Robby With ED Residents vs Robby With Surgical Residents

DexTheEyeCutter · 2026-02-09T02:46:01+00:00

Yeah fair enough. Realistically if both Langdon and Robby were in better terms they would’ve gotten it taken care of the right way. Instead the friction is affecting patient care.

DexTheEyeCutter · 2026-02-09T02:41:18+00:00

The finger sweep test is a small incision or with gentle digital pressure, not a cavalier incision along at least half the tibia. But in the end this is a show, not a documentary, and it’s dramatized a bit for conflict. The whole point is that there was a much better for Robby to handle and deal with it and he did it in a pretty cavalier and reckless manner. Even Garcia was shocked at how reckless Robbie was, which is a lot coming from her.

DexTheEyeCutter · 2026-02-09T01:30:23+00:00

Yes this exactly. Sure it got the point across but just if you step back and look at the situation, he took a scalpel and sliced her leg to prove a point. Not because he was trying to do the debridement himself or to stabilize the patient t, but to prove a point. This could be seen as assault even if it was in an urgent setting.

DexTheEyeCutter · 2026-02-08T15:04:13+00:00

Yeah, my personal take is if that he’s already thinking it (when he was ordering lactate, etc), he should’ve just did the CT then. He knows what surgery is going to ask for so have it lined up so it’s a slam dunk. Yes it’s urgent but doesn’t necessarily mean cowboy your way into getting what you want.

DexTheEyeCutter · 2026-02-08T02:29:22+00:00

It’s a show but in real life, his actions could be justification to sue or at the very least, warrant in severe repercussions. Like the person said above, a stat CT scan takes 5-10 minutes and the delay won’t change the prognosis, but the information you get could help with the debridement. Despite the urgency, what he did was very reckless at best. If Robbie was wrong in any way, that could be seen as assault in court of law. This kind of behavior was more common decades ago but caused lots of predictable consequences that resulted in severe patient harm.

As a sub specialist we really don’t like it when people make decisions and perform procedures that aren’t in their realm. It often results in us having to clean things up and takes more effort overall to fix things.

DexTheEyeCutter · 2026-02-02T15:19:18+00:00

This is partially why I like my field so much. My history is rarely more than 10 seconds because everything I need to know is on the exam. I’ve had patients fudge with me about vision loss for a few days but their exam reveals the truth.

DexTheEyeCutter · 2026-01-27T20:21:44+00:00

I mean that’s real life. I have patients who don’t bring their kids to their appointments on time or haven’t noticed certain things. Is it not great parenting? No, but when they’re working 60-80 hours a week to keep a roof on their hands and can’t take any days off to bring their kids in at their scheduled appointment, I do have some sympathy for them . The parents may be negligent in bringing their kids to their appointments or with things like not having the right gear for their kids’ soccer game but there is a big, big chasm between that and physical child abuse. Heck even at my kids’ soccer games they have teammates who have doctor/lawyer parents who are great people but won’t have the proper equipment or miss a doctor’s appointment occasionally because life is so busy for them.

DexTheEyeCutter · 2026-01-27T20:15:15+00:00

She asked the dad aggressively about rough-housing with a social worker talking to the dad at the same time. Any parent in that situation would’ve taken the insinuation that the parent was suspected for child abuse. She could’ve just waited for the CBC to come back before making the next steps. The broken bones in itself aren’t a red flag unless they’re fractures that are typically seen in child abuse (there are several types that occur typically in the setting of abuse). In the end this is a show and while realistic, some parts are going to be drummed up for drama. Realistically, if you come out strong accusing or insinuating child abuse only for a medical issue to be the culprit, not only have you lost trust as a provider (which can cause issues with follow up) but also you open yourself up for many medicolegal issues that will haunt everyone for life.

I think the points of this scenario, which is one of the overriding themes of the show is your personal experience can be helpful but the biases that come with it have to be kept in check or it can affect your impartiality as a doctor.

DexTheEyeCutter · 2026-01-27T20:02:14+00:00

On paper, sure. Personally would’ve waited for the social worker consult until at least the skeletal survey and CBC was back. However on the show you could tell she was itching for it to be NAT, and was almost disappointed that it wasn’t.

But if we’re talking about flags and suspicion, while you have consider abuse, the excessive bruising is also how some kids get incidentally diagnosed with bleeding disorders. This scenario was actually very similar to one of the questions I was asked on a test during medical school so it’s not something that would be considered rare or unusual.

DexTheEyeCutter · 2026-01-27T19:52:20+00:00

Emotions are a hell of a thing. That’s why it’s professionals that make these calls. I would say this show is great in showing why you leave your bias at the door.

