"go to the emergency department every time your child has a fever" -- Kamala Harris

[doctalaughs]

The answer is simple: have fewer emergency rooms with a nurse doing triage in the front.
If you are sick you get in quick.
If you aren't sick then it's advantageous for the system to make people wait 3-4 hours. People will think twice about coming for an earache.

The same concept could apply to most medical visits- people will come in less for things that will self-resolve. Time is a universal copay that applies to both rich and poor.

There are many countries where the clinic opens and you get in line - you are seen when you are at the front and it may be all day, but at least you'll get real attention from a doctor who does a physical exam and isn't practicing medicine based on satisfaction surveys and not getting sued.

This whole "convenience care" model of medicine where ERs are advertising a "2 minute wait" and "doctors" are advertising seeing you while you checkout in the Walmart line while spending 10 out of every 15 minutes checking EMR boxes and catering to ridiculous surveys is the downfall of our country.

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[deleted941485]

Thank you for that lovely gem last night Kamala

Can't wait till a perfectly fine kid with a temp of 100.1 checks in because Kamala told them to do it

I'm sure, somewhere, its already happened

Which you will do for free every time. If you charge the patient Kamala will show up with the FBI and drag you to jail and take your license. Cute feverish applause!!

 

[deleted941485]

Yes, they do. It's called being a normal person.

When I go to the doctor, I say thank you.

When I go to the dentist, I say thank you.

When I go to the mechanic, I say thank you

When I order a beer, I say thank you.

If the bar is crowded, I don't throw my glass against the wall and start threatening the bar staff. I don't tell and curse. This is because I would be arrested if I did. However, for some reason this behavior is tolerated in the ED.

Thanks for your insightful medical student perspective though. The adults will continue talking now.

The med student perspective in the regard is beyond worthless. When I was in school most of them drove around with Obama later Bernie bumper stickers talking about free tuition and how we need to be doing more for our patients.

 

[Apollyon]

I don't think that @Dr.Bruh is coming back.

 

[deleted941485]

I don't think that @Dr.Bruh is coming back.

Because he’s not a doctor or a med student? Just another Bernie bro with a sore spot for the oppressed?

 

[Apollyon]

Because he’s not a doctor or a med student? Just another Bernie bro with a sore spot for the oppressed?

I'm not motivated enough to even click on his/her name and see how many posts s/he has, or when s/he signed up.

 

[Hamhock]

Or you could just google the transcript. Why do you expect people to do your work for you?

Or because what the OP posted doesn't exist.

When people make wild claims, they need to provide the evidence.

HH

 

[AlmostAnMD]

I was paraphrasing, mind you, not quoting. The muggle interpretation (as @RustedFox would say) of someone saying the word FEVER and EMERGENCY DEPARTMENT and MY CHILD over and over and over again for a minute becomes GO TO EMERGENCY DEPARTMENT. No, she did not directly issue that command, but the result is tantamount to the quote lol

 

[EsTxDr]

There really needs to a fever education campaign. Pediatricians, schools, and communities should educate parents that fever is a normal and natural part of their child developing, that it's not inherently dangerous, and give pointers on how to treat fever at home. They should be given education on warning signs to look out for, and when to bring the child to the pediatrician, or more rarely the ED.

Why do we even treat fever as a "disease" and as if it's harmful? I instruct all parents I see that the fever is just their child's immune system reacting to environmental stimuli, and that ALL kids get a lot of fevers and that it's normal.

Can that educational campaign also educate pediatricians on when an LP is indicated in a child with fever and maybe how to perform their own LP? It seems like the LP education for pediatricians is sending the patient to the ER with an order for an LP written on a Rx pad, but usually only when the child is afebrile, tolerating PO/voiding and playing all over the room. Not every pediatrician obviously, your mileage may vary, hopefully it does.

I do the "fever is a good thing" talk all the time, deaf ears. I can literally finish a 15 minute dissertation on treating true fever, fever's cause and purpose and the patient will interrupt and ask when we are going to give Tylenol. Although I've had multiple times where the "parent" simply confesses to not treating the fever because Tylenol costs $3 and "I aint payin for that", normally while texting on their expensive phone from their expensive purse. I've even admitted a child once due to the "mom" reporting she was not going to pay for Tylenol to treat her child at home (less money than her two boxes of cigarettes in her purse) and if I couldn't write a prescription that medicaid would pay for she wasn't doing it.

