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.