Low Grade Fevers


Just found another thing to add to my list of pet peeves.

First, I’ll recap. There are three things that get on my nerves to the point that I have had to rant about them: Cell phones, using the term “emergency room,” and anyone who engages in “baby talk.”

Introducing #4: The “low grade fever”.

This peeve is more about doctors than it is about patients. Most patients don’t and shouldn’t know about medical definitions. I sympathize with patients and families who are inappropriately sent to the emergency department for evaluation of “low grade” fevers. Most of the time, this isn’t your fault. Just don’t go telling everyone else what your doctor said so that the problem gets worse.

The definition of a fever is either a core temperature of more than 100.4 degrees OR an increase of 2.4 degrees or greater above the patient’s basal body temperature. Before you use part B of this definition, you better be showing me some graph paper with temperatures plotted on it. Some experts even state that a temperature isn’t a fever until it hits 101 degrees. Hyperthermia is considered an elevated temperature beyond the body’s normal set points and is generally defined as a temperature of 106 degrees and above. Hyperthermia is bad news and requires immediate medical evaluation.

In 99+% of cases, fever isn’t the enemy. Fever is potentially dangerous in newborns and infants less than 30 days old. Seek immediate medical care. Fever in kids less than 3 months old is still possibly dangerous, but less likely so. Kids older than 3 months are generally safe with fevers. I’ve had several parents come to me concerned that their kid’s brains are going to fry. Your kids aren’t eggs and their skulls aren’t skillets. Brains don’t fry unless you’re in Hannibal Lechter’s kitchen.

If you’re using tympanic thermometers, don’t. There are many studies showing that tympanic thermometers are unreliable or at least less reliable than other methods. Yes, some studies show that tympanic thermometers are reliable. If you had three measuring devices showing that a cup was 8 ounces and six showing that a cup was anywhere between 6 and 12 ounces and couldn’t tell the difference between any of them, which one would you use to bake a cake?

I’m getting off track.

First, don’t try to BS me and tell me that you’ve taken your temperature or your child’s temperature when you haven’t. When parents of an 18 month old bring him in for evaluation of “low grade fever” of “ummmm 99 …. point …. 2 or3,” sorry, but my BS meter has already gone off. No Motrin for you … 1 year!

Second, I don’t care what your doctor told you. Less than 100.4 degrees is not a low grade fever. It isn’t a fever period. I know it’s probably not your fault. I know you’re trying to be a good parent. If your doctor insists that a temperature less than 100.4 degrees requires an emergency department visit, get another doctor.

A temperature of 99.4 is not a low grade fever any more than a blood pressure of 100/60 is low grade hypertension or driving 50 MPH on the highway is low grade speeding.

And no, you don’t need antibiotics for a low grade fever … even if it really is a fever. Amoxicillin doesn’t contain Tylenol and Zithromax isn’t a decongestant. They won’t help.


UPDATE NOVEMBER 4, 2014Ebola Picture

I noticed that this post still tends to get quite a few hits  and quite a few comments even though it is four years old.

My sentiments haven’t changed. Low Grade Fevers are a non-entity and until someone shows me medical research to the contrary (no, stories about your cousin’s sick child whose temperature usually runs in the 80’s don’t count), Low Grade Fevers will remain a non-entity.

It’s almost comical how many people have engaged in ad hominem attacks against me and suggest that I pick another specialty because I dare to present some medical studies and factual information to burst their bubbles about something this simple. No, your baseless assertions that I am mean, have poor bedside manner, and that I’m a female hygiene product in disguise don’t hurt my feelings. They just show me how many people possess no logic and try to win an argument by whining and crying when no one else agrees with their assertions that the world really is flat.

However, with the recent Ebola hysteria and the influenza season looming on the horizon, I had to put this question out there.

For all of you people whose systems go into shutdown when your temperature hits 98.75, let’s suppose that you are traveling internationally. Are you going to go to the customs agents and tell them “I’m not like everyone else. My temperature may be normal by your standards, but when I hit 98.75 degrees, I could be in the early stages of Ebola infection and I should be quarantined for 21 days”?


  1. 2 things you should know: every pediatrician I’ve taken my children to (in two different countries!) have used tympanic thermometers. Why do that if they are so inaccurate?

    And 2, where we live now, Switzerland, my ped wouldn’t give my child a vaccine because his fever was elevated–37.2 celsius–99 fahrenheit.

    This is why parents worry and use tympanic thermometers. Their pediatricians have told them to.

  2. And what about the return visit because the Tylenol or Motrin “wore off” and the fever “keeps coming back”? That one is just a huge eye-roll for me.

    • It’s “Hear Hear.” For Christ’s sake, don’t tell me you’re a doctor; no wonder most of the parents disagree, as the incompetence must be high-grade among you and your colleagues in agreement with this ridiculous post.

  3. Well said! It doesn’t matter how many times you explain this to some people, though, they still drag their kiddos in for 99.1 “fevers”. These are the kids who are doing cartwheels in the ED waiting area.

    • I work in daycare and we have to send children home at 100* I’ve yet I have seen a child with a fever of 99 and up EVER do a cartwheel or anything other than stare off pale. And I’ve sent hundreds of ifs home thousands of times over the year. They aren’t fine in fact feverol seizures begin at 100* which I’ve also had happen. Explain that how did those children get feverol seizures If they didn’t have “fevers” at least not by your definition.

      • A: FEBRILE seizures.
        B: FEBRILE seizures are more likely to start around 102, though they can start lower it is less likely.
        C: FEBRILE seizures are more harmful in that they are scary for parents and caregivers rather than directly harmful for kids.
        D: You should know more about FEBRILE seizures if you are taking care of children who so frequently experience them while in your care.
        E: Why are so many children getting so sick at the daycare in which you are employed? I would be very concerned.

      • My daughter has been running a “fever” of 99.3F-99.8F for about two months. Ibuprofen will bring it down but she’s not sick! She’s clear for strep, ear infection and flu. She’s eating like normal, jumping off the walls and playing soccer. Her nose isn’t running her throat isn’t hurting her body isn’t aching. I’m not taking her into the doctor again like an idiot.

        Also, I don’t treat fevers until they reach 102F and over (unless they’re infants) because fever is good. It’s your body’s mechanism for beating that infections butt. That’s university biology 101
        This doctor is right, too many idiotic cases that can be treated at home crowd the ER. There are people who need the ER and those people cannot walk in and get treated immediately because of this kind of BS. In order to get seen ASAP you have to take a $1200 cab ride aka the ambulance. That’s unfair.

      • My son who’s 2ys 4 months has he fevers of 103/104 and he’s been running around. Playing acting completely normal they only difference is his face & eyes are red .. None of my 3kids stare off or get pale she their fevers get to 99 or even 100 .. And being the owner of a daycare I know that because if licencing and state regulations a child with a fever of over 100• must be sent home no matter how they look or feel .. Of course not all kids are going to react like mine and some do get lethargic when their temps rise . But to say that febrile seizures happen often at low temp of 99/100 is insane an highly unlikely .. Please for the sake of those children educate yourself better in that area !

  4. Mama On A Budget on

    Don’t even bother with the basal temperatures and MDs. I have taken my waking temperature with a basal thermometer for over 4.5 years (with the exception of a pregnancy thrown in there). I’ve brought my records with me to every doctor’s appointment. I can prove with data and graphs that my highest temp is 98 even and my average temp is about 97 even – and they all say I’m crazy.

    Which is why when I get a fever, I drink more water, take some vitamin C, and let it burn off whatever it is that is making me sick. And yet I (as well as my 3 and 4.5 year olds) were able to survive the “Swine Flu” and 104-105 temps last year without being told to take antibiotics (that weren’t necessary) or get a vaccine for the same damn thing after the fact.

    A fever is just the body’s way of killing off the virus. If it doesn’t last more than a couple days, everyone needs to just chill the heck out. Bringing your snot-nosed febrile kid to the doctor’s office and letting them sneeze all over the toys is just your way of sharing the bug with everyone else. Then going to the grocery store to fill the unnecessary Amoxicillin Rx just gets the little old people waiting for their blood pressure meds and insulin refills sick, too. Stay home, feed them (and yourself) some chicken soup and orange juice, and get some rest – for everyone’s sake!

      • Likely for fertility reasons. Natural family planning techniques use basal body temps (among other things) to track fertility. A woman’s body temp increases right around ovulation a few tenths of a degree (F). Women who are either trying to conceive or trying to avoid pregnancy often track BBT to assist in their endeavors. I personally know several couples using this technique. It is not uncommon.

      • Nurse K — there are folks who measure BBT to _increase_ their chances of getting pregnant. You seem blissfully unaware of anything fertility-related beyond the Nuva-Ring.