 

[Dred Pirate]

I was paraphrasing, mind you, not quoting. The muggle interpretation (as @RustedFox would say) of someone saying the word FEVER and EMERGENCY DEPARTMENT and MY CHILD over and over and over again for a minute becomes GO TO EMERGENCY DEPARTMENT. No, she did not directly issue that command, but the result is tantamount to the quote lol

at least quote/paraphrase the lady correctly even if you don't agree with her. the 911 operator told her to go the ED, Kamala did not-she never actual said that it is right for the parent to take their child to the ED. We can argue over abuse of the ED - it happens all the time, we all know it - but in no way was the quote from her promoting this. She was saying you shouldn't get stuck with a huge bill because you were trying to take care of your child and following directions given to them- I think we can all agree on that. The proper way to take care of your child is what is up for debate - 911 needs to direct more people to urgent care, do more education, pediatrician's office need to do more than just send your kid to the ED (most do, there are bad apples everywhere). Yes- there will always be some people who just won't get it - that is the reality of life - you don't throw away 90% success because you can't get to 100%.

Of note - our local EMS is actually going to start taking people to urgent care and even a PCP office if deemed necessary - I love this, although I am sure at some point it will backfire when their triage something that seems minor and it turns out to be not so minor and has a bad outcome.

 

[gamerEMdoc]

I don't expect any over the top gratitude. But there are basics of common courtesy that should be extended to anyone in a professional setting, regardless of their job. I don't expect any more courtesy than I'd extend to the barista that hands me my coffee at Starbucks. Or the cashier at a grocery store. Expecting basic human decency towards one another does not mean you are acting high and mighty.

If you go to a restaurant, and immediately started screaming at your waiter, how long would you be allowed to sit there? What if you got drunk and tried to attack them? For some reason, we essentially allow people to get away with displaying behavior in the ED that would never be allowed in an outpt medical setting, and certainly not in any other professional setting.

 

[jojo58]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

Let me guess: youre allergic to morphine and think healthcare is a "right"

 

[sonofva]

You'll never convince the public at large to stop panicking over fevers, so don't even try. It's futile. Even if they see 999 people with fevers get better on their own, with no treatment, all it takes to override your "see I toldja so" is one person to die suddenly and they hear, "Well, it all started with a fever. Everyone told him it was nothing. Now he's dead! And they're saying he was 'septic' and that 'you shoulda brought him in sooner!'"

Fevers are the shark bites of medicine. 99.99999% of the time you won't get bit, but all it takes is one bad one to scare the **** out of everyone until the next one.

"AND MY GRAMPAPPY SMOKED 10 PACKS A DAY SINCE HE WAS 5 AND LIVED TO 101!"

 

[VA Hopeful Dr]

I don't expect any over the top gratitude. But there are basics of common courtesy that should be extended to anyone in a professional setting, regardless of their job. I don't expect any more courtesy than I'd extend to the barista that hands me my coffee at Starbucks. Or the cashier at a grocery store. Expecting basic human decency towards one another does not mean you are acting high and mighty.

If you go to a restaurant, and immediately started screaming at your waiter, how long would you be allowed to sit there? What if you got drunk and tried to attack them? For some reason, we essentially allow people to get away with displaying behavior in the ED that would never be allowed in an outpt medical setting, and certainly not in any other professional setting.

Building on this, I think most doctors will accept and understand a certain amount of rudeness/irritation/whatever outside of normal polite behavior because people do come to us sick/hurt/scared. We don't expect Miss Manners level behavior. But, I don't think its crazy to expect better than Thunderdome level behavior either.

 

[Hamhock]

I was paraphrasing, mind you, not quoting.

but you were obviously not paraphrasing...and that's why requesting a video (evidence) is necessary.

HH

 

[Birdstrike]

Life is good

 

[deleted109597]

The reason we have fevers is because our ancestors who had fevers outlived the ones who didn't. Or at least outbreeded them, which is the same effectively genetically. Fevers are beneficial, not harmful.

