This could have been done in 5 seconds but instead it took 5 hours

January 9, 2007

In case you don’t want to read this whole story, the moral is to try to get Dr. Robert Lindeman of Natick Pediatrics as your pediatrician if you live anywhere close to Natick, MA.

On December 23rd my preschooler came home from a play date with an aching, swollen foot. No one knew exactly what had happened except that he’d fallen. The next day he was still complaining about it and limping badly. (He’s not a big complainer or limper.) Normally I dread any interaction with the health care system so I would have ignored the injury and hoped it got better. But it was the day before Christmas and two days before we were leaving the country for a week.

We went to a family social function on the 24th. There were plenty of doctors there, including pediatricians. We asked one pediatrician (whom we don’t know well, but who practices pediatrics in the ER) to have a look. She took off my son’s shoe, had a look, and said she wasn’t sure. Her dad happened to be there, too. Turns out he is a pediatric orthopod! He had a look and said he couldn’t see through skin (since he lacks X-ray vision) and that he didn’t know if it was broken. Both told us that if it was a Jones fracture it could be serious and require treatment.

Then my wife saw our friend Dr. Lindeman, and asked him. He didn’t take off my son’s shoe or talk to him but said:

“It’s not broken. I can tell by the way he’s putting weight on it. Don’t worry about it.”

When we got home we called our pediatrician’s office. Our excellent pediatrician, Dr. Patricio Vives (old school, no website to link to), wasn’t around on Christmas Eve. The person covering for him said she couldn’t tell what was wrong and suggested we might want to go to the ER for an X-ray for “peace of mind.”

Oh no!

I took my son to Children’s Hospital and prepared for the worst. Good thing I did. Rather than complain about all the details I’ll just say it was a 5-hour experience, which included 4 hours and 45 minutes of waiting, 10 minutes in radiology, and 5 minutes with the doctor.

At one point (3 hours or so in) I was told –when I went to the desk and asked nicely– that we were next on our “track. ” (They have different tracks depending on whether orthopedic/surgical, medical, etc.). Around the 4 hour point, a staffer came out with a clipboard and after seeing our name toward the bottom of the list said, “you must have just come in.” I have to admit I almost lost my cool at that point. A few minutes later she came back and more or less admitted they’d lost track of us.

Who knows how long we would have waited after that. Luckily one of the physicians recognized our name and had us called in. It turned out to be another friend of ours. She saw my son, told us the radiology report was negative, and then had my son stand on his toes. As soon as he did that she concluded he was fine.

This experience was kind of embarrassing for me (and of course a big time waster). What I take away from it is to listen to advice from people you trust and don’t ask the opinion of people you don’t know well. If we hadn’t asked the first pediatrician and pediatric orthopod I just would have listened to Dr. Lindeman and not bothered to call the person covering for our pediatrician. (I’m pretty sure that if Dr. Vives had been around he would have steered us properly.) It also would have been nice to have a consumer-friendly decision support site, which could have taught me the tiptoes trick and saved my time and my health plan’s money.
So let me at least put in a proper plug for Dr. Lindeman (since I didn’t pay him for his quick assessment). He’s a first-rate office-based pediatrician with MD and PhD degrees from Columbia University. He’s board certified in pediatrics and pediatric pulmonology. He uses secure messaging with patients and families (though sadly he’s not using RelayHealth). He also handles call himself, rather than farming it out to someone else.
I don’t live anywhere near Natick, but anyone with kids who does should check his website or call his office at (508) 655-9699.

——

May 31, 2007

Yes, folks, I’m referring to the now-famous Flea blogger, so this post is getting a lot of hits today. I stand by my endorsement of Dr. Lindeman, which is based on ever-so-much-more than this particular anecdote. You’ll see a bunch of critical comments below from people who don’t have firsthand knowledge of this case and don’t know Dr. Lindeman. They’re off the mark IMHO.
David Williams

14 thoughts on “This could have been done in 5 seconds but instead it took 5 hours”

  1. 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 you feel the same if Dr. Linderman said not to worry, and upon arriving at your foreign destination you 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. You would not likely have been as grateful to Dr. Linderman if he was incorrect.