      • Mama On A Budget on

        Yes – to GET pregnant. Thanks.

        Some of us prefer to trust our bodies over big pharma. Nuva ring… around for 5-10 years. Temperature rising at/after ovulation and changes in cervical position and discharge… since the dawn of man.

      • And I think if “Mama’s on a Budget” she’ll have a problem with the Nuvaring since it’s $125/month
        Insurance rarely covers it.
        But I digress.

    • Eight years in the Navy…In that time, a dual-humerus fracture, two tumor resections, a grade 3 ankle sprain, and I’m a female with abnormal results all the time until every 4th or 5th which came out normal.>:(
      90% of those temperatures were 97.0 to 97.3.
      The way I figure it: Throughout history, males were allowed to formally study medicine centuries before females. Males tend to ‘run’ warmer than females…Doctors tended to use each other as subjects (Listening to each other’s heartbeats, taking temps, feeling glands etc..) therefore, it make sense to me that the ‘typical’ human temperature would be that of most males…98.6-ish. I am very glad someone posted that a LGF is classified as 2.4 degs over normal basal temp. Progressive.

  5. I think this was intended for children and worrisome young adults with fevers, although it doesn’t really say.

    However, I’d like to give a little shout-out to the fact that very elderly people with serious infections often have no fever…20-30% in fact.

  6. The low-grade fever is rant-worthy, to be sure. Maybe not as frustrating as allergies (which you covered very well last year) but pretty bad.

    My fever peeve regards decimals. The nursing home tells the family the patient’s temp was 100.6, but when they’re telling me in the ED, it becomes 106. At least in that case there are records I can fall back on.

  7. Off topic, sort of. I never had trouble getting pregnant…but I did do the BBT as part of a paper for college. I actually discovered over 3 months of measuring that I ovulated twice a month!! I spent a ton of money to confirm it with those predictor tests, too. I got pregnant on the 7th day, 23rd day, 19th day and 14th day respectively with my four kids. I still find that amazing and I did document it!

    As for my kids and fevers…I used the tympanic thermometer, but many times felt it was wrong and did a rectal to confirm a high fever.

  8. Body Heat..if anybody remembers that movie…Kathleen Turner was always a sizzlin’ 100 degrees or somethihg like that.

  9. Both community hospitals I am familiar with use tympanic thermometers ..both in the ED and on the floors. I often guide them to put it all the way in and nurses say it doesn’t matter..which doesn’t make any sense to me because when I guide them in they kind of have to go around the bend and I can definitely tell a difference. I would think it would be warmer all the way in then just on a ledge in the outer ear. ?? Does the depth matter?

    And ..if no one should use these tympanic thermometers ..then *WHY* do hospitals use them …and does it matter ..does the temp accuracy matter?
    I used to take my basal body temp for about a year. I had infertility concern with first child. However ..when you’re afraid you may never conceive ..you become a *slave* to the chart and it can get mechanical. You get so obsessed with timing.
    The Soup Nazi – My FAVORITE Seinfeld episode! Ha ha! When I think of all the scenes in that episode ..but the Soup Nazi – EXCELLENT! :)

    Another favorite – Scrubs – My Machines!


    I can watch that over and over and over and over again and now will before signing off. :(

    That actor is just PERFECT playing the extremely irate radiologist! :)

  10. We had a guy that kept coming in with lowish “real” fevers (101 or so); finally got diagnosed with malaria. That was kinda cool.

  11. I get irritated with that too. Just last night I had “Oh, I checked my temp and it was 99.0 so I have a fever since I usually run at 96.5″. Yeah right, prove it to me.

  12. One more thing …my normal temp was always 98.6 …until I had sepsis, etc back in 06.

    But ever since then ..my norm seems to be in the 97s.

    I did ask a doc about it and I don’t recall his explanation ..but an illness like that can cause the normal temp to reset to a lower norm.

    Can anyone explain that?

  13. According to this article the gold standard for temperature measurement in the clinical practice should be RECTAL temperature. Oral temp outperformed tympanic temp measurement. All patients seeking help in the ED for ‘low grade fever’ should be alerted about these facts, and thus all need to have their temp measured up their ass.

  14. Peds do not always send fevers to the ER. When my son had a fever of 106 and we couldn’t get it go down with Motrin, I called my pediatrician (middle of the night) and he told me to just give him Tylenol with the Motrin–it worked–got it down to 103 and my son was able to sleep.

  15. Of course, the urgency in which moms think their child needs immediate medical attention is directly correlated to whether or not they are on medicaid. It is only going to get worse now that more people are about to get “free” care…

  16. in no way do i find that a fair statement. i am a mother on medicaid. i dont rush my son in for everything because its free. i took ny son to the er last night because his fever kept spiking to 104.4 despite the tylenol and motrin i had been rotating in four hour intervals. you must be the kind of know it all nasty nurse i put in there place last night. i am finishing my training as an ma now so im not an idiot, im just poor hence the medicaid. i would suggest if ypu dont enjoy working with cranky people without adopting there attitude, you should probably find another career.

  17. Pingback: pet peeve list

  18. Concernedmother on

    When you have a child with a fever that pretty much does not break down regardless of following the instructions (Tylenol every 4 hr), crying with headache, tummy ache, does not want to eat anything, lost almost 10lbs in 5 days, what a mother should do then? I have insurance and not on Medicaid. I don’t think it is any doctor’s business for being cautious with my child. You are getting paid so what do you care how frantic a parent feels. Doctors attend medical school to put parents and children’s mind at ease and to get paid comfortably. But I may be wrong. Maybe their main focus is the almighty dollars. Those same doctors are the ones who will quickly contact child services to state that the parent was negligent and if he or she had reached out immediate medical attention, this or that would not happen. So you know what, maybe some of the doctors in here chose the wrong profession and need to return to school for something else. This is a person-approach type of career just like Sales or Customer Service. If you (doctors) are grouchy all the times and start taking everything personal, then you will always need to post frustrating comments in similar sites to release your nerves. So chill and do your JOB!!!!

  19. OP
    Who the hell are you? You sound like an imbecile. Is this post supposed to be amusing? You seem hung up on semantics. You may not like referring to a borderline fever as “low grade” but it is a valid way to describe it. Also, as the first commenter said, there are physicians out there who will consider a 37.7 temperature to be above normal. But even if you don’t, it strikes me as ridiculous that you would waste time ranting about concerned parents. It seems that someone wants (needs?) to feel important. Were you not given enough attention growing up?

  20. First World Problem. Be thankful for the compassionate parents that bring in a child for a “low grade temp” instead of the ones whose neighbors have to bring in their battered children.

  21. So I care for a little one, I’m the nanny, anyway…the boys that I watch have a body temp of 97.4 when they are healthy. I’ve checked, many times while they are healthy. The mom is the same way. Anyway for the last 4+ months now, the baby, who is 16months has had fevers, almost daily…they usually brake with “Tylenol” and run from 99.4 (according to you not a fever) to 102. A few times 103 to 104. He has also been exteamly fussy these past months, and has at least 3+ movements of diarrhea per day. His doctor says not to worry unless he has like 5+ movements a day. He’s just not himself. His appetite comes and goes. I know that’s normal but this isn’t. I know you can’t diagnose, but does this sound like anything..? At what point do we take him back to the doctor?

  22. Err…Here’s a story about why “low grade” or non-febrile “fever”, or maybe “subjective fever” is a better terms, is an important piece of the puzzle, even and perhaps especially when it disappears by the time the patient is triaged. I seem, it first glance, like the kind of neurotic somatosizing attention seeker that clot ERs and inspire frustration, disdain, and belligerent blogs: Anxious, wan, complaining of “low-grade fever” and headache that improve miraculously by the time the disgruntled resident who drew the short straw arrives to examine me. In Dec 2011, I presented to the ER of a nationally prominent teaching hospital with all the vague symptoms you might reasonably hate at 3 am on a Friday-Sunday shift. I was told by a smirking resident I had no fever. When I quoted his hospital’s own outreach pamphlet he threatened to call security (clearly my supine position and crushing headache belied murderous intent…) I demanded to see his attending, and we discussed Dr. Smirking’s education. I was then discharged without any treatment or test.

    I subsequently discovered, ten days later, that I was suffering chronic CO poisoning within my home.

    There is no excuse for this in the NW, where “flu-like symtpoms” beset residents as soon as it gets cold and gas heaters are turned on. The CDC, the news media, public service announcements all warn that CO poisoning is the most common missed ER diagnosis, because CO poisoning mimics the flu, allergies, a cold…causes headaches, malaise and elevated body temperature. Some studies have suggested more than half of “flu” Dx in cooler months are, in fact, CO poisonings. CO poisoning often “resolves” in the wait for ER attention: Carboxyhemoglobin’s half life is only a few hours.