 

[Birdstrike]

The reason we have fevers is because our ancestors who had fevers outlived the ones who didn't. Or at least outbreeded them, which is the same effectively genetically. Fevers are beneficial, not harmful.

“I’ve got a fever and the only prescription is more cowbell”

 

[gamerEMdoc]

The reason we have fevers is because our ancestors who had fevers outlived the ones who didn't. Or at least outbreeded them, which is the same effectively genetically. Fevers are beneficial, not harmful.

Well, its impossible to convince the public of this when medical professionals don't realize this either. How many people/kids do you see on a daily basis who have called their PCPs office with a fever, and they are told we can't see you today, go to the ED? Or people even sent from their FP/peds office for a fever? Or nurses who call urgently asking for tylenol/motrin for the kid in triage with a fever of 104!!! Or the doctor/nurse/midlevel who brings their own kid to the ED for a fever. These are not uncommon scenarios. The idea that fevers are dangerous is just as pervasive as the idea that assymptomatic hypertension is an acute medical emergency, and no matter how many patients we educate about either of them, when they call their PCP, they'll be told that they ARE an emergency and they need to come see us. So until we in medicine have all learned that fevers aren't dangerous, they don't NEED to be treated other than for comfort reasons, and they are certainly not time urgent conditions, then we can't expect the public with far less knowledge than the medical community has to understand this.

 

[thegenius]

The reason we have fevers is because our ancestors who had fevers outlived the ones who didn't. Or at least outbreeded them, which is the same effectively genetically. Fevers are beneficial, not harmful.

No no no...we have had this discussion before.

If you get a fever, you are more likely to die than not. For all comers.

Maybe for those who get infected with a germ, it is beneficial to mount a fever.

And we know that you give tylenol and/or motrin to all these germ-ridden kids who come into your ER.

 

[Birdstrike]

ER Doctor: "This is terrible. All these people who aren't sick keep coming in with fevers and I can tell there's nothing wrong with them immediately."

Administrator: "Endless supply of customers. It's job security, bro."

 

[thegenius]

You know what we call someone driving 40 over the speed limit?

A customer.

You know wat we call someone who regularly smokes cigarettes for decades?

A customer.

Job security!!!

 

[Hamhock]

The reason we have fevers is because our ancestors who had fevers outlived the ones who didn't. Or at least outbreeded them, which is the same effectively genetically. Fevers are beneficial, not harmful.

No no no...we have had this discussion before.

If you get a fever, you are more likely to die than not. For all comers.

Maybe for those who get infected with a germ, it is beneficial to mount a fever.

And we know that you give tylenol and/or motrin to all these germ-ridden kids who come into your ER.

I am not sure if thegenius is being rhetorical or not, but I think you are both not understanding the way evolution (ie natural selection) works.

There is no reason to think that 'survivors' (better understood as those 'optimized for the most successful procreation') generated fever any more or less frequently than 'non-survivors'. In fact, there is no reason to think that 'non-survivors' didn't generate fever MORE often. Modern individuals are not necessarily "more advanced" in every way...in fact, statistically, it almost impossible that each individual's characteristics is more "advanced"/"optimized"; this most likely applies to fever (if fever matters at all now or "then").

Indeed, evolution does not work on a granular cause-effect basis with respect to each variable we observe today (ie fever).

HH

 

[thegenius]

Well, its impossible to convince the public of this when medical professionals don't realize this either. How many people/kids do you see on a daily basis who have called their PCPs office with a fever, and they are told we can't see you today, go to the ED? Or people even sent from their FP/peds office for a fever? Or nurses who call urgently asking for tylenol/motrin for the kid in triage with a fever of 104!!! Or the doctor/nurse/midlevel who brings their own kid to the ED for a fever. These are not uncommon scenarios. The idea that fevers are dangerous is just as pervasive as the idea that assymptomatic hypertension is an acute medical emergency, and no matter how many patients we educate about either of them, when they call their PCP, they'll be told that they ARE an emergency and they need to come see us. So until we in medicine have all learned that fevers aren't dangerous, they don't NEED to be treated other than for comfort reasons, and they are certainly not time urgent conditions, then we can't expect the public with far less knowledge than the medical community has to understand this.

This is curious...are you suggesting that the etiology of a fever should not be worked up?

