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Based on the discussion in a concurrent thread about how different ERs are
handling RLQ tenderness (pain is different) after 5 pm, with some places
having replaced CT scans with 24/7 US and others with even 24/7 MRI, it
becomes clearer that world class medicine does require thinking like a
business in many circumstances.  World class means developing resources,
improving availability, training enough MRI techs to staff 24/7, and
enabling radiologists to read those scans real-time from home. All this
systems work and QI may be as important to delivering world class medicine
as the enhanced skills of the physician. 

I'm a dinosaur trained in the art of history and exam. My artisan skills at
clinically diagnosing an appy may be better than those of the younger docs,
but that isn't necessarily good enough for some situations. 

Conversely, imaging every child with a complaint of RLQ pain but no physical
findings leads to overdiagnosis, overtreatment, and poor social determinants
of health due to health care consuming 20% of the GDP. World class medicine
also involves balancing all these factors.

Kevin Powell MD PhD FAAP
Pediatric hospitalist
Saint Louis, MO


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Doc Holiday
Sent: Thursday, July 14, 2016 5:06 AM
To: [log in to unmask]
Subject: Re: Darrell G. Looney: World-Class Pediatric ER

From: [[log in to unmask]] on behalf of Karen Balzanto
[[log in to unmask]]

Sent: Tuesday, July 12, 2016 4:30 PM
Re: Darrell G. Looney: World-Class Pediatric ER


Hence the ridiculous way we now practice medicine...


--> It no longer sounds like the "practice" of medicine; more like the
medical business. It's run as a business and it passes the prime test for
any business, i.e. "if the CEO has an option between doing the right thing
for the patient and going bust as a business or doing the wrong thing and
the business stays in the black, which will he/she choose?


The one thing which always strikes me as evidence of the amazing power of
brain-washing is how so many people in the medicine-for-profit world refer
to what used to be the patient as the "customer" of the "corporation", when
it's actually more like the "raw material" for the "industry"...







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