Until this issue is resolved, providers will read articles like this, nod their heads in agreement, and then sadly ignore these recommendations in favor of income and employment security.
Explore This IssueACEP Now: Vol 35 – No 05 – May 2016
In order to implement these recommendations, every physician or health care provider must feel assured that he/she isn’t missing a red flag or overlooking a finding that would indeed indicate the utilization of one of these tests. However, in order to achieve this degree of assurance, one must perform a good history and physical examination. That doesn’t happen nowadays.
The “history” consists of a few perfunctory questions asked from a computer template that often has little association with the top two or three conditions in the patient’s differential diagnosis. It is typically acquired without the physician ever looking at the patient and without giving the patient an opportunity to interject a comment.
The physical exam—if done at all—consists of a “stethoscope tap,” in which the diaphragm of the scope is placed on the right and left upper chest for less than one second in each location, and the “belly pat,” in which one hand is placed on the patient’s abdomen—usually with the patient fully clothed, without even indenting the contour of the abdomen. In fact, you can find more and more physicians who pride themselves on not doing a physical examination, claiming that a physical exam is a dinosaur and no longer pertinent in a digital, technologically advanced world. I recently attended a symposium in which a number of speakers actually mocked physicians who still do physical exams.
Thus, the only way left nowadays for many physicians to feel assured that they are not missing a red flag is to order an abundance of unnecessary tests that would have been obviated by a decent history and physical examination.
—Jerry W. Jones, MD, FACEP
The patients who come to the ER want tests, not a dissertation on why they are not necessary. This is the mindset. Every survey has shown that more tests, even negative, generate better evaluations and ensure your job.
—Freda Lozanoff, DO, FACEP
You guys just don’t get it. Choosing Wisely is a euphemism for saying, “help decrease the cost of medical care and be liable for any of your mistakes.” Without tort reform that gives me complete protection if I follow Choosing Wisely and safe harbor guidelines, I do not intend to modify my practice in any way. I’ll say it again, I will not participate in any program that increases my medical liability. When legislation is passed that says I cannot be sued if I follow Choosing Wisely or safe harbor guidelines, I will be happy to modify my practice.