Or just simply that treating an elevated temperature with anti-pyretics is kind of pointless?

I think most people think, even those with little education, that fever COULD / PROBABLY means an infection somewhere, which is reasonable. I suppose there are non-infectious causes of fever but that's an advanced topic that I don't expect laypeople to understand.

We really should be telling people, and I think we do this (we are just not saying it on this thread)...that most germs that cause fever in these little kiddos are benign and there is nothing to worry about.

If i were a pediatrician or PCP, sometimes I wonder what I would say to someone over the phone who is calling because their kid has a fever. They tell them to go to the ED for appeasement. Not because they truly think they are super sick. Just imagine how that conversation will go..."give tylenol / motrin, if you still think they look sick just say home?"....nah you tell them to go see a doctor now. Which these days means either the ER or Urgent Care.

 

[Birdstrike]

As someone who used to work in the ED and now works outpatient, the reason patients are always told over the phone, "Go to the ED" is not because the nurse or doc saying it is dumb, wants to abuse the ED or is lazy. It's because of lawyers.

If you have a nurse telling people "you're fine" over the phone without me being able to personally evaluate them, it's just a matter of time one of those patients ends up crashing.

For example, I walk out the door at 4:30 pm. At 4:35 my nurse takes a call from Joe Blow who says, "I have back pain, what should I do?'

My nurse tells him, "You're fine. You always have back pain. Take your percocet."

Joe Blow stays home, because "Dr. Birdstrike's nurse said I was fine." 12 hours later he can't move his legs, never will walk again and his brother who hasn't talked to him in 12 years is already calling a lawyer knowing they've got a jackpot waiting for them, all because Joe Blow didn't think it was important to mention the fever and the inability to pee and Nurse Betty didn't think it was important to ask. Dr. Birdstrike gets sued. Nurse Betty doesn't.

It's because of lawyers, guys. 100% of the time. Having someone blown off over the phone has zero value. Having someone blown off after a residency trained board certified ER doc has evaluated them, has value. Tremendous value.

If my nurse sends someone in, it's because I trust you, WAY more than her, because of your skills. If I personally send someone in, I'm personally calling you and you can bet there's a damn good reason, and a plan.

 

[Hamhock]

It's because of lawyers, guys. 100% of the time.

Almost completely agree. Lawyers and the lack of true primary care and after-hours availability.

The ED has allowed outpatient docs to sleep at night; with at most, a phone number to a nurse to cover for them.

HH

 

[VA Hopeful Dr]

Almost completely agree. Lawyers and the lack of true primary care and after-hours availability.

The ED has allowed outpatient docs to sleep at night; with at most, a phone number to a nurse to cover for them.

HH

Nah. When I'm on call 100% of the calls go directly to me. I rarely tell people to go to the ED.

What often happens is they go and say I told them to when I didn't. I love getting notes from the ED where the patient says that yet my phone note from 2 hours earlier says to come into the office for an appointment later that day. They just didn't want to wait for said appointment.

 

[GeneralVeers]

Nah. When I'm on call 100% of the calls go directly to me. I rarely tell people to go to the ED.

What often happens is they go and say I told them to when I didn't. I love getting notes from the ED where the patient says that yet my phone note from 2 hours earlier says to come into the office for an appointment later that day. They just didn't want to wait for said appointment.

Again why we need liability-free EMTALA screenings. It would sort out 90% of this nonsense.

 

[Hamhock]

Nah. When I'm on call 100% of the calls go directly to me. I rarely tell people to go to the ED.

What often happens is they go and say I told them to when I didn't. I love getting notes from the ED where the patient says that yet my phone note from 2 hours earlier says to come into the office for an appointment later that day. They just didn't want to wait for said appointment.

Awesome.

Really, that is cool that there is a physician on call at night for patients in your ?group/solo practice.

In my experience, this is exceedingly rare. Hell, recently I've tried to call physician to physician at night and been told I can only talk to the nurse.

Of course, I don't see the patients who have doctors who practice like you.

I guess that's why I said I almost completely agree with GV. It' nearly 100% lawyers; just a bit of other stuff like I described in my post.

HH

 

[BoardingDoc]

Nah. When I'm on call 100% of the calls go directly to me. I rarely tell people to go to the ED.