    And before you whinge about the impracticality of running a carboxyhemoglobin blood test on every fluish patient, please remember there are now portable pulse spectrometers that can distinguish serum Osat from carboxyhemoglobin saturations. Your hospital probably has one. If it doesn’t, go straight to risk management and demand one. Sound like too much trouble for a pain in the ass subset of patients? You might want to consider the cost-benefit analysis of a $45 blood test versus a malpractice suit for failure to Dx.

    And yet, I think I still hear the resentful teeth-grinding of ignorant curmudgeons. Still, there is NO EXCUSE for missing a CO poisoning. Even without a portable COhb enabled P-spect, even before the bloodtest(which ought to be routine during winter months in cold climates) comes back, ONE SIMPLE HISTORY QUESTION CAN SAVE YOUR ASS AND SPARE YOUR PATIENT A WORLD OF HURT:

    “Have you recently turned on or started using a different gas heater/ woodstove/ fireplace/ boiler/ old water heater/unvented gas cooking stove?”

    Are you really to busy to ask that one question? Or is it that you’ve become so hardened to ignorance you fail to recognize it in yourself?

    And why should you “be nice” to “difficult patients” like me? After all, haven’t you been taught that we’re litigious, and that your chances of being sued increase with contact time? Maybe. And maybe not. The prestigious teaching hospital failed me, and the attending missed my Dx. I suffered substantial harm as a result. But because the attending treated me with respect and kindness, I could not fault him for his mistake and have no desire to litigate.

    Believe it or not, I actually do know how hard your job is even without “difficult” patients like me. Indeed, the reason I and others like me often give you too much, largely irrelevant information is because WE WANT TO HELP YOU HELP US.

    And in case you’re wondering: When you took your CPx to get your license, your “history” segment was one I helped beta-test and standardize during the initial development of the CPx. To be a doctor, you must have credentials. But it is seeming to me that increasingly, to be a “successful” patient one must be bland as store-bought pudding.

    Hippocrates has left the building–but wasn’t that Freud I saw in the lounge?

  23. Hmm… All of my children suffer from genetic autoinflammatory disease ( HIDS/ TRAPS). When they flare they will run temps as high as 106. Now that being said they will run what we call low grade fevers between 99.5- 101 we call they low grade because they are taking maintenance NSAIDS daily so who knows what the temp would be if they were not on the NSAID. It may not be an “actual” fever to you but one can still feel pretty lousy with 99.5- 100.4. Just a not Dr.Kastner at the NIH you know what the NIH is right? the National Institute of Health recommends treating these flares at 99 degrees because if you don’t they temps rage and the flares are harder to control. We HATE going to the ER and only go if we can’t get a fever to drop…because I Hate running into healthcare “professional” who don’t know what they’re talking about…we’ve been battling this for 17+ years please don’t treat me like I’m an idoit.

    • Hmmmm.
      That’s it. You’re getting a slapdown.

      OK my punctuation-challenged commenter, show me where “Dr.Kastner at the NIH you know what the NIH is right” says every person in the emergency department with a temperature of 99.5 requires aggressive “fever” management.
      Yeah. Didn’t think you’d find anything.

      But, while we’re at it, maybe we should change standard medical treatment for every patient in the United States whose parent thinks he or she feels “warm” because you’ve got a chip on your shoulder over your kids’ genetic disease. My kids have a genetic disease, too. Maybe I could impose all of their medical restrictions on your family while we’re at it.

      If you’ve been battling healthcare professionals who don’t know what they’re talking about for the past 17 years, then why don’t you go see Dr. Kastner next time your kids have a “fever”? Get his cell phone so you have a direct line at all times to his competent care. See how well that works for you — HE DOESN’T TREAT PATIENTS.
      You expect “ER” physicians to have an in-depth knowledge of every possible disease and genetic syndrome on Earth then be at your beck and call when you snap your fingers and walk into the emergency department spouting off run-on sentences about how your kid needs STAT ibuprofen with a normal temperature? Get a clue.

      If you don’t want to be treated like an idiot, don’t act like one.

      • Yes my punctuation and grammer isn’t the best when I’m tired or my spelling for that matter. You are taking my post as a personal attack, which it was never meant to be. I don’t expect my ER docs to know every possible genetic disease and we don’t go to the Er for ibuprofen. Actuaally I can email Dr.Kastner and my pediatric rheumatologist.
        The point of my post was not everybody with temp under 100.4 is normal and maybe just maybe you could show some kidness and understanding to some weary parents who may be struggling with something your not familar with? By the way I don’t have a chip on my shoulder. let me give you a case senerio. 16 year old son spikes a 106 degree fever and we are sent by our pcp to ER. By the time we get there and sit through triage temp has gone down to 101. We are then told by the ER personel there is no possible way your son has had a 106 temp he wouldn’t have been able to walk in here !??? He way more tachacardic(sp?) then he should have been with 101 temp but because I’m just his parent and they are the professionals what could I possibly know? Those are the battles I was talking about. We are ever so thankful for the wonderful healthcare professionals that we deal with on a regular basis it would be nice to encounter that in the ER whenwe have to go in also.

    • Grumpy Old Bastard on

      Your children all suffer from both HIDS and TRAPS? How unusual for 100% of children in a family to be suffering from two very rare genetic disorders, one autosomal recessive and one autosomal dominant, with defects in both chromosome 12q and chromosome 12p). The geneticists must love studying your family.

      It’s also odd that you say you only take your kids to the ER if you can’t get their fevers to drop, yet as per your second comment, an hour or two in an ED waiting room is all it takes to magically lower their temp from “106” to 101. I hope you gave that ED glowing Press-Ganey scores for having worked such magic.

    • Grumpy Old Bastard on

      Also: “Just a not Dr.Kastner at the NIH you know what the NIH is right? the National Institute of Health recommends treating these flares at 99 degrees”.

      Every single one of your children suffers from these two rare genetic disorders, and you’ve been dealing with them for 17 years, and your regular doc hasn’t helped you learn how to treat these flares at home so you don’t have to keep rushing off to the ED? What can an ED do for a child with periodic fever syndrome running a 99 degree temp that a parent can’t do at home?

      Don’t subject your kids to hospitals unnecessarily. That’s where all the sick people are.

      • I have 4 children each have one mutation for HIDS. And two of them have the one mutation for HIDS and Traps. Yes we hit the genetic lottery. We do not go to the ER for 99 temp. Do you guys really read a post before answering or just react to what you don’t like? We treat a temp with prednisone at home when a temp is at 99 because if we don’t treat then it tends to be harder to control the higher the temp. We try not to go to the ED at all they are on immune suppressant meds. There have been occasions when a temp won’t drop no matter the nsaid or prednisone and then we have to go in and yes once we sat in the ED and by the time we were seen med given at home have kicked in other times they have been admitted to peds floor.

        The only reason I responded at all to this post was to point out that sometimes a temp under a 100.4 should be taken seriously. That not all parents just drive into the ED because they have nothing better to do. And it would nice to be met with compassion instead of arrogance and contempt by those we are looking to for answers. A lot of peds docs. have never heard of periodic fever syndrome it took us 9 years to get a diagnosis.

  24. How disgraceful you are to the medical profession. Those of you who think you are high and mighty, and know it all… posting that a temp. of under 100.4 is nothing to be concerned about…. that a temp like that is not a fever and basically nothing to worry about. To concerned parents reading this ridiculous thread, if your child is running frequent temps over 99.5 this should alert you that something may be wrong. Perhaps it doesn’t warrant a trip to the ER but certainly must be brought to the attention of your childs Dr. and should not be blown off. For my daughter a temp over 99.5 is typically related to a Lupus flare. Most often this is accompanied by extreme fatigue and chronic pain. Even on the naproxen she takes for inflammation and the disease modifying medication, plaquenil. And before you snarky @$$holes try the same $h!t you tried with HolyRoar6… Yes Kids get Lupus too. Maybe you should go back to med school and study up about Autoimmune disease. But please, don’t even consider going into ped. rheumatology and try to treat my my child with your condescending, narcissistic attitude.

    • A temperature is but one data point. If the ‘elevated’ temp is the only complaints than I am unlikely to greatly care.
      However if it is accompanied by severe ear pain, abdominal pain, rash, shortness of breath, sinus pressure of 7 days duration, undue fatigue, new joint pain, or something else that suggests possible bacterial infection OR you have a history of some disease where slight changes in temperature have some meaning than this post is not about you.

    • Yeah. My kids stop listening to me any time their temperature goes above 97.7 degrees. I keep telling their pediatrician about it and he just says to give them Tylenol, but it never seems to work.

