In my opinion, two of the emergency physician’s greatest tools are bedside education and communication. When you know why they want a test, perhaps you can change expectations. Just telling people they don’t need a test isn’t education; it’s a demoralizing smackdown. Your question reminds me of a patient I saw a couple of years ago who had been experiencing a cough for a week. He was adamant about getting a chest X-ray. After explaining the lack of utility of a chest X-ray, he wasn’t the least bit dissuaded. I asked, “What concerns you about your cough? Why do you want an X-ray?” He replied, “My father had a cough, and when they finally did a chest X-ray, they diagnosed him with lung cancer.” This wasn’t about the test; it was about an uneducated fear of lung cancer.
Explore This IssueACEP Now: Vol 35 – No 05 – May 2016
In my opinion, two of the emergency physician’s greatest tools are bedside education and communication. When you know why they want a test, perhaps you can change expectations. Just telling people they don’t need a test isn’t education; it’s a demoralizing smackdown.
Despite attempts to educate them, some patients may not change their minds. However, even if you acquiesce to some of those demands, you still have reduced unnecessary testing for so many more. Choosing Wisely provides us with a tool. It is not only an evidence-based educational tool but an authority that supports your advice and to divert the heat toward.
Jerry, very interesting perspective, and I completely agree. The advances in and availability of medical technology have fallen victim to the law of unintended consequences. With overreliance on diagnostic technology, the art of physical examination has begun to erode.5,6 Testing used to confirm the concerns developed through a thorough history and physical examination, but now, all too often, it’s the other way around; the physical examination takes a back seat to the diagnostics. The “right” tests complement a good history and physical examination, but more tests will never be a substitute for the art of bedside diagnosis.
Bill and Alise, I sense your frustration and suspect you speak for a great many who are simply sick and tired of well-intentioned bureaucrats who have developed a financial conscience, demanding fiscal responsibility and stewardship while asking physicians to do much, much more with far, far less. Your comments strike the most important points with laser-like precision.
“Help decrease the cost of medical care and be liable for any of your mistakes.”