Is family medicine really that bad?

[JohnGrisham 1,676]

41 minutes ago, Medapp2017 said:

I'm curious, is 80+ hrs/week a reality even for ROAD specialties? I've heard from O&D residents that their days are mostly 8-9am to 5-6pm excluding call, and they would be on call, as junior residents, once per week or even less frequently. Senior residents would usually be back-up call for juniors so the hours are even better. 

 

Off-service rotations. 

[rmorelan 2,527]

45 minutes ago, Medapp2017 said:

I'm curious, is 80+ hrs/week a reality even for ROAD specialties? I've heard from O&D residents that their days are mostly 8-9am to 5-6pm excluding call, and they would be on call, as junior residents, once per week or even less frequently. Senior residents would usually be back-up call for juniors so the hours are even better. 

 

well I cannot speak for all fields even in ROAD - but I can break some some of the math for radiology, and perhaps suggest that really isn't much different than other fields.

So lets take what you are saying as base - M-F 8:30-5 for 45 hours a week (note - that is wrong for me - we started at 7:30 and went to 5 - but what is 3 extra hours a week among friends). For the first 3 years of residency as a radiologist I did 5 call shifts every 4 weeks, with 2 of those on the weekend. So I will average things out over 4 weeks. During that time I would be on weekend call for 2 daysX24 hours, and 3*15 = 45 hours for the week day call going from 5pm-8am. A couple of times a month I would get the following day off as post call (saving me 9*2=18 hours for the post call days - obviously not on friday shifts as I am off anyone on Sat). Note you may be "post call" but it isn't like a day off - I collapsed and was lucky to get up before the evening, was up for a bit and the back to bed ha. So just the absolute base would be over 4 weeks (4*45+2x24+3*15 - 18)/4 for 64 hours a week as base level. Assumes you NEVER have to work late because you ran over (like that never happens but we are being conservative here). On those call shifts by the way - you really are basically up the entire time. Radiology only sleeps when every other field is also asleep - if they are up they have a problem, and that means you have a problem most of the time. 

That would be great at 64 hours but we aren't even close to being done yet. For starters you also have to add the actual study time, which you simply cannot get away from (and of course you won't want to). Residents in radiology should be spending 1-2 hours a night studying and I would say that simply is a part of the job, and yeah I am counting those hours. If you even did a single hour a day - and that I would take as a minimum you are up another 7 hours a week - so now we are at 73 hours. In reality for myself that was much higher, and I would already be above 80 after that alone. Ha, other fields many have longer days, but usually shorter amounts of study required - simply because they learn their stuff on the job more. 

So then we are left with research, which is another basic requirement. Pretty variable but everyone has to do some of it if you want those nice fellowships (or any fellowship), and it does help with the job as well. I cannot even begin to quantify  the amount of time I did on that - lets just say it is a lot. You wouldn't have to do all that but many do. 

Sure in the senior years your call drops - but exam preparation then just goes into high gear. I spend way more than 80 hours - well over 100 hours actually in my late 4th and 5th years preparing for my board exam. 4 hours of studying a night on week days, and 12 hours a week on the weekend (did take Friday night off - gotta decompress at some point ha). All I did was work and study for the most part. 

So that gives you a basic picture for ball parking radiology. Let's say about 73 hours if you do minimum required work, and minimum required studying, and no research. You can see that the odds of actually doing those minimums would be rather low. Plus if you backwards average in the extra 5th year studying time over the other 4 years then yes you are over 80 from that alone. 

Your first year may not be quite as bad on every rotations to be fair (the off service rotation year) - some will be very bad (ortho and nuero surg come to mind ha). Rad onc was much easier as a counter point. 

My point is - and I really need to stress this for people considering the field of radiology - that whether you think rads belongs still in ROADS (strong arguments it doesn't as staff) the residency program itself is very challenging, and consumes vast amounts of your time. We get people accepted into our program from time to time that don't understand this - possible from the bias of the ROAD term etc. Those people quickly find out how incorrect their prior expectations are, and not all of them make it through the program. 

[Lactic Folly 375]

I agree that residents transferring into radiology from other programs didn't find the hours as favourable as they had hoped or expected. One may spend many hours in the hospital on a surgical rotation in PGY-1, but there just isn't the same expectation for a off-service resident to read outside those hours, therefore overall a lighter experience compared to the start of PGY-2. However, residents in other specialties might take issue with inclusion of study and research time into the weekly hours, as all residents need to spend time on those activities outside of the hospital. 

