Dr. Tomaszewski is professor of clinical emergency medicine at the University of California San Diego Health and chief medical officer of El Centro Regional Medical Center.
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ACEP Now: Vol 37 – No 11 – November 2018Reference
- Tomaszewski CA, Nestler D, Shah KH, et al. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected non–ST-elevation acute coronary syndromes. Ann Emerg Med. 2018;72(5):e65-e106.
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One Response to “How to Manage Suspected Non–ST-Elevation Acute Coronary Syndrome”
December 2, 2018
Jerry W. Jones, MD FACEP FAAEMOverall, a good presentation and I do agree with many of your views though there are a few statements that give me pause.
“Most emergency physicians strive to attain a miss rate of less than 1 percent. However, it is questionable if the benefits of further testing outweigh the risks of harm of untreated disease once that threshold reaches 2 percent, which the committee felt was a more realistic expectation. With shared decision making, patients may be willing to accept rates higher than those to which physicians hold themselves accountable.”
0% rate of MACE remains the holy grail of all physicians treating patients with chest pain and especially emergency physicians. I think every ER physician should strive for 0% MACE, no matter HOW unattainable that figure may realistically be. Aiming for 2% will only result in figures higher than 2%. And I can’t imagine trying to talk a patient into leaving the ER with a potential for MACE greater than that with which I myself would feel comfortable. That just seems hypocritical and unethical to me. At some point we must ask ourselves, “Are we working for the patient or for an insurance company?” In the quote above, you essentially ask if it is worth trying to reduce incidents of MACE from 2% to less than 1%. Worth to whom – the patient or the insurance companies? These percentages are not spanning a career in EM – many of us will reach those percentages every few months.