“Flea”, who practices as a pediatrician in the Northeast, gets a letter from his professional liability insurer instructing him “to maintain a high index of suspicion for the worst possibility” when patients present themselves, “even when the clinical presentation does not automatically lead one to [the] conclusion [that their lives or long-term health are in jeopardy]”. His response (Feb. 13):
I’m sorry, ProMutual, I cannot practice medicine this way. Let me give the most trivial of examples.
The worst that a child with a fever could have is sepsis or leukemia. I simply cannot maintain a high index of suspicion and do appropriate testing to rule out sepsis and leukemia (i.e., draw a complete blood count and blood culture) on every one of my patients with fever, without regard to the patient’s clinical appearance.
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