I will say that 5 pm is rather optimistic for a regular end time and would likely depend on staff and fellows finishing the rest of the work. My residency program usually had residents reviewing with staff until 5:30-5:45, after which the residents would go back and edit their reports for the staff to be able to sign later that night, which means 7:30 to 6 or 6:30 was probably a more realistic amount of time in the hospital (7:30 being an average of 7 and 8 am start times due to rounds).

 

[rmorelan 2,527]

2 hours ago, Lactic Folly said:

I agree that residents transferring into radiology from other programs didn't find the hours as favourable as they had hoped or expected. One may spend many hours in the hospital on a surgical rotation in PGY-1, but there just isn't the same expectation for a off-service resident to read outside those hours, therefore overall a lighter experience compared to the start of PGY-2. However, residents in other specialties might take issue with inclusion of study and research time into the weekly hours, as all residents need to spend time on those activities outside of the hospital. 

I will say that 5 pm is rather optimistic for a regular end time and would likely depend on staff and fellows finishing the rest of the work. My residency program usually had residents reviewing with staff until 5:30-5:45, after which the residents would go back and edit their reports for the staff to be able to sign later that night, which means 7:30 to 6 or 6:30 was probably a more realistic amount of time in the hospital (7:30 being an average of 7 and 8 am start times due to rounds).

 

Sure - and I don't want to discredit the amount of studying time the other fields do either - if anything I want to point out that when we collectively say residents work 80+ hours, well this is one of the reasons why and you have to look beyond just what you do it the hospital or you get skewed results. I would say that some fields - like radiology as it happens - does require studying amounts that would be on the higher side of things - but it isn't alone up there either. I point it out in particular because that was one of the major areas that people didn't seem to consider with specifically radiology when they came into it - thinking that when the day was done you could just go home and relax - absolutely not. You have to look at the actual full total of time per week to be a resident - both in and out of the hospital to really understand what their lives are like, and to properly compare things.  When you do that you find that most residents in whatever they are in are working their asses off, regardless of the actual program they are in. 

plus I do agree - I was being conservative in my numbers to play on the safe side - leaving exactly at say 5pm often is't very likely at all. Latest I left was I believe 10pm one night ha on a regular shift but that was very strange. 

Edited April 13 by rmorelan

[Ms4ever 0]

On 4/13/2020 at 1:05 AM, rmorelan said:

Sure - and I don't want to discredit the amount of studying time the other fields do either - if anything I want to point out that when we collectively say residents work 80+ hours, well this is one of the reasons why and you have to look beyond just what you do it the hospital or you get skewed results. I would say that some fields - like radiology as it happens - does require studying amounts that would be on the higher side of things - but it isn't alone up there either. I point it out in particular because that was one of the major areas that people didn't seem to consider with specifically radiology when they came into it - thinking that when the day was done you could just go home and relax - absolutely not. You have to look at the actual full total of time per week to be a resident - both in and out of the hospital to really understand what their lives are like, and to properly compare things.  When you do that you find that most residents in whatever they are in are working their asses off, regardless of the actual program they are in. 

plus I do agree - I was being conservative in my numbers to play on the safe side - leaving exactly at say 5pm often is't very likely at all. Latest I left was I believe 10pm one night ha on a regular shift but that was very strange. 

 

On 4/12/2020 at 8:35 PM, rmorelan said:

well I cannot speak for all fields even in ROAD - but I can break some some of the math for radiology, and perhaps suggest that really isn't much different than other fields.

So lets take what you are saying as base - M-F 8:30-5 for 45 hours a week (note - that is wrong for me - we started at 7:30 and went to 5 - but what is 3 extra hours a week among friends). For the first 3 years of residency as a radiologist I did 5 call shifts every 4 weeks, with 2 of those on the weekend. So I will average things out over 4 weeks. During that time I would be on weekend call for 2 daysX24 hours, and 3*15 = 45 hours for the week day call going from 5pm-8am. A couple of times a month I would get the following day off as post call (saving me 9*2=18 hours for the post call days - obviously not on friday shifts as I am off anyone on Sat). Note you may be "post call" but it isn't like a day off - I collapsed and was lucky to get up before the evening, was up for a bit and the back to bed ha. So just the absolute base would be over 4 weeks (4*45+2x24+3*15 - 18)/4 for 64 hours a week as base level. Assumes you NEVER have to work late because you ran over (like that never happens but we are being conservative here). On those call shifts by the way - you really are basically up the entire time. Radiology only sleeps when every other field is also asleep - if they are up they have a problem, and that means you have a problem most of the time. 