      You’re another one who apparently thinks that medical treatment for the entire universe should be modified to conform to your child’s idiosyncrasies. Let’s give everyone DMARDs for a “fever” of 99.6. Woo hoo.
      So you mean to tell everyone here that your pediatric rheumatologist busts out the immunoglobulin every time your child has a “temperature” of 99.6? Bull.
      When you find any medical articles that suggest testing a child to see if “something is wrong” when the child has a temperature over 99.5, you post them here.

      Until then, if you’re relying on solely the presence of a 99.6 degree “temperature” to clue you in to your child having a lupus flare, then maybe you should read a little more about your child’s disease rather than running your yap on a medical blog.

    • Dear SIL: This post is not about patients who are exceptions to the rule. It seems you are taking this quite personal and you shouldn’t be. It appears that with either syndrome that children can go years without a fever and if they do have one often present with multiple symptoms. Hence the term “flare up”.
      For you to become so indignant when WC was clearly referring to people who should wait to see their GP if a fever is the ONLY symptom is just over the top. The attitude is not condescending or narcissist, but a result of frustration that people (and some general practitioners) not using common sense. It amounts to wasted ER resources and money, frankly.

  25. Victoria Ashley on

    I have to say, I’m kind of surprised by some of the “Dr’s” comments on this thread. There is in fact such a thing as a “low-grade” temp/fever,& no it’s not nearly as serious (obviously)as a regular fever(& usually it doesn’t warrant a trip to the ER,unless the pt has some kind of underlying condition etc.) HOWEVER, with that being said…have some compassion please. This exact attitude is one of the main reason’s for the major lack of respect now for the healthcare professional in the last few years!!

    Not all future patients are up for a Darwin award Doc’s. Trust me, I get it (I’m a nursing student, so I literally see both sides of it, & sometimes the pt can be in the wrong & give the Dr undeserved grief & expect them to be Houdini.)

    Generally speaking though, parents are in fact intuitive(& can be right at times)when it comes to their child (yes,some parents can be overly extra-anal & in you’re head you can’t help but want to scream the word “Munchhausen’s” just so they stop.)However,for the regular half-decent parent, they really are just trying to do what’s right. I highly doubt most parents are thrilled at the prospect of sitting in an ER for all hours of the night, extremely tired,& with a child who isn’t feeling well. All to be told by some Doggie Houser lookalike, that it’s “no big deal” & treated like they are nothing more then over-dramatic idiot’s who wasted the very important Doc’s time.

    Put YOURSELF in their shoes Doc, the “you” BEFORE med school. The “you” before “you” knew everything. Just have a little bit of understanding, it’s not a parent’s or a pt’s fault that their particular case isn’t a runner up to help you get a Lasker Award or the like.

    The good thing is that I’ve recently heard,that med school’s are now starting to teach a little bit more about communication & the importance of it. The sad thing is that with the lay-off’s of most RN’S & LPN’s recently,in favor of “MA’s” and “PA’s”(no,NOT physician assistant’s-the other PA.)Who are just taught the simple “skill” & not the reason & theory behind it. Ma’s/Pa’s who aren’t taught(because it’s simply not in their scope of practice to) advocate for the Pt and be a valuable asset for the Doctor(like Nurse’s are required to!) Compassion is going to be nothing but a long lost English word. All healthcare in the future will undoubtedly suffer because of this, most of all the Patient’s and even the Doctor’s.

  26. Our nephew ran a “non-fever” of 99.4 to 99.8 for for more then a week..only other symptom was some intermit. fatigue otherwise he was acting like a normal 7yr old boy..he was diagnosed with leukemia after my sister in law took him to see his pediatrician…so sorry, as a parent of 4 and an Aunt to a cancer survivor..your blog was way off the mark.

  27. Med Staff Credentialer on

    Regardless of your medical and personal opinions, it’s obvious that you never learned effective communication skills. You’ve shown how you would (and obviously do) relate to parents and others who come to the ED with their concerns, but you have also shown the same blatant disregard for other people’s opinions that have taken the time to post comments. Whether you agree or not, your delivery and smug responses will no longer be tolerated in U.S. hospitals as they begin to fully implement focused and ongoing professional practice evaluations and sound credentialing practices. When someone treats the hospital’s “customers” with this attitude, they should be addressed immediately by the department chair and not allowed to continue this behavior. It can wreak havoc on relationships of patients and other healthcare providers, and it also has the ability to obstruct good clinical care. There are plenty of doctors out there who can deliver good care along with good customer service, and those that can’t conform will be weeded out, probably to work in outpatient clinics or private practices where there is not as much oversight and accountability for bad behavior and possible missed pathology. I hope you are intelligent enough to recognize your improvement opportunities and take advantage of them soon. Otherwise, I hope the medical staff leadership will accept their responsibilities to assist you into another career path. “First, do no harm.” Words, actions, non-actions, verbal and non-verbal communications all funnel into those powerful four words.

  28. Picklesticks, thanks for sharing your nephew’s story. So sorry to hear about his diagnosis. Hope he’s doing well with the treatments. I have to agree with the importance of following up a persistent “low grade fever.” I’m not a doctor but I have been seen by a team of specialty doctors, all of whom agree that a temp 99.5-101 over 1-2 weeks and still not resolving warrants some work-up/investigation. It could be autoimmune issues, infectious disease, drug reaction, or malignancy. A normal bacteria or viral infection would have run it’s course and the patient should be well on the road for recovery. It is worth noting that GI tract will slow down significantly when the core body temp is above 99.5. When you can’t eat and digest well, you get sicker. Thus, our body is not built to be dealing with a persistent core temp over 99.5 for a long time.

  29. This is an Emergency Medicine blog. All the exceptional stories here (leukemia, lupus, HIDS) really have nothing to do with emergency medicine.

    The fact remains that there is almost no circumstance in which it is either necessary or appropriate to go racing into the emergency department of your local hospital, child in tow, simply because your child has a slightly elevated temperature. Your child’s regular pediatrician is far better placed to deal with your concerns.

    And whether you like it or not, it’s not technically called a fever (“low-grade” or otherwise) unless it’s 100.4 °F (measured rectally) or higher. That’s not Dr. Whitecoat being mean, that’s just the definition.

    The emergency department is for emergencies. A temperature of less than 100.4 in a child, unless there is some underlying medical condition, is rarely an “emergency” that needs medical attention right away.

    • I don’t know where you live but in ont if you don’t have a doc which is most ppl … You go to emerg… I’f you call telehealth they tell you to go emerge. My docs answering machine says to go to emerge if it something that requires attention before 2 weeks which is their booking time…

      • Who “doesn’t have a doc” if they have kids? Oh, let me guess… You have Medicaid so you don’t care how much a visit to the ER will cost, since the taxpayers will cover it?

      • Umm I’m in Canada … A) docs have huge waiting list so now we have nurse practitioners to try to fill in the gap a little but still most people don’t have docs. Expecially when they choose addresses closest to them leaving the people in the smaller outlying areas “out of their area” B) um no I don’t have “Medicaid” whatever that is… And C) no It doesn’t cost me to go to emerg it but there is also no option to pay for even the doctors….

  30. I’ve had a body temp of 99.3 to 99.6 for the past 6 months. prior to that it was around 96. I was exposed to black mold for 3 years. I know for a fact I’m fighting about 5 different infections. I’ve seen my blood under a microscope. I’ve seen parasites, lyme like microbial cysts. mycoplasmsa, I have gut dysbosis, Sibo. and fungal infection. I has a very vibrant full of life person a few years ago. Now i’m a shell of my former self. I’ve been on all the protocols for mold and lyme but it’s just not breaking.. In any event. a 99.3 persistent low grade fever is something to take seriously. Maybe if it only happens once in a while no big deal. But if you feel like crap and the fever is constant chances are you have something chronic.

  31. You’re kind of a d!@%. I am very lucky to have very healthy kids. My oldest daughter has been on an antibiotic once when she was five and had a temperature of 103.5 due to a kidney infection. My second daughter is 18 months and has yet to be on an anti biotic. I, on the other hand, am not so lucky. I was hospitalized with bacterial pneumonia twice. Both times my temp didn’t get above 99.6. The my symptoms, examination, and xrays said I had pneumonia but the entire time I was in the hospital I never had a ‘fever’. I understand why parents freaking out over the bodies natural response can be annoying but do you really have to be so douchtastic about it.

    • Do you teach your kids to construct an argument like that?

      Also, bacterial pneumonia tends to do the “sneak up on you” thing and ride low in terms of body temperature. I have been DX’d with it too- and if you take any NSAIDs or a couple other things that is also going to have a hand in lowering your temperature as well.

