My conceptual approach to giving diagnostic and treatment plans and recommendations.
1. I have a $100 bill, $50 and sometimes $1.
2. I show them to you and tell you to take the $100. It’s the best.
3. I’ll tell you more about the $50 and $1 if you want.
~thread~
1. I have a $100 bill, $50 and sometimes $1.
2. I show them to you and tell you to take the $100. It’s the best.
3. I’ll tell you more about the $50 and $1 if you want.
~thread~
You are 50 y/o F with fever and cough. T40, P120, R30, BP 88/52. WBC 24K. CXR shows R pneumonia with effusion.
$100: You have pneumonia I’m starting antibiotics
$1: Could be something else. Go home and call me in a few days
$100: You have pneumonia I’m starting antibiotics
$1: Could be something else. Go home and call me in a few days
Bedside ultrasound shows nice big pleural effusion.
$100: we are going to perform a thoracentesis.
$1: We will let it sit there and if it’s an empyema, you will likely get sicker and after the fluid becomes solid a surgeon will have to peel it out in the OR.
$100: we are going to perform a thoracentesis.
$1: We will let it sit there and if it’s an empyema, you will likely get sicker and after the fluid becomes solid a surgeon will have to peel it out in the OR.
The fluid shows pH 6.9, WBC 20,000, gram stain (+) for gram (+) diplococci.
$100: My colleague is going to put in a chest tube.
Pick the $100
$100: My colleague is going to put in a chest tube.
Pick the $100
As I’m putting in admission orders, you mention you had a NSTEMI 2 years ago. No PLAVIX. Just ASA and BB.
Right now, no CP. EKG and TROP normal.
$100: cardiac diet
$100: regular diet
You pick regular. I enter the order.
Right now, no CP. EKG and TROP normal.
$100: cardiac diet
$100: regular diet
You pick regular. I enter the order.
The ER gave you ceftriaxone + azithromycin. I’m ordering your ABX.
My hospital’s recommendations:
$100: Ceftriaxone + azithromycin
$100: Ceftriaxone alone since I know you don’t have an atypical organism
$50+$25: Levofloxacin. It will work, the issues are cost and resistance
My hospital’s recommendations:
$100: Ceftriaxone + azithromycin
$100: Ceftriaxone alone since I know you don’t have an atypical organism
$50+$25: Levofloxacin. It will work, the issues are cost and resistance
We finally got a close one!
If I asked the patient to choose, the result would largely be as a result of the bias that I gave in my presentation of the options.
Put another way, if doctors disagree about this choice, how are patients supposed to make a decision?
If I asked the patient to choose, the result would largely be as a result of the bias that I gave in my presentation of the options.
Put another way, if doctors disagree about this choice, how are patients supposed to make a decision?
In summary, asking a patient to make a medical decision is a ridiculous dereliction of your responsibility as a doctor, except when the decision is irrelevant.