What often happens is they go and say I told them to when I didn't. I love getting notes from the ED where the patient says that yet my phone note from 2 hours earlier says to come into the office for an appointment later that day. They just didn't want to wait for said appointment.

I love when I see notes like yours for a patient in the ED. It becomes my trump card for when the patient is invariably upset that "I didn't do anything" or "they need to know exactly what's wrong right now." I gently (or not so gently) remind them that not only do I think they're fine, but that their PCP was able to tell over the phone that they were fine and could wait to be seen. Byeeeeeee.

 

[gamerEMdoc]

This is curious...are you suggesting that the etiology of a fever should not be worked up?

Or just simply that treating an elevated temperature with anti-pyretics is kind of pointless?

I think most people think, even those with little education, that fever COULD / PROBABLY means an infection somewhere, which is reasonable. I suppose there are non-infectious causes of fever but that's an advanced topic that I don't expect laypeople to understand.

We really should be telling people, and I think we do this (we are just not saying it on this thread)...that most germs that cause fever in these little kiddos are benign and there is nothing to worry about.

If i were a pediatrician or PCP, sometimes I wonder what I would say to someone over the phone who is calling because their kid has a fever. They tell them to go to the ED for appeasement. Not because they truly think they are super sick. Just imagine how that conversation will go..."give tylenol / motrin, if you still think they look sick just say home?"....nah you tell them to go see a doctor now. Which these days means either the ER or Urgent Care.

No, I dont think the cause of fever needs worked up emergently in a well appearing child over 3 mo old. It probably doesnt need worked up at all, and certainly doesnt require emergent testing. In a vaccinated child, fever is almost always viral, and requires nothing more than a non-urgent physical exam. There’s very little utility of seeing a child with a fever at 3am, when they otherwise could have been seen at 8am by their pcp.

Croup with stridor? Sure. RSV bronchiolitis? Sure. But the majority of fevers we see are could/colds, runny noses, etc. They are well appearing kids.

The point I was getting at though is the misinformation that the fever itself is dangerous. I see medical professionals perpetuating this all the time. We arent immune to it on our end either, there are ED nurses who will not dc a child without rechecking a temp to assure it’s going down, as if the fever still being there means the child cant go home.

 

[VA Hopeful Dr]

Awesome.

Really, that is cool that there is a physician on call at night for patients in your ?group/solo practice.

In my experience, this is exceedingly rare. Hell, recently I've tried to call physician to physician at night and been told I can only talk to the nurse.

Of course, I don't see the patients who have doctors who practice like you.

I guess that's why I said I almost completely agree with GV. It' nearly 100% lawyers; just a bit of other stuff like I described in my post.

HH

Its a big group, works out to about 2 nights or one weekend per month. It also helps that the main chain of urgent cares here in town are open til 9 on weeknights.

 

[gamerEMdoc]

Nah. When I'm on call 100% of the calls go directly to me. I rarely tell people to go to the ED.

What often happens is they go and say I told them to when I didn't. I love getting notes from the ED where the patient says that yet my phone note from 2 hours earlier says to come into the office for an appointment later that day. They just didn't want to wait for said appointment.

Oh yeah, I totally believe you. It's amazing how many people call their doctor, or even see their doc or local urgent care, then still come to the ED "just to be safe" or for a second opinion. It's mind blowing. I had a patient recently who I saw through PIT who went to an UC with erythema migrans and joint pains. Got lyme testing at the UC, which was positive and they gave the patient an Rx for doxy. The patient then came to the ED straight from the UC, because the patient said they didn't have a PCP and knew they would need followup. Stories like this happen almost every shift.

 

[RoyBasch]

As someone who used to work in the ED and now works outpatient, the reason patients are always told over the phone, "Go to the ED" is not because the nurse or doc saying it is dumb, wants to abuse the ED or is lazy. It's because of lawyers.

If you have a nurse telling people "you're fine" over the phone without me being able to personally evaluate them, it's just a matter of time one of those patients ends up crashing.

For example, I walk out the door at 4:30 pm. At 4:35 my nurse takes a call from Joe Blow who says, "I have back pain, what should I do?'

My nurse tells him, "You're fine. You always have back pain. Take your percocet."

