Will be? Already there. I do a lot of QA work and the most consistent, indefensible quality problems are a simple result of not examining patients and taking a history. It is a problem with older docs as well as younger but more so with the latter and they are more prone to be unapologetic about it. The older guys at least are embarrassed that they didn’t look or ask. Some of the newbies think that their job is to work from the data in the chart and that the inadequacy of that data is someone elses responsibility.

You make a good point. I do not know of any studies comparing outcomes. I have seen plenty of anecdotal cases of misdiagnosis/mistreatment due to a focus on the equipment, rather than the patient. I would be surprised if the research did not show worse outcomes both physically and financially. This appears to be an area that could use some good objective research.

If you do not see the patient, how do you know that what you are ordering is relevant? How do you know if you should be ordering something else?

If you have an a patient with acute shortness of breath, refuses to lean back, because it makes breathing worse, very hypertensive, . . . do you order a BNP before seeing the patient? (Of course, this is not to imply that the BNP is useful for any competent ED physician.)

The AHA did not even include, Treat the patient, not the monitor, in the most recent ACLS publication. Perhaps this is to avoid offending the video game practitioners.