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Stick To One ER, Avoid Unnecessary Tests

Via Kaiser Health News:

On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in  from another hospital, where he had already had an initial work-up — including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along.

This is excellent advice. Every ED has seen a patient, probably today, with “they saw me at the ER across town, but they didn’t do anything and I’m still sick.” While it makes some sense not to return to a restaurant that gave you a meal that wasn’t to your tastes, medicine is quite different.

If a patient gives me this history, I now have a blank slate, and need to essentially start at zero with them. So, I will do the correct workup to exclude the life threats based on the history and physical exam, which may be exactly the tests they had yesterday. I’m not going to assume they did the same tests, or that they were normal. It’s the standard of care at this time, and I have very, very few alternatives.

Let’s flip this around: It’s a patient we saw a day or three ago who comes back to us and says: “I’m not better,” that’s so much better for the patient, and us! We have immediate access to their records and tests, and will not have to repeat studies we already know the result of. Therefore, the patient avoids unnecessary testing, and gets better care.

Yes, you say, you could get the records from the other hospital, and the answer is, maybe, someday, better during M-F business hours (when hospitals are set up to work, still), less on Sunday morning on a four-day weekend. Someday EMR’s will be inter-operational, but frankly that’s going to require legislation as hospital systems want to own “covered lives” and they see control of medical records as proprietary information as theirs and theirs alone. (Also, who’s going to spend money to give away their information?)

So, stick to one ER. Yeah, sometimes you have to go back a couple of times. That’s okay. It’s the right thing for you.

*This blog post was originally published at GruntDoc*


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One Response to “Stick To One ER, Avoid Unnecessary Tests”

  1. this essay is exactly the reason people should use their primary care physician and NOT ERs or urgent care centers whenever possible except for true life-threatening emergencies. Your “medical home” primary doctor has your history and experience with you which no one else does!

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