      If a person deals with patients/clients telling them day in day out that they don’t know how to do their job, they are going to get irritated. Many health professionals feel this way- but it obviously didn’t stop you from getting care.

  32. I know you will just flame me, and I don’t really expect anything different after reading the posts and comments made here, but the majority of you are in the wrong profession. It is so disheartening to see that doctors and health care professionals are so cold and callus. It is unfortunate that bedside manner is not more important today. Please remember that one day you will be on the receiving end of this one day when your health fails you, and for your sake, I hope your health professionals have just a touch more sympathy and respect than the folks here seem capable of showing.

  33. So.. The individual that wrote this, might as well call it quits. I am a mom of two special needs children. Not once in here does she refer to children with different than “average” health. Once my daughter hits about 99.2, her system is completely out of control regardless of what the original cause was. She ends up with a runny nose and a bad cough that is always followed with vomiting.. resulting in Pneumonia, every time. She has seizures by 100 degrees and needs hospitalization for IV fluids. This person is a quack. My son, after 100.4 is automatically hospitalized for 48 hours because of his needs. This person didn’t take any other individual other than a normal person, to thought. How disgusting.

    • …Really?

      The fact that you refer to your children as “special” needs indicates that they are unique cases. This is a short entry, a blip document about general peeves. If you believe it does not apply to you because your children are unique and likely have immune system issues or other particular issues that set them apart? WHY are you so offended? They likely didn’t take “any other individual other than a normal person, to thought” because maybe they don’t represent the majority of the issue.

      And if the author did address YOUR specific situation, they would then have to address every “special” situation, including mine, and anyone else’s who might possibly not pass for “average”. I mean, right? Because otherwise, not “fair”?

      Get over it. Really. If they aren’t calling you out? Maybe there is a reason. I have auto-immune disfunction and documented [in medical records and frequent charting] low BBT. But it doesn’t actually matter- even when I go to an unassociated urgent care, the fact that I have an auto-immune disorder and present with symptoms along the lines of “feeling like death” even though I’m not presenting with an “official” fever, they will take me seriously. Because I’m not abusing the system and having trouble walking from the front door to the walk-in kind of signals something is amiss.

      if you aren’t abusing the system? Don’t suck and attack the author who is sounding off about people who muck up urgent care. I mean, unless you are actually doing that and are a bit sensitive.

  34. I also consider fever to be the body’s natural defense mechanism! It’s a sign that the body is fighting the virus that is invading the body, so why weaken it by administering Tylenol or Motrin at the first sign of fever? God knew what he was doing when he designed our immune system, so unless my family comes down with really high fevers, I leave them be, make them rest, and push fluids! At night, they may get a half dose of Tylenol to help make them more comfy so they can sleep. I’d like their livers to stay healthy, thanks!

  35. I’ve had swollen lymphs for three years. I have allergies. I have had fatigue for the last three months. My temp is now naturally any where from 99.9 to 100.8 for the past month! I was given antibiotics three times and lidocane because I asked for it. I had epstein Barr and I’m sure it’s just a flare up. No it’s more serious they say. Yeah, or you need my copays tobpay off your school loans.

    At least I know what’s wrong with me, because they sure as hell do not!

    Doctors, book smart, yes, ethical? Hell no, caring? As IF! Greedy? Hmm, bitter because insurance has their nuts in a sling? Yeah, that too!
    George Carlin said it best, “ever wonder why they call it medical practice? It’s all guess work in a white coat!”

    Never trust doctors,lawyers or insurance companies. They sure as hell aren’t in it for betting your life. They do it for the money. How about you sad sack doctors shut the fuck up and stop biting at the hands that feed you. You should all be so lucky to have a patient you ungreatful, smug,egotistical asshats! Why are any alleged doctors bitching about temps? Not like you take them, that’s what medical assistants do! Where is Dr. House when you need him? Oh that’s a fantasy, a doctor who actually knows what their doing!

  36. Stephanie Reynolds on

    I think it’s about time for everyone here to get a grip. I, too, suffer from multiple Autoimmune diseases (Severe Crohn’s disease, Thyroid disease with a history of ThyCa, and Sjogren’s Syndrome, to name a few) and frequently suffer from Dermatological manifestations and a slightly elevated BBT when my body is entering a flare. My base temperature is between 96 and 97 F. However, I am well acquainted with procedures and medications to deal with these flares, as does most anyone with a chronic illness. White Coat and the other ED physicians posting here are not discussing chronic illness. ED physicians are not likely to diagnose chronic illness. This is the job of practicing physician who is able to perform the battery of tests and evaluations necessary for such diagnoses.
    My own diagnoses came after years of illness and suffering without a specific diagnosis.
    I still make trips to the ED when I am showing signs of emergent complications such as a bowel obstruction; however, I do not go to the ED every time my temp goes above 100 F, because I will simply see my regular physician at my next opportunity.
    When speaking of children without chronic illness, a “low grade” fever is most often a good thing as it is indicative of the bodies’ natural defenses for dealing with minor infection or viral illness.
    Crowding the ED with such minor illness that can wait until the Doctor’s office opens, simply causes chaos and diverts the ED physician’s attention from actual emergent patients.
    When you have to wait for six hours in the ED to see a physician, it is probably because patients are triaged in order of severity, and a “low grade” fever simply doesn’t rate very high on this list.

  37. Dear Doc,

    I hear you on this…see my husband is a physician and not only agrees with you 100% about the temperature thing, he even SOUNDS like you–like he has a major chip on his shoulder about why the rest of us plain folk still want to believe 99.4 degrees is a low-grade temp.

    That is until this week. I have consistently asserted throughout our marriage (and shown him on multiple types of thermometers) that my body temperature is generally at 97.2-97.6. However, for the past week and a half, every night, I have run a “low grade fever” of 99.5ish. (Complete with the aches and shivers and sweats when it breaks in the middle of the night) We ARE supposed to be leaving the country this weekend for a family vacation with all the in-laws (a year in the making), and so YES, I am going to go try to get blood work done because I DON’T want to spread something. Moreover, even he is now a little nervous that something is wrong with me. I have had no other symptoms and prior to this straight stretch of “feverish” nights, I’ve had two or three other random “fever nights” with no other symptoms since Christmas. My thought for you, is that every human is unique–should we run to the “Emergency Room” everytime–of course not, but having such a strong dismissive attitude toward thinking folks, and not admitting that there are variable situations, is a bit silly on your part.

    And the last thing I’d say, is that LOVE for our family members is why we bring them in–I don’t know if you have kids or not, but when we have a child who is visibly ill and uncomfortable, the child is scared (and so area we as the parents). If my husband wasn’t there to wrangle me in, I’m sure my pediatricians would be much more annoyed by me. As it is, I have someone under my roof with years of knowledge to prevail upon my logic. But even my stoic Doc husband, admits that something is wrong with me and that a little blood work is in order. Folks who are irritated at you on this post, just want to you to admit that perhaps, once in a very rare while, 99.4% IS evidence of something bigger. This post and your “You idiots” attitude IS contributing to the general hatred of doctors, despite the years and years of study and sacrifice you (and my family) have endured.

  38. I hate having to go to the ER. That is a fact. The last time I was there is still very clear in my mind. I had had a “genuine” fever for eight days and finally, my breathing was too bad from my asthma that I relented to my parents and soon found myself iin the ER. My temp before driving there (about 15 min. drive) was 104, taken with a mercury oral thermometer. Once we got there, they took my temp with one of those thermometers that swipes across the forehead and it read 100.1. huh. No fever?? The ER doctor started to look a bit annoyed like I had come in for this?? He looked at me and asked “YOU think you have pnuemonia?” I said Yes. I think I have pnuemonia. He didn’t seem to believe me, but ordered the x-rays anyway. Little while later he came in in a hurry and said that I DID have pnuemonia and it was quite extensive…I should be hospitalized right away. I was so taken aback by this sudden change that I didn’t respond right away. He then went on trying to convice me but little did he know I had come packed for it.
    So, why I hate the ER is because there are so many people working there who just aren’t, yes, kind! I get pressured and scorned there when I plain don’t feel good. I’m sure they get plenty of people who don’t really need to be there, but they can still be kind.
    As to temps, I hear both back and forth all the time. My big question is about how accurate the new thermometers are. Obviously the mercury is not going to be faulty… and how could my temp drop from104 to 100.1 in 15 minutes? The answer seems too obvious to me.

  39. …I last commented on this in November, but I continue to get updates.

