Comments on: Medical workups: The old days are gone http://www.kevinmd.com/blog/2007/09/medical-workups-old-days-are-gone.html Tue, 14 Feb 2012 21:39:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/09/medical-workups-old-days-are-gone.html#comment-80241 Anonymous Thu, 20 Sep 2007 23:33:00 +0000 http://clients.emmense.com/kevinmd/2007/09/medical-workups-the-old-days-are-gone.html#comment-80241 I guess it depends on what is most scarce. <br/><br/>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.<br/><br/>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.<br/><br/>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. <br/><br/>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. <br/><br/>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. 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.

]]> By: Mikehttp://www.kevinmd.com/blog/2007/09/medical-workups-old-days-are-gone.html#comment-80236 Mike Thu, 20 Sep 2007 19:56:00 +0000 http://clients.emmense.com/kevinmd/2007/09/medical-workups-the-old-days-are-gone.html#comment-80236 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.<br/><br/>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?) 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?)

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/medical-workups-old-days-are-gone.html#comment-80234 Anonymous Thu, 20 Sep 2007 19:11:00 +0000 http://clients.emmense.com/kevinmd/2007/09/medical-workups-the-old-days-are-gone.html#comment-80234 Thing about the example cited, the final common denominator is the CT scan.<br/><br/>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.<br/><br/>No, I'm not advocating elimination of the physical exam, but I don't know if this is an example of it's value. 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.

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