That would be great at 64 hours but we aren't even close to being done yet. For starters you also have to add the actual study time, which you simply cannot get away from (and of course you won't want to). Residents in radiology should be spending 1-2 hours a night studying and I would say that simply is a part of the job, and yeah I am counting those hours. If you even did a single hour a day - and that I would take as a minimum you are up another 7 hours a week - so now we are at 73 hours. In reality for myself that was much higher, and I would already be above 80 after that alone. Ha, other fields many have longer days, but usually shorter amounts of study required - simply because they learn their stuff on the job more. 

So then we are left with research, which is another basic requirement. Pretty variable but everyone has to do some of it if you want those nice fellowships (or any fellowship), and it does help with the job as well. I cannot even begin to quantify  the amount of time I did on that - lets just say it is a lot. You wouldn't have to do all that but many do. 

Sure in the senior years your call drops - but exam preparation then just goes into high gear. I spend way more than 80 hours - well over 100 hours actually in my late 4th and 5th years preparing for my board exam. 4 hours of studying a night on week days, and 12 hours a week on the weekend (did take Friday night off - gotta decompress at some point ha). All I did was work and study for the most part. 

So that gives you a basic picture for ball parking radiology. Let's say about 73 hours if you do minimum required work, and minimum required studying, and no research. You can see that the odds of actually doing those minimums would be rather low. Plus if you backwards average in the extra 5th year studying time over the other 4 years then yes you are over 80 from that alone. 

Your first year may not be quite as bad on every rotations to be fair (the off service rotation year) - some will be very bad (ortho and nuero surg come to mind ha). Rad onc was much easier as a counter point. 

My point is - and I really need to stress this for people considering the field of radiology - that whether you think rads belongs still in ROADS (strong arguments it doesn't as staff) the residency program itself is very challenging, and consumes vast amounts of your time. We get people accepted into our program from time to time that don't understand this - possible from the bias of the ROAD term etc. Those people quickly find out how incorrect their prior expectations are, and not all of them make it through the program. 

Thanks for this info! Regarding radiology fellowships at what point in radiology residency do we apply for them (beginning of 3rd year?) and roughly when do you find out if you get accepted to the fellowship? 
Thanks! 

[rmorelan 2,527]

4 hours ago, Ms4ever said:

 

Thanks for this info! Regarding radiology fellowships at what point in radiology residency do we apply for them (beginning of 3rd year?) and roughly when do you find out if you get accepted to the fellowship? 
Thanks! 

hey - you would apply (and thus must be fully ready to apply) by ~May into your 3rd year. The US ones are settled first usually though the summer, and the Can ones can be latter (strangely TO in particular is very late). You basically should know by your 4th year what you are doing. 

[Rationalistlens 2]

On 1/27/2020 at 10:55 AM, confusedclerk said:

Hi all,

As a clerk wanting to go into family medicine, I am now having some doubts. I've spoken to several family doctors who complain that they don't get compensated enough/compensated fairly and have read reports online on family doctors having to do much more paperwork at home when compared to other specialities. Some benefits of family medicine I see are the ability to take longer to see your patients (as opposed to certain specialities), the programs being a 2 year residency as opposed to 5, and having a great work-life balance. As much as I like these pros of family medicine, I don't know if I would ultimately regret choosing the speciality. Although making as much money as possible isn't my goal, I don't know if I would want to go into a career that so many people are apparently unsatisfied. 

Just wondering if any family medicine applicants/residents had some insight into family medicine as a career.

 

I am a practicing family physician, so take my opinion for what its worth. 
 

I will recommend you to stay away from family medicine as it stands right now. 
 

Under a massive propaganda in cahoots with the provincial governments, med schools sell you family medicine as this great speciality. On every step you are shown how great and diverse FM is. 
 

But no one tells you the practical implications. No one tells you the medico-legal implications of being a FM physician. No one tells you the financial implications of being a FP. 