    Since I last commented I have had to make more than one reluctant trip to the ED at Mass General in Boston. [for those not following along at home, this is hardly a medical establishment behind the times]

    I have trouble when I show up at someplace like an ED or urgent care. I don’t like going there, I show up when I really definitely know I need to- often because I am at the point where I am worried about breathing. I will kind of put up with everything up to that point [which isn’t great either]. When it comes to describing my symptoms, they’ve presented on option which kind of skirts the whole “low grade fever” issue, though. *Subjective fever*, which I often experience and is apparently helpful information, has helped to express that I feel shaky and hot and can’t get comfortable, sweaty but have something like chills, but my temperature seems to still be within the normal limits.

    This seems to have fixed many issues when attempting to communicate my symptoms. Just saying.

  40. Most of these comments eem either clearly dull and not worthy of a response or in support of the claim. I have to ask, is it wrong of me to call a nurse if I’m concerned about symptoms and be frustrated by the question “do you have a fever?” I’m sitting here on the line barely warm yet have symptoms and you’re concerned if my temperature is high? This nurse gave me the hardest time about not having a fever. Am I in the wrong for thinking there might be a reason I’m feeling awful?

  41. Amber Hamilton on

    Thank you so much for this article! I am a nurse with old injuries causing muscle spasms and I have seasonal allergies. I just needed some confirmation that my persistant 99.5 temperature probably is just due to pain or allergies, or I just run high. Too many people out there believe that they must have cancer, etc. etc. But “when you hear hoof beats, first think ‘horse’- not ‘zebra’.” :)

  42. I love you right now. I just love you. My daughter is 8 and for the past two months she’s had a consistent 99+ fever. She feels absolutely fine. She’s playing soccer and hopping around goofing off like a kid normally does. The month she got the strep infection that took three rounds of antibiotics she was noticeably sick even though her fever barely reached 101F.
    I’m beginning to think her basal body temp is just higher than the average temp. The pediatrician wants to do some bloodwork to rule anything out because I have RA and Sjogrens so I normally run at a higher temp if I don’t take immunosuppressants and those AI diseases are genetic. Anyway I’m getting off track.
    You’ve eased my worries. If she’s acting fine and has no sore throat, cough, ear pain, vomiting or headaches I’m just going to let it ride.

  43. I do have a question about this 100.4 C though, seems like an arbitrary number. When the basal body temperatures vary widely, why isn’t that a person might feel ‘feverish’ or their body be in a state ‘alarm’ while they are not registering a 100.4 C? I agree that a fever of 99.9 or even a 100.4 probably does not warrant a visit to the emergency room, but low grade fevers that are intermittent and recurring are a tell tale sign of a few cancers as well. it isnt exactly helping anyone by asking them to adhere to a number because their thermometer did not say 100.4 C and instead stayed 100C.

    Let me ask you a question similar to the ‘ebola’ question (in sarcasm anyway): Are you going to tell the family of a man or woman who died of undiagnosed stage 4 cancer that his ‘recurrent low grade fever’ just didnt reach the magical 100.4 number on your scale, so meh!

    Once again, a low grade fever or even a ‘fever’ might not warrant a trip to emergency room, but a magic number of 100. 4 sure as hell doesn’t mean much in terms of recognizing ‘fever’ as a symptom of an underlying cause.

  44. Column sounds as if written by a pompous ass. Clearly not an MD any person should endure. If you are so smart- perhaps you should recognize your need for human skills. This column is a disgrace to medicine. All feeding into it here perpetuate this. The comment about Medicaid demonstrates the truly unprofessional, unkind and inhuman people who really need to find another career and get out of the way of those of us who do actually care.
    Perhaps in all your greatness you should rewrite the reference text definition of low grade fever: “low-grade fever,
    an oral temperature that is above 98.6° F (37° C) but lower than 100.4° F (38° C) for 24 hours.”
    low-grade fever. (n.d.) Mosby’s Medical Dictionary, 8th edition. (2009).

  45. What about those who KNOW their normal body temperature is not the average 98.6 like it’s “supposed” to be? I know my normal body temp is 97.1 because I have had to chart my temp for medical reasons. So when I have a temp of 99 and I’m not feeling my best I know that my body has a fever. I’m not a baby by any means. I can deal with a 99 temp. I’m just pointing out that you can not say that there is no such thing as a low grade fever when you do not know that every single person has the 98.6 degree “normal” temp. And why is it that doctors have discovered cancer in children that have continuous low grade fevers and yet you sit here laughing at those who have tracked their childs health because of that very reason. You may be educated and smart but you do not know everything. Being open minded is how science is discovered.

    • “What about those who KNOW their normal body temperature is not the average 98.6 like it’s “supposed” to be?”

      Did you even read the original post? Where Whitecoat wrote:

      “The definition of a fever is either a core temperature of more than 100.4 degrees OR an increase of 2.4 degrees or greater above the patient’s basal body temperature.”

      And if you have a child with “continuous” low-range fevers, you’re better off tracking that and taking him or her to your regular paediatrician. It’s not one of those things where you’ve been tracking it for weeks and suddenly one Sunday afternoon you think, “Hey, maybe I should get this looked into, I think we’ll go off to the emergency department.”

  46. My friends has been having low grade fever for the past 15 months taken all tests,all tests have shown negative ,liver has little damage, Please let us know if a pet scan is required

  47. I work in an ED and all I have to say is thank you. You don’t know how many times I want to punch people who tell me their child has had “a fever of 99.2 for an hour.” And that is why I pay $178/month for my health insurance….idiots.

  48. These so called over protective parents bringing their kids in with 99.1 temperatures are helping to pay your bills as doctors. I don’t personally have children, but maybe you should give these parents kudos for even being concerned enough to bring their children to the doctor. It seems you ungrateful doctors obviously don’t need our money, so maybe the answer is to not go to the doctor and just wait until we all have to go to the ER. We can always consult the internet until then.

  49. So, I just missed my birthday celebration yesterday because I spent another sleepless night with a 101 fever and chills and was afraid I might have something contagious. Over the last year, this seems to happen to me almost once a month. Sometimes accompanied by vomiting. I have no ovaries, not HIV POS, no TB, good lab values, yet I feel like crap and then it mysteriously disappears by the end of the day. My doc just shrugs when I mention it. So, my questions to you bastions of humanity (ha!) are: Should I worry about contagion and isolate myself or should I press my doctor for testing he doesn’t seem to think I need? What would you do?

    • C’mon. Bastions of humanity … “(ha!)”???
      The article wasn’t really addressed to people who truly do have fevers, only to people who claim they have fevers with a normal temperature.
      However, because I do happen to be a bastion, I’ll give you a couple of ideas.
      Even though fevers may result from an infection, that does not mean that an infection causes every fever. Similar to saying that every beagle is a dog, but not every dog is a beagle. There are multiple other things that can cause fevers – especially long term fevers. Here’s a link to some of the other diagnoses associated with chronic fevers:
      Note that these include connective tissue diseases, medications, and even some cancers.
      Exactly what is causing the fever in your case is going to require some further testing and some detective work. If your doctor shrugs it off, then it may be time to find another doctor.

    • Hi Yvonne,

      I saw someone go through the same thing. Her kid spiked a fever once a month almost to the day, and then it went away. He had no medical conditions. They found out he had a parasite, and it was when the parasite laid eggs once a month that he spiked a fever. They went through countless doctors to find one that tested for parasites, so good luck. It might be something else for you, but it could be if they can’t find anything else wrong with you. Hope this helps.

      • Thanks for the advice, WhiteCoat. I hadn’t thought of a parasite – and I’m a retired lab supervisor. Sheesh.

        My doctor’s response when I emailed him asking if it could be diverticulitis was – if it continues to happen make an appointment. My response to him was: Can I have your cell number so I can call you at 0300 when I actually have a symptom for you to observe?

        I have Kaiser, where the docs are over-worked and bleary-eyed husks of their former caring selves. I actually like my doc and he seems rather knowledgeable – and exhausted – like I should be caring for him.

        What most people bitching on this site don’t understand is the ceaseless waves of ER visits,by the uninsured, drunks brought in by the cops, the mentally impaired, the homeless looking for a bed, the drug seekers, and yes, concerned parents, who should be at an urgent care – not an ER. It’s no wonder that [some] staff members tend to get their humanity sucked right out of their souls. In my experience as a trauma team member, which meant responding to every ER call, I’ve seen the gamut of bad behavior toward patients, mainly by nurses, but I’ve also seen lives saved. If you can’t have a blog where you can vent your frustrations, yet you are expected to be, again, a bastion of humanity, there will be more of this behavior in the workplace, not less. If these delicate, little fleurs who complain here think this grousing is bad, they should get an earful of the black humor after a team has lost someone they tried valiantly to save. People, even doctors, need a place to vent.

