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PED-EM-L  January 2011

PED-EM-L January 2011

Subject:

Re: crp

From:

Marty Herman <[log in to unmask]>

Reply-To:

Marty Herman <[log in to unmask]>

Date:

Mon, 17 Jan 2011 08:37:41 -0600

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (84 lines)

Got to jump in too.
Many times I have been in this situation. Most of the times it's because a test was ordered by the PCP or a resident and then the child sent in for us to figure out what it means. Sometimes I do this to my self. Perhaps a weak moment, perhaps just taking the easy way out, whatever..
 
 i over heard a pediatrician once remark to a mother who complained that he did not order enough tets that his job wasn't to please her every whim but rather to do what was right for the child and in his medical/professional opinion the child did not need the tests requested. She was free to gt another opinion ...
 
Of course there are times that I take a firm stance, only find out later that I misssed something. THat's why I preach to the residents that they have remain open minded, communicate and document their findings very well. 
 
Marty

 
> Date: Mon, 17 Jan 2011 13:14:35 +0000
> From: [log in to unmask]
> Subject: Re: crp
> To: [log in to unmask]
> 
> From: don zweig ([log in to unmask]) 
> > How do you use the crp in evaluating kids?
> 
> --> I don't.
> 
> > How do you interpret a high crp with low sed rate
> 
> --> I am not the correct person to answer this, with only EM as my training.
> 
> > ...8 yo with headache, decreased appetite and dizziness...
> 
> --> Had one of those at home last week, when we woke him up for his first day of the school term... Resolved with chocolate.
> 
> > crp ws 38. i was hoping for normal
> 
> --> Having seen quite a few cases of meningitis/sepsis/other-itis/etc with low and normal CRP, I have long ago stopped "collecting" such cases in order to explain why I don't do it...
> 
> The best way to avoid finding a high CRP is to not do the test! I always think of CRP as a 4-letter word with a vowel missing...
> 
> > Should i go with my impressing that she is well
> 
> --> You question appears to be "who should I trust - the experienced EP who has seen the patient, took a history and examination and a urine dip, etc, OR this one blood test?"
> 
> If the answer could be to trust the blood test, then all you'll need for most patients is a phlebotomist at reception and most EPs would be out of a job...
> 
> > I did labs because mother was concerned
> 
> --> And now the mother is concerned because you have the blood test...;-)
> 
> And so are you...
> 
> I DO have sympathy for the atmosphere you work in, but I believe that this sort of testing is what LEADS to patients in your part of the world NOT trusting YOU when you reassure them, but only trusting tests.
> 
> Sort of like how every time an EP oreders a test/imaging in order to prevent litigation that he/she ADDS TO the problem of why EPs are NOT trusted and lawyers SUCCEED in "beating" them with test results or with simply pointing a finger at the absence of a test!
> 
> Although children ARE brought in by parents instead of being taken to primary care, there is no expectation in the UK for the ED to provide this care. Once we decide child is safe to continue with GP we direct the parent to make the appointment and send patient away...
> 
> Also, I must admit I would not have done a CXR either, unless there was another reason which you had not mentioned in your description of the case thus far...
> 
> From: Bergmann Terence ([log in to unmask]) 
> > Ignore it!
> 
> --> This brings up the other interesting aspect...
> 
> As much as I have just described why I would not have done a CRP, from my understanding of the medico-legal "mood" in the USA, once you HAVE done it, it's tougher to ignore the result...
> 
> Imagine this child comes back the next day (or sees GP) and says "I feel perfectly fine" and actually LOOKS perfectly fine and remains so for the next couple of weeks... Even remains perfectly well for a couple of months... Then suddenly comes up ill with something really "horrible" and depressing... And the lawyer says that the EP "knew" this child had "something", as shown by the raised CRP, so why allow it to become worse? EP should have arranged follow-up and is repsonsible for checking to see that the CRP drops back to normal before "believing" the child is actually well...
> 
> Then the EP would find himself as the one trying to say that the CRP does not mean that much...;-)
> 
> Maybe someone on this List has the medico-legal (USA-style) knowledge to clarify further...
> 
> > fighting anxious parents is sometimes a losing battle
> 
> --> Agree! A battle worthy of not being fought at all!
> 
> Not sure that one can do it where you are, but here we'd say something to the effect of "I am satisfied that an emergency condition is unlikely in your case, but I would like to escalate things higher, for review and potential investigation, for which reason I am recommending that you go to your GP, where this process could be taken up. Here's your referal note."
> 
> Granted, this is easier in a doctor-patient relationship which is NOT clouded by a consumer/customer--service-provider relationship...
> 
> Here's my "business moto": The customer is always right; the patient isn't always sick... 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/ped-em-l.html
 		 	   		  
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

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