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The cardinal sin of medicine?

An Emergency Medicine physician blogger calls laziness the “cardinal sin of

How did this quality achieve such status?
TrenchDoc explains:

Simple. It is the ONE thing that we as
physicians can control. We cannot prevent patients from smoking and driving
their minivans into light poles. We cannot help that patients have myocardial
infarctions without any symptoms whatsoever. We certainly can not force them to
take medicine or have routine checkups. We CAN however be careful,
double-checking and unassuming diagnosticians. I don’t mean by this that we
should order a whole boatload of tests on each patient… quite the contrary… I
mean we should SPEND THE TIME with the patient to find that one unlikely detail
that is the key to solving the problem.

Honestly though, being lazy, quick and
cheap are the easiest of sins to commit in our vaunted system. We pay
physicians in this country basically upon the number of procedures or the
amount of patients they care for per hour. Eventually, poorly directed
efficiency gives way to poor quality of care and to be honest, I am as guilty
as anyone when it comes to missing important clues from a patient.

In his blog post, TrenchDoc goes on to describe a terrible
case of a mentally disabled woman who fell out of an electric shopping cart at
a Value Mart.  She complained of severe back
pain and got every imaging study under the sun (which showed a normal
spine).  She was discharged from the
Emergency Department, only to be readmitted to another ED weeks later when her
pain was still too great to bear.  This
time she said it was her leg that hurt… take a look at the horrible fracture
she had that was missed at the first ED.

I have argued that one of the major causes of decreased
quality of care is reduced patient-physician interaction time.  We are so pressured to rush through our
history and physical that we often miss the diagnosis, furiously documenting
everything without mentally processing what we’re doing.

I agree with TrenchDoc’s call to spend more time with
patients, though time doesn’t come easily.
How do you think we can help physicians find more time to be with their

This post originally appeared on Dr. Val’s blog at

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