        These detractors need to get their head out of their posteriors and off of a site designed to release some steam. Thanks for your help, Bastion WhiteCoat. I didn’t expect a rely. Thank you, as well, Ashley.

  50. Jennifer, Raymond MD on

    Was the point of this entire post for what ranting about what you believe, getting everyone arguing? Couldn’t you just have kept it to yourself? It’s kind of unnecessary. If a parent or person want to go to the hospital for a temperature or 1. Higher or lower temperature than average let them. Mind your dang business. If you want to complain about people coming in to get help, or seek information because they don’t know what’s going on your in the wrong profession. People also don’t need the added stress to anyone who is seeking help. Instead just inform people, not list your pet peeves. Why argue about which thermometer is best? It’s pointless because even if the thermometer is broke and giving you a false temperature, you still have a right to go to the doctor whenever and for whatever you want. You could have a a splinter, who cares, if the doctor complains, then who cares. You pay for insurance, or government pays, and doctor’s are paid so there is no need for this ranting post!! IF YOU WANT TO GO TO THE DOCTORS FOR A 99.1 OR A 89.9 GO, WHO CARES, if you think it’s right go. That’s what these people get paid for.

    Pointless post! Why get everyone fighting.?

    • Much respect to you Dr. Raymond happy to read positive and caring thoughts from you. Truth be told every E.R. Blog I’ve been reading lately strongly suggest we people shouldn’t show up for any reason what so ever, I guess we’re all annoying and one physicians comment was (you guys don’t want to piss us off!!!) NO WE DONT…maybe… That’s a threat we should take seriously, just behave yourselves, okay. One guy probably harmless, and I’m sure the rest don’t think that way.. There are certain topics that I get that can cause and create anger, but fevers and all the many different reasons why -regardless if it’s a pet peeve or not I’m surprised. To the Medicaid mom and the parents of the special needs kids sorry those things were said to you. Someone will respond with helpful thoughts, you’ll see.

      • To all of the families whether using private insurance or Medicaid, you have a RIGHT to be treated. You do not need to settle for SUB PAR medical care or attitudes, biases and unethical judging of yourself or family for going to the ER.

        I was feeling great, until I woke up with a terrible pain in my throat without fever. Turns out it was a double inner ear infection as well as sinusitis that is moving into my lungs (infection) UTI.
        I didn’t go to the ER, but my doctor almost didn’t have time to get me in THAT day. Had she not, then by god I’d have gone to the ER & guess what? Had one miserable nurse, doctor or rude office personnel had an issue with it, I’d have REPORTED THEM.


        Consumers of healthcare, we have to start DEMANDING good treatment. With all the financial cuts these doctors are angry and resentful. They have school loans and debt like the rest of us and some days, well their attitudes just SUCK.

        Little advice for all the doctors with a bad attitude, if you can’t have compassion for other’s well being, perhaps it’s time to think of a new career. A career where people always have bad attitudes, poor service and a chip on their shoulder. Do you JOB, you should feel blessed, filled with pride about your job, not have an attitude and treat others with contempt.

        I’m going to pray that you doctors with bad attitudes get therapy.

        • You’re mistaken about the “right” to be treated. If you walk into a doctor’s office, you have no right to anything. You can demand all you want and the doctor can ask you to leave. You have a “right” to receive a *screening exam* in an emergency department and if you don’t have an emergency, you have a “right” to nothing else. A double ear infection and sinusitis moving to your lungs isn’t an emergency. If you weren’t triaged out of the emergency department with those complaints, you might have received a decongestant that you could have purchased over the counter, or, if you had a particularly bad doctor, you might have even received a prescription for antibiotics which have been proven to have no effect in sinusitis of less than 10 days’ duration. http://www.motherjones.com/environment/2013/04/sinus-infections-antibiotics-resistance
          The post that you’re responding to is educational. Low grade fevers are a farce. By the way, so are almost all “double ear infections” in adults and any notion of “sinusitis moving to your lungs.”
          A vast majority of doctors aren’t angry and resentful. Often bad attitudes from patients beget bad attitudes from medical providers. When I have someone cop an attitude and threaten to report me to the AMA (an organization to which a vast majority of physicians don’t even belong, anyway) because they don’t get their Z-pack for their magical migrating sinus infection, then I’m not going to be all warm and bubbly inside.
          It’s a two-way street, lady.

  51. Jennifer, Raymond MD on

    If your are seriously arguing this case, your mistaken.,and loosing. The ER is for any MEDICAL EMERGENCY, including a fever. Please don’t make people feel guilty for caring enough to seek help. Seeking help/information about what’s going on is always the better option. Especially if you are unsure and feel you or your child needs to be seen just in case.

    I’ve had a patient with a 99.1, ongoing up to about 99.4, although not highly elevated, and would normally be the bodies way of fighting off a infection, this patient ended up having serious brain problems, i’m glad she sought out help. This was an extremely rare case, miniscule.

    The point is, it is never a waste of time or money, to seek help/information, if you feel you need to.

    • @ Dr. Raymond, thank you so much! I’ve been fighting a what I call low grade fever for few days. Guarantee if I call my PCP he will tell me to go so ER so labs can be ran & results will be immediate. I’m a cystectomy patient that still suffers w/resistant utis, some I’m not even aware & also w/open wound (which looks great) from a knee replacement where incision dehisced and I contracted MRSA. So now for 3 days I’m feeling very lethargic, calf is very hard, little bit of pelvic pain, severe headaches @ times and slight cough only when I lay down though. So now I feel like if I go to my ER and say fever has been high 99’s through 100.6 off and on, I will be judged….So thanks for sorta making me little paranoid to seek treatment based on the original post.

    • If only you could be in all e.r.’s at all times, please reply often your opinions are a breath of fresh air.

    • Med Student on

      If your are seriously arguing this case, your mistaken.,and loosing.

      If you are indeed a medical doctor, you’re the first functionally illiterate one I’ve ever met.

      • Whitecoat & Med Student are both indeed nothing but wanna-be doctors on the internet.
        I’d suggest any one who deems it necessary to be treated at an ER, just go.

        Why are we even entertaining these pimply faced kids who claim to be a doctor “online”. Likely they are tweens or teens with an itch to go to medical school, or medical school drop-outs.
        The extent of whitecoat’s education is using “.com” resources: (Exhibit A quote from whitecoat)” if you had a particularly bad doctor, you might have even received a prescription for antibiotics which have been proven to have no effect in sinusitis of less than 10 days’ duration. http://www.motherjones.com/environment/2013/04/sinus-infections-antibiotics-resistance

        And this little erroneous git’s opinion which is obviously a microassault based in his deep rooted misogyny because his mommy didn’t hold him enough! He resorts to insults on a typo–epic failure.

        As Carole said a breath of fresh air.

        • Before you are blocked from the site, I’m approving this comment to show everyone else a glowing example of why some doctors get bad attitudes.
          First you publish a bunch of tripe about double ear infections and sinusitis going to your lungs (because that must happen all the time in invertebrates). That was under “VERA’s” name, though.
          Then, when I expose pretty much everything in your comment as being absolutely untrue, you get your panties in a wad, put on a big pouty face and change your name to “Luther” so you could make it appear that someone else actually sympathizes with you. Gasp! How did I know that?!? Both comments came from the same IP address, brainiac. Notice how your avatar didn’t change between the comments?
          Your comment provides no cogent response … I’ll wait while you look up that term … but instead you respond with a bunch of non-sequiturs … go ahead, I’ll wait while you look that one up, too … and create a bunch of ad hominem attacks (I provided the link for that one to speed things up a little).
          Now, because I’ve exposed your whacked out idea about having a “right” to medical treatment as being, well, whacked out; because I’ve apparently exposed your doctor as prescribing antibiotics for inappropriate reasons; and because you can no longer garner sympathy from the people in the studio audience with you at the Jerry Springer Show by telling them your doctor snatched you from the throes of death by prescribing a ZeePack to save you from a case of magical migrating sinusitis and DOUBLE EAR INFECTIONS TO BOOT … now you have decided to expose me for what I am: a farce with acne vulgaris who can’t form an understandable sentence and who dropped out of medical school because my mommy didn’t suckle me enough while I obtained my graduate equivalency diploma. Damn, you’re good. With those logic skills and your keen knowledge of the migration patterns of sinus mucous, we should create another medical TV show. We won’t call it “House,” instead, we’ll call it “VERA-Luther”!
          Of course, if you were my patient, you could now go complain to the AMA (see prior comment from your alter-ego Vera for the link) or maybe the surgeon general, telling them that I was mean and rude. Then you could give me all “1”s on my satisfaction scores, writing in crayon in the margins that you’d give me all “zeroes” if there was any way to do so. You might even be able to copy the satisfaction surveys and write “Vera” on one and “Luther” on the other to give me “double” bad scores like your “double” ear infections, you sneaky devil, you.
          But unfortunately, you’re not in the emergency department. So go float back down to your mommy’s basement, Little Snowflake, so you can wail and moan to the other snowflakes on whatever chat room you came from about how all doctors are mean because one just got fed up with your whininess and deceit.