If you practice full family medicine, your income will depend on volume of patients you see, unless you are in a FHO (you cant create new FHOs anymore in big cities). So for all intents and purposes, the more patients you see, the more $ you will make and secure to keep your business running and your own family fed. You ask what is the problem with that? Well the more patients you see, the more chance of making errors in 5-10 min consultation for a patient who might need a full 30 min evaluation (including the time for your brain to process the diagnostic algorithms and ddx). And trust me, as a FD you CANNOT spend 30 mins, heck even 20 mins, with every patient that you see in one day or your business will go bankrupt, pts in waiting room will leave you extremely negative comments (they dont and wont give a damn how thorough and accurate and great care you were providing to the patient you were in exam room with...and they could also file complaint to your college, probably nothing will come of it but the headache and stress you will go through from getting a letter from your regulatortycollege)
 

On any given day, a neonate might come to your clinic who is really sick but does not look sick enough to YOU (who is not an expert in pediatric care) to direct them to ER at that point in time. So you decide to send him home and he dies, guess who will be held responsible? You as a primary care FP (you are not a ped, keep in mind, and hence are not an expert in pediatric care). You will be held responsible for missing a critically ill child in a 5 -10 minute visit for which you were being paid only $33-40. The same patient when goes to ER, the ER physician will make at least $77 for the same presentation with the ADDED advantage of being able to do stat xrays/cbc to further hone his/her ddx.... Now you tell me, are you willing to take that risk of making critical decisions in light of the Limited time you can spend and limited $ you earn from making those hard and tough diagnostic decisions? 
 

yes this doesnt happen daily. Maybe it will happen 5 times in your life time that you see a critically ill neonate. But you just need one error to have your livelihood ruined and your face plastered on the news and your reputation destroyed. And that also makes it even more tricky. The less presentations you see, the rustier your clinical acumen and diagnosis. Hence even greater risk of not recognizing a catastrophe happening in front of you. 

i can go on and on. 
 

 

Dont ever do FM. find something you like and focus on that specialized care you can be and dream to be an expert in.

[gogogo 63]

1 hour ago, Rationalistlens said:

I am a practicing family physician, so take my opinion for what its worth. 
 

I will recommend you to stay away from family medicine as it stands right now. 
 

Under a massive propaganda in cahoots with the provincial governments, med schools sell you family medicine as this great speciality. On every step you are shown how great and diverse FM is. 
 

But no one tells you the practical implications. No one tells you the medico-legal implications of being a FM physician. No one tells you the financial implications of being a FP. 

If you practice full family medicine, your income will depend on volume of patients you see, unless you are in a FHO (you cant create new FHOs anymore in big cities). So for all intents and purposes, the more patients you see, the more $ you will make and secure to keep your business running and your own family fed. You ask what is the problem with that? Well the more patients you see, the more chance of making errors in 5-10 min consultation for a patient who might need a full 30 min evaluation (including the time for your brain to process the diagnostic algorithms and ddx). And trust me, as a FD you CANNOT spend 30 mins, heck even 20 mins, with every patient that you see in one day or your business will go bankrupt, pts in waiting room will leave you extremely negative comments (they dont and wont give a damn how thorough and accurate and great care you were providing to the patient you were in exam room with...and they could also file complaint to your college, probably nothing will come of it but the headache and stress you will go through from getting a letter from your regulatortycollege)
 

On any given day, a neonate might come to your clinic who is really sick but does not look sick enough to YOU (who is not an expert in pediatric care) to direct them to ER at that point in time. So you decide to send him home and he dies, guess who will be held responsible? You as a primary care FP (you are not a ped, keep in mind, and hence are not an expert in pediatric care). You will be held responsible for missing a critically ill child in a 5 -10 minute visit for which you were being paid only $33-40. The same patient when goes to ER, the ER physician will make at least $77 for the same presentation with the ADDED advantage of being able to do stat xrays/cbc to further hone his/her ddx.... Now you tell me, are you willing to take that risk of making critical decisions in light of the Limited time you can spend and limited $ you earn from making those hard and tough diagnostic decisions? 
 

yes this doesnt happen daily. Maybe it will happen 5 times in your life time that you see a critically ill neonate. But you just need one error to have your livelihood ruined and your face plastered on the news and your reputation destroyed. And that also makes it even more tricky. The less presentations you see, the rustier your clinical acumen and diagnosis. Hence even greater risk of not recognizing a catastrophe happening in front of you. 

i can go on and on. 
 

 

Dont ever do FM. find something you like and focus on that specialized care you can be and dream to be an expert in.

Thanks for the brutal honesty. It's sobering to someone interested in FM. I hope you find some joy in the career.

Do you think the same thing about niche FM practices (e.g., GP derm/psychotherapy/sports/addictions/etc.)?

[ZBL 210]

29 minutes ago, gogogo said:

Thanks for the brutal honesty. It's sobering to someone interested in FM. I hope you find some joy in the career.

Do you think the same thing about niche FM practices (e.g., GP derm/psychotherapy/sports/addictions/etc.)?

