http://www.medrants.com/archives/4917 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 http://www.medrants.com/archives/4917/comment-page-1#comment-529440 Michael Kirsch, M.D. Fri, 16 Oct 2009 02:10:16 +0000 http://www.medrants.com/?p=4917#comment-529440 I agree, but sometimes closure is the right answer. Clinicians who are too expansive or indecisive are handicapped. We will never reach 100% certainty of a diagnosis, and we need to know when to pull the trigger. This threshold changes in every patient, depending upon the disease severity, risk of missing a significant diagnosis, patients' (or their family's) demand for more certainty, fear of litigation and physicians' style of practice. These are issues of medical judgment, which are honed over time. When I see patients with elevated liver enzymes, I don't look for Wilson's Disease, even though it's on 'the list'. While premature closure is not ideal, delayed closure is equally deleterious. www.MDWhistleblower.blogspot.com I agree, but sometimes closure is the right answer. Clinicians who are too expansive or indecisive are handicapped. We will never reach 100% certainty of a diagnosis, and we need to know when to pull the trigger. This threshold changes in every patient, depending upon the disease severity, risk of missing a significant diagnosis, patients’ (or their family’s) demand for more certainty, fear of litigation and physicians’ style of practice. These are issues of medical judgment, which are honed over time. When I see patients with elevated liver enzymes, I don’t look for Wilson’s Disease, even though it’s on ‘the list’. While premature closure is not ideal, delayed closure is equally deleterious. http://www.MDWhistleblower.blogspot.com

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