Joe Blow stays home, because "Dr. Birdstrike's nurse said I was fine." 12 hours later he can't move his legs, never will walk again and his brother who hasn't talked to him in 12 years is already calling a lawyer knowing they've got a jackpot waiting for them, all because Joe Blow didn't think it was important to mention the fever and the inability to pee and Nurse Betty didn't think it was important to ask. Dr. Birdstrike gets sued. Nurse Betty doesn't.

It's because of lawyers, guys. 100% of the time. Having someone blown off over the phone has zero value. Having someone blown off after a residency trained board certified ER doc has evaluated them, has value. Tremendous value.

If my nurse sends someone in, it's because I trust you, WAY more than her, because of your skills. If I personally send someone in, I'm personally calling you and you can bet there's a damn good reason, and a plan.

I'm entirely sympathetic to the "nurse hotline" people. I agree 100% it's a medico-legal liability situation. I'm sympathetic, if you called me over the phone and started describing symptoms, I would have to tell you without vital signs, physical exam, or any testing, I can't fully assess the situation. Certainly without even an exam to defend myself, it's a fairly indefensible position if I give any official recommendations and the patient has a bad outcome.

The thing I don't understand is if they can never really tell people they are ok, and pretty much every conversation must end with "go to the ER directly for immediate evaluation," why do we have "nurse hotlines"?

 

[GeneralVeers]

I'm entirely sympathetic to the "nurse hotline" people. I agree 100% it's a medico-legal liability situation. I'm sympathetic, if you called me over the phone and started describing symptoms, I would have to tell you without vital signs, physical exam, or any testing, I can't fully assess the situation. Certainly without even an exam to defend myself, it's a fairly indefensible position if I give any official recommendations and the patient has a bad outcome.

The thing I don't understand is if they can never really tell people they are ok, and pretty much every conversation must end with "go to the ER directly for immediate evaluation," why do we have "nurse hotlines"?

I've found these nurse hotlines to be odd as well. They are set up by insurers with the goal of cost-savings and preventing unnecessary visits, but often they result in referral to the ER for a more expensive evaluation than the patient simply going to the their PCP or an urgent care during business hours.

 

[RoyBasch]

No, I dont think the cause of fever needs worked up emergently in a well appearing child over 3 mo old. It probably doesnt need worked up at all, and certainly doesnt require emergent testing. In a vaccinated child, fever is almost always viral, and requires nothing more than a non-urgent physical exam. There’s very little utility of seeing a child with a fever at 3am, when they otherwise could have been seen at 8am by their pcp.

Croup with stridor? Sure. RSV bronchiolitis? Sure. But the majority of fevers we see are could/colds, runny noses, etc. They are well appearing kids.

The point I was getting at though is the misinformation that the fever itself is dangerous. I see medical professionals perpetuating this all the time. We arent immune to it on our end either, there are ED nurses who will not dc a child without rechecking a temp to assure it’s going down, as if the fever still being there means the child cant go home.

I have a theory on pediatric fevers consternation.

Disclaimer: I have absolutely ZERO evidence to support this, but it seems plausible. I am saying this more tongue-in-cheek but I wonder if anyone agrees.

When a neonate is first born, I imagine the pediatricians are very clear to them that ANY fever in a true neonate is VERY dangerous and they require emergent evaluation to rule out a Serious Bacterial Infection in a patient less than 4, 8, 12 weeks old (depending which "city" criteria you want to use [Rochester, Philadelphia, etc.])

And I think we would all agree that the young neonate with a true fever is a possible emergency and it absolutely warrants a workup (even in the older neonate greater than 4 weeks but less than 12, even if not ultimately antibiosed and admitted) on an emergent basis.

The problem is I think all the parents hear is: "Fever....child....emergency." And that imprints strongly on their memory. The part that this is only an emergency in the first couple days, weeks, and months of life and not necessarily thereafter fades from memory.

So they keep taking the child with fever into the ER every time for many months and years. Until finally after about 3, 4, 5 years and every time "everything is fine." That powerful emotional memory of "Fever...child...emergency" starts to be overcome with the weight of evidence of all the negative evaluations and the parents stop wanting to waste their time at 3am or whatever and they stop coming in.