Not in FM, but of those I’d suspect sports med is the only one where your practice may focus exclusively on that niche area (and palliative, and maybe OB). Otherwise it is probably a mix of general practice and those other areas. Note GP derm is not a real thing - it’s a self-proclaimed title. 

[Intrepid86 221]

 

3 hours ago, Rationalistlens said:

I am a practicing family physician, so take my opinion for what its worth... 

Dont ever do FM. find something you like and focus on that specialized care you can be and dream to be an expert in.

This is just curiosity, but how long have you been practicing for?

[1D7 153]

4 hours ago, Rationalistlens said:

But no one tells you the practical implications. No one tells you the medico-legal implications of being a FM physician. No one tells you the financial implications of being a FP. 

If you practice full family medicine, your income will depend on volume of patients you see, unless you are in a FHO (you cant create new FHOs anymore in big cities). So for all intents and purposes, the more patients you see, the more $ you will make and secure to keep your business running and your own family fed. You ask what is the problem with that? Well the more patients you see, the more chance of making errors in 5-10 min consultation for a patient who might need a full 30 min evaluation (including the time for your brain to process the diagnostic algorithms and ddx). And trust me, as a FD you CANNOT spend 30 mins, heck even 20 mins, with every patient that you see in one day or your business will go bankrupt, pts in waiting room will leave you extremely negative comments (they dont and wont give a damn how thorough and accurate and great care you were providing to the patient you were in exam room with...and they could also file complaint to your college, probably nothing will come of it but the headache and stress you will go through from getting a letter from your regulatortycollege

This is most specialties. There are not many specialties out there that have a slower pace built into the culture, except maybe pathology. Everyone else either is incentivized to go through high volumes, pressured by hospitals/referrers, or it is built into their culture.

Family physicians are in general at much lower risk of being sued because you see less sick patients. Family physicians pay some of the lowest CMPA fees.

https://www.cmpa-acpm.ca/static-assets/pdf/membership/fees-and-payment/2020cal-e.pdf

 

[gogogo 63]

1 hour ago, ZBL said:

Not in FM, but of those I’d suspect sports med is the only one where your practice may focus exclusively on that niche area (and palliative, and maybe OB). Otherwise it is probably a mix of general practice and those other areas. Note GP derm is not a real thing - it’s a self-proclaimed title. 

Thanks. I'm very interested in sports med. Is practicing exclusively sports med as a GP possible in the GTA? Does it come with sacrifices (e.g., tight job market or lower pay)? And what about GPs doing just pain?

[1D7 153]

4 hours ago, Rationalistlens said:

On any given day, a neonate might come to your clinic who is really sick but does not look sick enough to YOU (who is not an expert in pediatric care) to direct them to ER at that point in time. So you decide to send him home and he dies, guess who will be held responsible? You as a primary care FP (you are not a ped, keep in mind, and hence are not an expert in pediatric care). You will be held responsible for missing a critically ill child in a 5 -10 minute visit for which you were being paid only $33-40. The same patient when goes to ER, the ER physician will make at least $77 for the same presentation with the ADDED advantage of being able to do stat xrays/cbc to further hone his/her ddx.... Now you tell me, are you willing to take that risk of making critical decisions in light of the Limited time you can spend and limited $ you earn from making those hard and tough diagnostic decisions? 

 

yes this doesnt happen daily. Maybe it will happen 5 times in your life time that you see a critically ill neonate. But you just need one error to have your livelihood ruined and your face plastered on the news and your reputation destroyed. And that also makes it even more tricky. The less presentations you see, the rustier your clinical acumen and diagnosis. Hence even greater risk of not recognizing a catastrophe happening in front of you. 

i can go on and on. 
 

 

Dont ever do FM. find something you like and focus on that specialized care you can be and dream to be an expert in.

For the medical students out there, you are only opened up to being taken to court if there are 'damages', AKA a bad outcome of some sort. That is the basis for why most inpatient physicians, including obstetricians, emergency physicians, radiologists, neurologists, and surgeons are sued at higher rates. These sort of specialists see sicker patients and are much more likely to be involved in bad outcomes, even if they didn't do anything wrong.

On top of that, inpatient physicians are the ones performing more invasive procedures. A surgeon will have bad wound infections and dehiscences. A radiologist will have pneumos post-lung biopsy. And it's pretty easy to see why OB is the most litigious field in medicine. For many specialists these sort of things don't happen '5 times in a life time', many procedural complications happen weekly/monthly/yearly.