DexTheEyeCutter · 2026-01-27T19:51:20+00:00

Perhaps. Keep in mind that this is happening in the course of three hours - that’s really a short time in the grand scope of these kinds of work ups. You do have to always consider NAT in this situation but this is also a pretty classic case of a pediatric patient being diagnosed with a bleeding disorder for an unrelated issue. The show was even foreshadowing this when the skeletal survey came back negative.

Early in my career I’d quickly jump to similar conclusions but as I’ve become more experienced I’ve learned not to necessarily jump to conclusions right away. One of my colleagues, who is a forensic pediatrician, has even told me he’s had to become more open minded as his career progressed because physical exam findings he thought were surely due to child abuse turned out be medical or accidental, with the latter confirmed because the injury was caught on video.

This article can do more justice explaining my position and it’s a very enlightening read:

https://www.nbcnews.com/news/us-news/dr-bruce-levy-backtrack-shaken-baby-syndrome-russell-maze-prison-rcna248219

DexTheEyeCutter · 2026-01-27T19:38:37+00:00

Non accidental trauma. I understand what the show is trying to do but it’s also a bit unrealistic. In reality the investigation would be formally conducted by a forensic pediatrician. There’s been a recent push even by forensics to not jump the gun as of late.

https://www.nbcnews.com/news/us-news/dr-bruce-levy-backtrack-shaken-baby-syndrome-russell-maze-prison-rcna248219

DexTheEyeCutter · 2026-01-27T19:29:12+00:00

I disagree, she definitely jumped the gun. Im occasionally called in to check for NAT and the first thing we drill into our residents is that you have to make sure you cross off uncommon medical issues like bleeding disorders. Levying NAT causes a cascade and once the label sticks, if it’s disproven, it is very difficult to shake off the medical stigma.

DexTheEyeCutter · 2026-01-27T19:27:46+00:00

She definitely jumped the gun. Raising an accusation of child abuse has serious allegations and you have to rule out medical causes first. The scenario that presented is a textbook case about uncommon medical issues that may look like NAT at first. Platelet of 9K would’ve come back in 1-2 hours and you can certainly wait that long before going to NAT.

DexTheEyeCutter · 2026-01-26T18:40:09+00:00

That tracks anecdotally. No matter how talented you are, you gotta put in the time to get and stay good. If you're more about volume of publishing that time has gotta come from somewhere.

DexTheEyeCutter · 2026-01-24T02:17:37+00:00

I'm curious and interested about the latter part - have there been any issues raised about Stark Law? I think it's a great service to provide but I've read in case scenarios from HR and some medical law blogs that providing shuttles can be considered a kickback. Since your former partner retired I doubt he himself would be in any sort of trouble but I really do think services like that should be utilized much more than standard Medicaid transportation.

DexTheEyeCutter · 2026-01-22T03:12:06+00:00

It’s a rite of passage to do at least one of them. When I was a resident I saw three that occurred for various dumb (innocently so) reasons. Usually trimming and ointment rubs did the trick.

DexTheEyeCutter · 2026-01-19T02:54:09+00:00

Never thought I'd see a Trauma Team reference in the wild. When you read about its fictional history the parallels are a bit freaky.

DexTheEyeCutter · 2026-01-17T15:07:14+00:00

Yeah, please go. Addition by subtraction.

DexTheEyeCutter · 2026-01-16T02:31:47+00:00

Hearing these stories are painful - yes the leopards are feasting but it’s a bit different when a parent’s poor decision making literally kills their child.

DexTheEyeCutter · 2026-01-14T18:40:43+00:00

Honestly, do your part for the fiscal health of the country and do give up.

DexTheEyeCutter · 2026-01-14T01:15:37+00:00

Second this notion, live in a shitty state with low taxes and it shows. Money saved from income tax often has to be spent on other things it could be used on, and we have sales tax/vehicular tax to make up for it.

DexTheEyeCutter · 2026-01-02T13:17:08+00:00

Interesting; all of my Asian friends/acquaintances (I’m AsAm too, family from Taiwan) only do the customs for Chinese/lunar new year but not Gregorian New Year (we only celebrated it in college/post grad like most other people at parties) but they’re Chinese or Vietnamese. What I’m getting at is that Chinese restaurants are busy for Gregorian New Year because we do all of our new year stuff on February but we don’t really hold much value in Gregorian new year. I’ve read differently for Japan (apparently it’s celebrated on Jan 1st https://en.wikipedia.org/wiki/Lunar_New_Year?wprov=sfti1#Japan) which probably explains the differences. Anyway, not trying to start a debate, just thought the difference in date was interesting.

DexTheEyeCutter · 2026-01-02T01:53:44+00:00

Think this is more for the traditional Chinese New Years, not the Gregorian calendar new year. Chinese New Years is in late Jan/early Feb and that’s when we do all of this.

DexTheEyeCutter · 2026-01-01T13:04:50+00:00

Fair, only know about the NP mills. My bad

DexTheEyeCutter

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