 

[GeneralVeers]

So they keep taking the child with fever into the ER every time for many months and years. Until finally after about 3, 4, 5 years and every time "everything is fine." That powerful emotional memory of "Fever...child...emergency" starts to be overcome with the weight of evidence of all the negative evaluations and the parents stop wanting to waste their time at 3am or whatever and they stop coming in.

Naw, I think people are just uneducated and unable to take care of the simplest health issues by themselves. - Occam's Razor

 

[TooMuchResearch]

I'm entirely sympathetic to the "nurse hotline" people. I agree 100% it's a medico-legal liability situation. I'm sympathetic, if you called me over the phone and started describing symptoms, I would have to tell you without vital signs, physical exam, or any testing, I can't fully assess the situation. Certainly without even an exam to defend myself, it's a fairly indefensible position if I give any official recommendations and the patient has a bad outcome.

The thing I don't understand is if they can never really tell people they are ok, and pretty much every conversation must end with "go to the ER directly for immediate evaluation," why do we have "nurse hotlines"?

Most patients don't know they can decline to go to the ED and still schedule a primary care appointment. But yeah, I'm not sure the triage line is triaging many people home. Alternatively, maybe they triage a lot of people home, but I don't see those patients so how would I know?

 

[Birdstrike]

I'm entirely sympathetic to the "nurse hotline" people. I agree 100% it's a medico-legal liability situation. I'm sympathetic, if you called me over the phone and started describing symptoms, I would have to tell you without vital signs, physical exam, or any testing, I can't fully assess the situation. Certainly without even an exam to defend myself, it's a fairly indefensible position if I give any official recommendations and the patient has a bad outcome.

The thing I don't understand is if they can never really tell people they are ok, and pretty much every conversation must end with "go to the ER directly for immediate evaluation," why do we have "nurse hotlines"?

Some don't have an after hours call service and instead have a recording that says only, "If this is an emergency call 911 immediately. Otherwise, call back during business hours." With hospitalists now being commonplace, I suppose you can get away with this.

My group has discussed possibly eliminating any after hours call service, since it does cost us money out of our pockets to employee these services, but a minority of MDs have wanted to continue having an after hours service in case they need to be paged. Some of the PCPs do still want to be available, and although I rarely get called after hours, I'm in the camp that wants to at least be available.

For example, if I place a spinal cord stimulator in someone's spinal canal a few millimeters from their spinal cord, and they're having a complication, I want to know immediately so I can make sure it gets dealt with immediately before it becomes something irreversible. I'd rather have to send someone to the ED immediately and have it turn out to be a false alarm, than to have them wait all night thinking it's not serious and find out in the am they have an irreversible neuro deficit.

 

[thegenius]

I'm entirely sympathetic to the "nurse hotline" people. I agree 100% it's a medico-legal liability situation. I'm sympathetic, if you called me over the phone and started describing symptoms, I would have to tell you without vital signs, physical exam, or any testing, I can't fully assess the situation. Certainly without even an exam to defend myself, it's a fairly indefensible position if I give any official recommendations and the patient has a bad outcome.

The thing I don't understand is if they can never really tell people they are ok, and pretty much every conversation must end with "go to the ER directly for immediate evaluation," why do we have "nurse hotlines"?

There’s lots of crap that isn’t emergent....although I too wonder about the efficacy of these nurses. I can see them punting on any thoracoabdominal complaint over age 30, dizziness.

A lot of times all that’s really needed is a conversation and physical by a doctor.

 

[TooMuchResearch]

There’s lots of crap that isn’t emergent....although I too wonder about the efficacy of these nurses. I can see them punting on any thoracoabdominal complaint over age 30, dizziness.

A lot of times all that’s really needed is a conversation and physical by a doctor.

Over 30? What about the 18 yo male with URI sx and mild pleuritic chest pain while coughing? Calls clinic to schedule an appointment, go to the ED immediately.

 

[thegenius]

Over 30? What about the 18 yo male with URI sx and mild pleuritic chest pain while coughing? Calls clinic to schedule an appointment, go to the ED immediately.

Well that nurse should be fired and replaced.

 

[RustedFox]

Over 30? What about the 18 yo male with URI sx and mild pleuritic chest pain while coughing? Calls clinic to schedule an appointment, go to the ED immediately.

Do we work together?