A simple panel used by an ER physician to rule out the diseases that may come back to bite you if you miss them:
I have devised a simple, cheap and quick “reassurance work-up” for these folks which consists of:
an ECG, an i-Stat, a D-dimer, and a troponin. Sometimes I add a chest x-ray if it seems helpful.
PCPs I talk to are ordering more D-dimers as well “just in case” that chest pain or shortness of breath in the office turns out to be a PE. However, there are plenty of things that can also elevate the D-dimer, and this invariably leads to more CT scans. Of course, patients are reassured with more testing:
Again, it’s surprising how happy this approach makes people. I get genuine thank-yous and (generally) they leave smiling and reassured. And my patient satisfaction scores stay high and the bed is quickly opened up for the next poor soul languishing in the waiting room.
The joys of defensive medicine.