  2. I not even sure where to start. A complete evaluation and radiographs for a limping child is the appropriate thing to do regardless of the date, time of day, and the inconvenience involved. The docs told you what most docs would have and should have. A negative xray in the end doesn’t undermine this one bit. And as for the wait..unfortunately this is the norm for after hours and weekend acute care/ER visits. The ER I refer to a six hr wait is not uncommon for a similar complaints not because they are inefficient or lazy but.. busy. This experience sounds typical of most non emergent visits to the ER regardless of how many MDs the patient or their family know.

  3. We had a similar experience a few months ago — our daughter had a bad, persistent headache, we went to the office of our excellent pediatrician but he wasn’t there, the doctor covering said that we should go the ER just to be safe, and we spent 4 hours at Newton-Wellesley waiting for a PA and doc to finally say that she probably just had sinus pressure………

  4. I dont get it. How does one expect any level of provider to determine if you have a fracture over the phone. It was a waste of time to even call your doc. As far as the wait, its called triage and your case was probably one of the least urgent. Going to a urgent care would of been a much better option.

  5. Anonymous–you should be glad to know that your daughter’s headache did not turn out to be meningitis, increased intracranial pressure, or something equally concerning. I’ll also be presumptive enough to assume that your daughter had some labwork and radiologic studies (CT scan?) not performed in most doctors’ offices. I am amazed how often parents return from an ER visit complaining that “everything was fine, what a waste…” An ER serves many purposes, including performing a thorough workup in a short time. The “emergency” in ER points not to the final diagnosis but to the chief complaint and the degree of concern of the referring doctor, or presenting patient.
    I hope that most of the patients I send to the ER come back with fairly benign diagnoses. It’s like surgeons say: if 100% of your “suspected appendicitis” cases turn out to be real appendicitis, then you’re missing quite a few. Much much better to be too safe than too casual–especially in today’s litiginous environment.

    I doubt I will ever be sued for sending someone to the ER to be evaluated. I’m quite confident I could be sued for NOT sending someone. I try to accomodate parents as much as possible, but I will always place my concern for a patient’s well-being over the “inconvenience” to a family. As should they.

  6. 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.

  7. 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.

  8. I do not know where you searched, but Google (and all other major players in the search area) offer local searches. Google’s is at:

    http://maps.google.com/maps

    A search for “urgent care 02446” (without the quotes) comes up with a number of promising hits.

    Alternatively, I am sure that something as mundane as the Yellow Pages (or, if you prefer, http://yellowpages.com/) would have served just as well.

    Cheers,
    Felix.

  9. Felix,

    Thanks for the suggestions. When I try the Google local search I pull up a number of ambulance services and a couple of Community Health Centers. I get hundreds of hits on the yellowpages site but they are hard to sort. I’m not at home to look at the physical yellow pages but that may be a good resource.

  10. As a Mother of 2 sons, now 21 & 25 I would NEVER trust the word of anyone Dr or otherwise outside of a medical facility. How can they possibly know correctly without an x-ray? that was just a good guess on his part. If you don’t care enough about your child to “WASTE” time in the ER, then you have no business being a parent! I listened to my sons ped. after he got hit in the head palying baseball with his friends. Just watch for a concussion, which I did and no concussion. 2 weeks later, he had a gran mal seizure in school, he was rushed to childrens hospital and had a massive blod clot on his brain. I should have listened to my own instincts as I always had and had him checked out before any of this had happened. I am sure a few hours of your precious time is worth your childs well being, and also what about the pain he was in? that didn’t matter to you? hmmm, I really wouldn’t want you as a parent who has time to see all these DR;s at a PARTY, but don’t have the time to take your child to see one of them!

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