Tuesday, July 24, 2007

Reassurance Workup

From Movin' Meat:

I have devised a simple, cheap and quick "reassurance work-up" for these folks which consists of: an ECG, an i-Stat, a D-dimer, and a troponin. Sometimes I add a chest x-ray if it seems helpful. (We are lucky in that most of these tests can be done in the ED's stat lab with a turn-around-time of about 15 minutes.) Then I sit down with the patient and invest a few minutes telling him or her about all the tests we did and all the Bad Things we ruled out. I list each electrolyte separately, the normal blood sugar (we ruled out diabetes), normal blood counts (rules out anemia), ruled out heart attack, blood clots, aneurysm, etc etc. It's interesting how well patients respond to that. The long list of things "you don't have" seems to really be effective in reassuring patients. Then a quick laugh -- I ask the question for them: "Great, doc, you told me what I don't have, so what do I have? Well, I can't tell you what is causing your symptoms, but there are only x number of Bad Things that can cause symptoms like yours, and you don't have any of those Bad Things, so I know it is safe for you to go home, we will keep an eye on it, and I expect that it will go away on its own."


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