Jamie Wallach wrote about a 4 mo. old with a cervical mass. She asks, "Did I miss something? Any thoughts greatly appreciated" "The first thought reading her detailed account was that she (the doctor) was a victim of patient disloyalty and a political ambush. I have occasionally seen this sort of thing. In a non-collegial professional environment (pretty much everywhere) dirty tricks get played. These patients, whether consciously or not, chose to leave your care when they self referred to the family doc. Did the family doc and the specialist call you and discuss your patient with you? I suspect not. They are better off with their new doctor, and you and Dr. Wallach is better off without this family. The course of action of you and your partner as described sounds sensible, prudent and prompt for this kind of situation. I would have second thoughts about using the ENT that the family doc sent this child to as well as the intensivest, if you can manage, avoid them. I try to instruct parents that the job of looking after their child's health is a team effort, the parents and I are partners, and need to communicate as partners, showing mutual respect and trust. As a responsible and caring member of that team I insist on being consulted if at all possible before deciding to seek care elsewhere (including the ER). The relationship with the physician is crucial in good outcomes for children. If parents can't or won't understand this it is time for them to seek care elsewhere. I've been at this for twenty years and am still learning about these things. Society is trying to shape the image of the physician into that of a glorified mechanic and this confuses people. I find that the more direct, compassionate, and detailed I am at communicating the limits of acceptable behavior for people the less often I have to take unpleasant measures, such as discharge from the practice. Young parents are in a perpetual panic and are easily spooked and misled by people who like to do those things. I try to be understanding, but I can't make choices for them. I came to clinical practice with the idea that I could potentially please everyone. It was a mistake." I could not agree more with Herb Ruhs. Well said. David