Dr. Jeremy Faust’s article, “Change from below” (April 2013, p. 4) was so spot-on, I have to write to offer whole-hearted support.

His discourse is on the doctor’s discomfort of a real patient in front of him with trying to follow evidence-based medicine.

In the doctor’s mind are concerns with patient satisfaction scores, plus potential criticism from colleagues and administrators.

Then there is the “what if” scenario of the worst possible result.

As a family doctor working some emergency department shifts over three decades in a rural medical setting, I have struggled with this, as has, I suppose, almost every other family physician and emergency physician.

Having worked with a wide range of doctors in the emergency department, I have noted that the most invasive and expensive (to the patient or his insurance company) emergency physician is usually younger, “better” trained (i.e., emergency medicine residency trained), less secure, more urban, and contracted temporarily from a distant state.

My patients and the hospital administrator love “doing everything” in the emergency department as long as there is “good” insurance coverage. It takes more time, and more confidence, for the emergency physician to explain why a test or procedure is not advisable, rather than just going ahead and writing the order.

Dr. Faust “gets” what most family physicians know from day one. That is, thorough evaluation plus follow-up trumps exhaustive work-up. A follow-up phone call can be better in every way than the unnecessary head CT “just to be sure.”

Keep up the good work, Dr. Faust.

Allan Reishus, M.D.
Craig, Colo.