      • Are you serious? WHY…you can learn something from her med student. Can tell already by that stupid comment your going to fail. You’ll only cost patients their lives and hospitals malpractice lawsuits due to your lack of following excellence in your profession. And DONT DISRESPECT her again..if you do, well we’ll just go back and forth all day everyday, because I will not back down defending her. Whitecoat you should of had her back, she did not say anything that deserved negative feedback from anyone. And please don’t block anyone, your blog is one of the best to read, because of our differences. Maybe this blog should not be open to the public so you guys can have a private place to vent about patients, I can understand and appreciate that. But meanwhile since we are welcomed let us all vent.

  52. Well looks like I’m one of those “crazy” parents who are concerned about their toddler’s recent ongoing fever. It’s been going on for 4 weeks. The first week it peaked at 104.9 and went down within two days. Two weeks later, it peaked again at 104.8, and went down to about 101 after 3 days. But my point is… it has never gone back down to 98. It has remained at 99 or higher. My ped checked for bladder infection, but came back negative. My child is very active and happy and has no other symptoms, so I am of course confused. I keep looking for other symptoms. She’s mentioned a few times her knees hurt and her eyes hurt- I told my doc- he doesn’t seem concerned. So I guess my biggest q is- the joint pain. how in god’s name am I supposed to know whether my two year old has joint pain?? She has just started telling me what she wants to eat, I doubt she’d complain about (or even know how to complain about) joint pain. Any suggestions on HOW I am supposed to flag this symptom?

    • My knee doctor had me lie on my back and took my leg bending it at the knee over and over. If your 2 yr old starts crying or says hurt, then you will know. Kids are pretty flexible, and you wont hurt her by bending her leg as long as you can get her to relax it and not stiffen up. If she stiffens up, then dont force it. Basically you are bending her knee for her. An eye doctor will know after doing an eye exam. Hope that helps:)

    • Young kids won’t be able to tell you. In general, though, if their joints hurt, they won’t use them. They’ll limp or they won’t walk if a knee or hip hurts. They’ll reach across their body instead of using a painful arm. If a joint is causing fever, chances are that it will be warm and swollen.
      As I mentioned in another comment, fever isn’t always due to an infection. May need to dig a little deeper for the cause. http://en.diagnosispro.com/differential_diagnosis-for/infectious-disorders-specific-agent-fever-of-unknown-origin-chronic/35606-154-170.html

  53. Whitecoat… Super professional. You’re blatantly disrespectful and narcissistic. Why do you hold such contempt for the people who pay your bills?
    If you don’t enjoy helping others heal, go work for ComCast.. with your snipey attitude I’m absolutely positive you’d fit right in.

    Now onto the comment I was going to post before being side tracked by a pseudo doctor.
    Yes in some cases a 99.0 temp signals something is wrong. Your body does not run a higher than normal temperature for no reason. This is your warning sign.
    Now if it only lasts a day or so, you would be safe assuming it is probably just a viral infection or something similar that resolved itself..
    A fever is meant to fight pathogens of all types invading the body.

    It is your body, you know it better than any doctor or nurse. Listen to yourself, if something doesn’t feel right, go to the doctor. Or better yet, a homeopathic doctor, these docs are amazingly compassionate. Most Western Medicine doctors become narcissistic as soon as their residency is completed.

    In my case, I ran a 99.5-100.0 degree temp for SIX MONTHS. Six horrible months, my normal body temp is around 97.6.. it took six months of doctor’s visits claiming nothing was wrong with me for me to take matters into my own hands.

    I found toxic black mold growth behind the drywall in my master bathroom.. it’s been four months and I’m detoxing and still deal with these “non fevers”.
    Toxic black mold is very dangerous and can have long term health effects from exposure. I have migraines on a daily basis, joint pain, neck pain, panic attacks, developed a heart arrhythmia, trouble sleeping, muscle pain and a slew of oter terrible health problems, and I am only 27 and had perfect health before exposure.

    Bottom line.. my “not fever” almost killed me, and probably would have if I had convinced myself nothing was wrong like the doctors wanted me to believe.
    Good luck everyone!!

    • "Toxic Black Mold" Hoax on

      The biggest hoax is the hysteria over the notorious black mold that grows on sheetrock. This black mold is formally known as Stachybotrys chartarum or Stachybotrys atra. The horror stories related to items such as infant deaths in Cleveland in 1993 and 1994 are not true. The statements of CDC related to possible cause have been retracted by that organization. With extremely rare exceptions (possibly only one documented case) there is no association between inhalation of Stachybotrys chartarum and any identifiable disease.

      It is true that Stachybotrys chartarum, as part of its metabolic processes, produces a chemical by-product called a mycotoxin. But there are hundreds, thousands, perhaps even tens of thousands of other molds that produce mycotoxins. Mycotoxins are large molecules that do not easily become airborne, thus the only real possible exposure is ingestion such as eating grains or other foodstuff with a large growth of Stachybotrys or direct infection through an open wound.

      The possibility that a person who is not severely ill, or whose immune system is not compromised from disease or suppressant medicines, exhibiting any reaction to a mycotoxin is practically nonexistent as shown by the total lack of scientific evidence showing a direct link between a specific mycotoxin and any disease or symptom.


    • "Toxic Black Mold" Hoax on

      …and let me guess. The “treatment” for your “toxic black mold poisoning” which “almost killed you”, and which consists of “detoxing”, is being provided by some sort of quack or doctor of woo, not a real doctor.

    • Hi Jessica,

      I ran a temp too of 99.0 for several months and then realized that it was everytime I took a certain medication. Just a thought but could be meds causing it too. Off the med I run my normal 97.6. There are several reasons it can run a little higher.

  54. You can say what you want. However, I know my children’s normal body temperature. So, last year when my 14 year old’s temperature was “elevated” ( is that a better term for you to handle) to 99.9 for a couple of days for no apparent reason other than a slight swelling of his calf due to a wrestling injury, I took him to his doctor. He was diagnosed with cellulitis in his leg. If I would have ignored the “elevated” body temperature he most likely would’ve developed serious complications including sepsis and possibly lost his leg, if not his life. So, don’t tell me that an elevated body temperature is nothing. Thankful you are not treating MY children.

    • So what you are saying is he had some symptom other than a fever?
      If so, than this blog entry wasn’t about your child.

  55. So…how about prolonged sub-febrile temperature as first (and for some time ONLY) manifestation of childhood cancers?
    Sometimes ER visit could be life-saving even when symptoms are subtle. Especially when your regular doctor is a moron who can’t tell his ass from a whole in the ground and brushes you off with ‘it’s viral, your child is fine’
    Doctors’ smugness bother me. It could actually cost lives.

    • A “prolonged sub-febrile temperature” is rarely an emergency. The emergency department is not the best place to take a child suffering from such.

      If you’re unhappy with your regular paediatrician, find another one. But it’s still the case that non-fevers are usually non-emergencies. The emergency department is for accidents and emergencies. It shouldn’t be a substitute for primary care.

  56. This sounded like it came from the snarky female doctor that has since been let go from my clinic… must be cut from the same cloth. She cut me off in middle of sentence that my temp had been running higher than normal between 99.4 to 99.9 since Emergency Room visit for flank pain instead of my normal 96.9 to 97.1. She actually sneered and said for your information fevers don’t start until 100.1. Sorry to disagree but I’m multiple medications include intravenous biologic infusions, methotrexate injections, etc to suppress my immune system for my conditions and an increase of several degrees is in fact a fever. My 99.9 is more than someone with a basal temp of 98.6 reaching the same temp. Even the Mayo Clinic’s information site informs: You have a fever when your temperature rises above its normal range. What’s normal for you may be a little higher or lower than the average normal temperature of 98.6 F (37 C). I think more so, you should be teaching the importance of treating each patient as an individual case not just a rigid scale of numbers. Ask what their temps normally run. Emergency rooms have changed drastically over the past few years and not for the better in many cases. I was recently discharged from the ER in the middle of actually vomiting in a pan a few months ago. They had me sign during heaving up bile. Years prior I would not be leaving until I kept down a juice or soft solid and was able to produce an urine sample without quick draw on my own. Nope.. shove you out the door.

  57. This is hilarious. When you take your temp daily for a month and average 97.8, are super sick and have a temp of 99.6, feel like you have a severe flu and end up gram stain positive, your opinions, sir, are moronic.

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