Let's check everything!

Specialties Emergency

Published

OK, so this is kinda (mostly ;)) a rant. Some of our younger/newer attendings order everything. Like UA, all basic labs (with coags even if they are not on any anticoagulants), x-ray, and then a CT of something. Chest pain 2 years ago? CTA of the chest. 24 year old who fell 2 weeks ago and has had intermittent nausea since? CT head, even though the rest of the neuro exam is normal. 31 year old with burning on urination? No other symptoms. CT with contrast to r/o pyelo.

I understand its a CYA world, but why do when even need doctors? I can order every possible test that has something to do with that body part. At the very least, I could save the hospital money.

And now these young attendings are teaching residents that they need to order everything.

Specializes in ER, PACU, ICU.

I used to work with a doc that would first order every lab possible for almost any complaint and then order rocephin, reglan, torodol, NS bolus, and sometimes a few additional meds (gi-cocktail, zofran). Then after all the labs were back and nothing showed up he would go into the pts room and tell them "Well its difficulty to pin down exactly what you have but I have given you an antibiotic that treats almost anything, an anti-inflammatory to treat any inflammation...." so basically there was no large arrow directly pointing to what the problem was so just treat the patient for everything.

Drove me nuts to work with him..... but the patients were always happy and hardly ever came back.

Specializes in Emergency & Trauma/Adult ICU.
I used to work with a doc that would first order every lab possible for almost any complaint and then order rocephin, reglan, torodol, NS bolus, and sometimes a few additional meds (gi-cocktail, zofran). Then after all the labs were back and nothing showed up he would go into the pts room and tell them "Well its difficulty to pin down exactly what you have but I have given you an antibiotic that treats almost anything, an anti-inflammatory to treat any inflammation...." so basically there was no large arrow directly pointing to what the problem was so just treat the patient for everything.

Drove me nuts to work with him..... but the patients were always happy and hardly ever came back.

This would push me over the edge.

Specializes in Emergency, Telemetry, Transplant.
I think everyone gets a slightly more comprehensive work up for the learning experience?

I think part of the learning experience is knowing when to do a more comprehensive w/u and when one is not necessary...not just, order everything approach. Then again, it's not my place to question how much of a w/u the docs want to do.

I used to work with a doc that would first order every lab possible for almost any complaint and then order rocephin, reglan, torodol, NS bolus, and sometimes a few additional meds (gi-cocktail, zofran). Then after all the labs were back and nothing showed up he would go into the pts room and tell them "Well its difficulty to pin down exactly what you have but I have given you an antibiotic that treats almost anything, an anti-inflammatory to treat any inflammation...." so basically there was no large arrow directly pointing to what the problem was so just treat the patient for everything.

Drove me nuts to work with him..... but the patients were always happy and hardly ever came back.

Unfortunately the antibiotic won't cover the resistance to abx caused by overuse. And it won't cover the crazy mutated pathogens we brew in the human chemistry sets we refer to as patients.

But, this approach constantly shows high customer satisfaction scores while increasing morbidity and mortality as well as running up the bill.

This is really a win-win for the hospital. like any business, the goal is to create a high paying customer who keeps coming back. This approach to medicine really is the perfect business model.

  • We validate the patients complaint. Clearly they needed an ER visit, otherwise we wouldn't have done all those tests and given those drugs.
  • In addition to the perceived need, we create a real need. Studies consistently show that this approach makes people sicker.
  • We draw people away from PCPs who often take a common sense approach. I think this is called "capturing market share". Think about a pt who you know could have been seen by a PCP. Obviously they wouldn't be getting IVs and CTs, the office doesn't do that.

This doctor may be practicing crappy medicine, but he is an excellent employee. The docs who scare me are the ones who do it thinking it is good medicine. I actually have more faith in the ones who know it is nonsense, but do it anyway.

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