. For God’s sake, you said his foot was painful, swollen, and he was limping, he’s NOT a complainer, and you’re leaving the country the NEXT day! As far as I’m concerned, there is no “threshold of injury” that would have negated the need for a full evaluation.
BTW, I live on the MA/NH border. There are plenty of urgent care centers.
Anonymous
A five hour wait is long and something we sure don’t strive for in my emergency department. At times it happens. It often happens when there is no beds in the hospital, during a 2 hour pediatric resuscitation, or some other combination of too many sick patients for docs, nurses, beds available. A five hour wait for foot pain is often the fall out result. Hardly worth a rant.
Agree some with the above poster. I have been named in 9-10 (btw all meritless) suits. Half the time it is the “nice person” you never would have suspected a lawsuit from.
David E. Williams
Anonymous on MA/NH border: What urgent care center should I have gone to near 02446?
Considering all the references in these comments to the fear of lawsuits influencing recommendations, patients would be rational to second guess their physicians. Should a patient go like a lamb to wait in the ER just to insulate his doc from risk?
I wouldn’t put up with an accountant or lawyer who gave me the most conservative, costly advice whenever I asked a question. Why should I accept it in a doctor/patient relationship?
Fortunately I have a good relationship with my regular physicians. They don’t treat me like an idiot, even though it seems the majority of commenters here think they should!
Anonymous
He still doesn’t get it. The patient, in this case the son, should go to the ER not because it is the most conservative and costly but because that is the place for an appropriate evaluation to take place after hours. I have a great rapport with my patients (don’t treat them like idiots but patients) and it is because of this, I advise the appropriate, if sometimes incovenient, course and not the 5 second back yard type evaluation. If this involves an ER visit, I try to communicate why they are going (not as lambs insulating me from anything but patients going to a place where they can receive an appropriate eval). The fact he thinks this should have taken 5 seconds to diagnose a bit odd. The fact he is a health care consultant is downright scary.
David E. Williams
I get it all right, and sorry to scare you.
My comment applies beyond the situation of my son, to any case where the physician is giving more conservative advice than is medically justified, just to reduce the risk of a lawsuit. It may be rational for the physician, but it’s not good for the patient.
Obviously if a patient needs to be seen in the ER then that’s where they need to go. If it’s only legally appropriate and not medically appropriate I don’t want to be that patient.
Anonymous
The point is ..it WAS medically appropriate to send him to the ER for an eval, and this or similar cases should not be “done in 5 seconds”. Sure, there are cases when tests are not medically appropriate or excessive tests/ evaluations are ordered…but his was not one of them.

"Go to the ER, for peace of mind"

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