Dr. Wes contrasts two approaches to the same patient. Old school vs new school.
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{ 3 comments }
Thing about the example cited, the final common denominator is the CT scan.
If the ER doctor did an exquisite physical exam, did no exam, or if the ER doctor sacrificed a chicken and read the entrails, the patient was getting a CT scan based on history alone.
No, I’m not advocating elimination of the physical exam, but I don’t know if this is an example of it’s value.
Examples like this ignore the majority (I think) of medicine, which is drunks and drug addicts who need a fix, or psych related complaints manifesting as physical symptoms. Or refills on meds/propecia/viagra/general visit because the patient “just wants to be sure everything is ok”. That is what the health care debate should address, but never does. Becauseits easier to just turn a blind eye to the fraud going on.
Anyway, the only way the example Dr Wes gives is poignant, is if the CT is totally negative. Then you just wasted time and resources. Doctors are here for the zebras. The NP’s and PA’s are here for the others. (so the theory goes, right?)
I guess it depends on what is most scarce.
If the guy were in Cuba where there are lots of personnel and few advanced machines then the lengthly assessment would be appropriate because the machine could better be used for someone else.
If the guy were someplace where the ER was overburdened with serious cases then sending him off for a scan promptly should free the Dr. up to help someone else. If that keeps the guy running the scan machine billing away his entire shift it’s all the better.
When I started in IT machine time was scarce and expensive. You wrote your program out, you thought about how to conserve memory and make it run fast.
Now days you throw something together and submit it, the complier will point out your errors for you. Machine time and memory are cheap. There were four people doing what I do by myself now.
Now the PERSON who is being looked at would probably prefer the 2 1/2 hour process because he/she would feel they’d been throughly attended to.
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