Friday, April 28, 20061
"Blink", chest pain, and the Goldman algorithm
During my time off, I read Malcolm Gladwell's fascinating Blink. One chapter deals with Chicago's Cook County Hospital, and it's adherence to Goldman's algorithm for diagnosing chest pain. Gladwell writes:
One of the stories I tell in "Blink" is about the Emergency Room doctors at Cook County Hospital in Chicago. That's the big public hospital in Chicago, and a few years ago they changed the way they diagnosed heart attacks. They instructed their doctors to gather less information on their patients: they encouraged them to zero in on just a few critical pieces of information about patients suffering from chest pain--like blood pressure and the ECG--while ignoring everything else, like the patient's age and weight and medical history. And what happened? Cook County is now one of the best places in the United States at diagnosing chest pain.Can this "less is more" philosophy be practiced realistically? Perhaps, but old habits are hard to break. ER docs that practice defensively will have a tough time with this.
Comments
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Anonymous
Wow, what an unimpressive paper.
Post a Comment »If my blog ever gets repaired, job one is going to be to discuss that one.
Just for starters,
"Among 1978 (8%) patients who complained of chest pain, 924 (47%) had obvious noncardiac causes of chest pain, including trauma, respiratory illness, musculoskeletal pain, and gastrointestinal complaints" indicates they're really excellent clinicians. They can tell GERD from MI/UA clinically? At my last conference they presented a paper showing that, with esophageal pH monitoring and real-time continuous 12 leads some patients withe GERD had cardiac ischemia at the same time.
Anyway, my effort will never be to keep patients out of the CCU, it'll be to not miss an MI.
GruntDoc
3:14 PM