Comments on: The reassurance workup http://www.kevinmd.com/blog/2007/07/reassurance-workup.html Tue, 14 Feb 2012 11:46:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/07/reassurance-workup.html#comment-78166 Anonymous Wed, 25 Jul 2007 12:58:00 +0000 http://clients.emmense.com/kevinmd/2007/07/the-reassurance-workup.html#comment-78166 Anybody remember the PIOPED data? The issue is clinical suspicion. IF you have have a mod-high pretest clinical suspicion then order it. If it is being ordered in the setting of a low clinical suspicion then don't order it. A D-dimer has it's uses but it has no purpose on an ER rainbow panel. Anybody remember the PIOPED data? The issue is clinical suspicion. IF you have have a mod-high pretest clinical suspicion then order it. If it is being ordered in the setting of a low clinical suspicion then don’t order it. A D-dimer has it’s uses but it has no purpose on an ER rainbow panel.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/reassurance-workup.html#comment-78164 Anonymous Wed, 25 Jul 2007 11:24:00 +0000 http://clients.emmense.com/kevinmd/2007/07/the-reassurance-workup.html#comment-78164 "The real source of defensive medicine is public demand for it. People want a lab number or a picture--clinical judgement is not sufficient. Americans are in love with technology."<br/><br/>So do you ask your patients if they want these tests, or do you just assume they do?<br/><br/>My guess would be that this issue is pretty closely tied to the doctor-patient; if you take the time to build one, the patient is more likely to trust your "clinical judgment". Limit consults to 5 or fewer minutes and yes, you may have a trust problem. “The real source of defensive medicine is public demand for it. People want a lab number or a picture–clinical judgement is not sufficient. Americans are in love with technology.”

So do you ask your patients if they want these tests, or do you just assume they do?

My guess would be that this issue is pretty closely tied to the doctor-patient; if you take the time to build one, the patient is more likely to trust your “clinical judgment”. Limit consults to 5 or fewer minutes and yes, you may have a trust problem.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/reassurance-workup.html#comment-78159 Anonymous Wed, 25 Jul 2007 02:01:00 +0000 http://clients.emmense.com/kevinmd/2007/07/the-reassurance-workup.html#comment-78159 Medicine is not an exact science, there are good standards but not for every condition and situation.<br/>For exmple, I had a patient with asthma. She had frequent exacerbations. One day, it was a pulmonary embolism with wheezing and shortness of breath and not her asthma. No risk factors for pulmonary embolism. So, what guidelines should you apply for such a patient ? D dimer in every asthm patient "just in case" ? <br/>Everybody loses in this scenario. The doctor may get paid but is unhappy with his job and on the long run, he becomes a less efficient doctor. the society ends up paying for these useless tests. Because on the long run these tests do not improve life expectancy or life quality in the general population.<br/>When we talk about "universal coverage", we have to understand that this kind of medicine and these kind of expectations have to stop in a universal coverage system. Otherwise, the system will go bankrupt very fast. We would have to be much more frugal with testing, in order to offer basic coverage for everybody. Medicine is not an exact science, there are good standards but not for every condition and situation.
For exmple, I had a patient with asthma. She had frequent exacerbations. One day, it was a pulmonary embolism with wheezing and shortness of breath and not her asthma. No risk factors for pulmonary embolism. So, what guidelines should you apply for such a patient ? D dimer in every asthm patient “just in case” ?
Everybody loses in this scenario. The doctor may get paid but is unhappy with his job and on the long run, he becomes a less efficient doctor. the society ends up paying for these useless tests. Because on the long run these tests do not improve life expectancy or life quality in the general population.
When we talk about “universal coverage”, we have to understand that this kind of medicine and these kind of expectations have to stop in a universal coverage system. Otherwise, the system will go bankrupt very fast. We would have to be much more frugal with testing, in order to offer basic coverage for everybody.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/reassurance-workup.html#comment-78138 Anonymous Tue, 24 Jul 2007 23:19:00 +0000 http://clients.emmense.com/kevinmd/2007/07/the-reassurance-workup.html#comment-78138 The real source of defensive medicine is public demand for it. People want a lab number or a picture--clinical judgement is not sufficient. Americans are in love with technology. The real source of defensive medicine is public demand for it. People want a lab number or a picture–clinical judgement is not sufficient. Americans are in love with technology.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/reassurance-workup.html#comment-78130 Anonymous Tue, 24 Jul 2007 19:42:00 +0000 http://clients.emmense.com/kevinmd/2007/07/the-reassurance-workup.html#comment-78130 Who exactly loses in that scenario? The doc is still getting paid, the hospital is still getting [aid, and the patient is satisfied.<br/><br/>If docs don't like it, why don't they promulgate some national standards of care that they can adopt? Who exactly loses in that scenario? The doc is still getting paid, the hospital is still getting [aid, and the patient is satisfied.

If docs don’t like it, why don’t they promulgate some national standards of care that they can adopt?

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