This is a lot of 'the grass is greener on the other side' sort of thinking.

[rmorelan 2,527]

4 minutes ago, 1D7 said:

For the medical students out there, you are only opened up to being taken to court if there are 'damages', AKA a bad outcome of some sort. That is the basis for why most inpatient physicians, including obstetricians, emergency physicians, radiologists, neurologists, and surgeons are sued at higher rates. These sort of specialists see sicker patients and are much more likely to be involved in bad outcomes, even if they did everything right.

On top of that, inpatient physicians are the ones performing more invasive procedures. A surgeon will have bad wound infections and dehiscences. A radiologist will have pneumos post-lung biopsy. And it's pretty easy to see why OB is the most litigious field in medicine. For many specialists these sort of things don't happen '5 times in a life time', many procedural complications happen weekly/monthly/yearly.

This is a lot of 'the grass is greener' sort of thinking.

if I can add to that - it is also that we see such a range of pathology that the scope of practice can be huge, and yet there is the expectation in majority if not all of the specialties mentioned that your performance should be perfect. A radiologist practicing as a generalist (which most rads effectively are) can see literally anything, on any imaging study as an example - including things rarely seen in something like 8 specialties. ER physicians? - literally anything that can ever go wrong with the human body can show up in the ER (where they not only have to do that job but do it fast), and so on. The complexity is very paralyzing at times - and you just do the best you can and constantly study to improve. 

plus yea - you can do everything perfectly and still have a bad outcome. Medicine is not a 100% safe thing, both for patients or it seems the doctors. 

 

 

[Rationalistlens 2]

3 hours ago, 1D7 said:

This is most specialties. There are not many specialties out there that have a slower pace built into the culture, except maybe pathology. Everyone else either is incentivized to go through high volumes, pressured by hospitals/referrers, or it is built into their culture.

Family physicians are in general at much lower risk of being sued because you see less sick patients. Family physicians pay some of the lowest CMPA fees.

https://www.cmpa-acpm.ca/static-assets/pdf/membership/fees-and-payment/2020cal-e.pdf

 

You are right that bad outcomes of course happen in other specialties as well. But that was not even my argument. My argument was that as a FP,  who only has superficial knowledge about everything due to the very nature of generalism involved, you are making decisions for things you do not have an expertise in. The gravity of it does not hit you when are you are a FM resident in hospital with supervisors to review your cases but only when you are MRP on your own with a waiting room full of patients you must see in less than 15 mins each and $33 each (being liberal here with 15 mins) and monthly expenses to pay to keep your clinic afloat.

ER doctors see catastrophes daily, that is their training. An average family doctor probably only diagnosed PE once or twice (that is if you were lucky or spent half your 2 year training in ER or did that elective out of interest on hematology ward) in their training and is expected to make sure in 10 mins without access to stat Ct and stat d dimers that one walk-in pt with pleuritic chest pain is not having a PE before sending them home. Especially when you dont see chest pains daily in your practice and hence dont really rememeber WELLS criteria on the back of your hand so you have to excuse yourself from pt encounter to do the score on your cell phone before telling them “i think I am concerned about a PE, you should go to ER to get it checked out” and then it turns out they did not  have a PE anyway. And must I remind you of the joy when that pt comes for follow up to you and reminds you, the lowly GP who probably never treated a PE in his life but was making decisions on suspecting/diagnosing it, “hey doc, i waited full 2 hrs in ER, they told me you are fine and sent me home, you were just worried for no reason.” And yes, all that “worry” for $33 for that encounter including the delays it caused on your schedule and other unhappy patients because you wanted to take time to properly reach the right decision for this patient’s discharge to home or ER.
 

My message: Stay away from FM. 

 

[Butterfly_ 426]

I think with proper communication litigation can be avoided.

 At the end of the day, it’s up to the patient to decide whether or not they want to to the ER. You shouldn’t tell them to go, you should provide them with the pros and cons and explain to them your rationale.

 

if you said, “ I know you feel fine, And the risk of you actually having a PE is low, I still think it’s a good idea to run some tests at the ER just to be sure because of xyz reasons.”

Same in the case of a sick kid. If you give proper instructions for returning to clinic or going to ER, you shouldn’t be sued. “Currently, your child’s vitals signs are stable, and the symptoms are likely caused by a viral urti, however, if your child’s condition worsens, aka Less wet diapers, becoming lethargic, not drinking etc, make sure you go to ER right away.

if you document and communicate  properly, you probably won’t be sued.