Clinical judgement and experience

22 Jan

There is a great article over at White Coats Call room it also links back to another article with dialogue between White Coat and Maxwell S Kennerly and attorney apparently based in Philadelphia.  It is an interesting read on the view of defensive medicine and whether or not it even exists.  I can agree with White Coat in that it does exist, and there is a fine line, and the fine line is called clinical judgement.  I see it happen all the time, the patient is admitted gets a consult for every specialist there is, prior to discharge the patient has gone through, heart Doppler, eendoscopy, colonoscopy, heart cath, vein mapping, CT of chest, MRIs, MRAs etc…during the “prep” for the colonoscopy the patient falls,  the list and scenarios are endless. The bottom line is if you keep searching for the possible things that could be wrong with someone you will find it, even if that wrong thing is a result of the hospital stay or just found incidentally, even if was not part of the original complaint, or diagnosis. I will not even mention the “hits” the kidneys will take from some of these tests.

The whole conversation seems to imply that physicians should be the do all, be all, know all, for the patient and in reality phycisians are human. It seems that society and the school of law are trying somehow to dehumanize the whole process of caring for people.  If you asked me if I wanted a bizillion specialists, ten diagnostic tests to rule out the most serious, but most improbable of all illness relating to a specific symptom I would surely say no! I want a physician who uses clinical judgement and experience, expertise not a computer who orders a zillion tests for the “could be” rare diagnosis. I see the harm done, the emotions spent, on defensive medicine.

It happens in nursing as well. Spend more time charting in front of the computer, document everything, just in case a bad outcome happens and you did not document every interaction, intervention, education provided. My time would be better spent in the rooms, with the patients and families  providing the care they need, assessing,  and teaching; it has turned into quick assessments, quick turning, quick teaching, and back to the computer to chart it all.

Well this is my rant about defensive medicine. I am sick of it! I am tired of these workups that can mostly be done as outpatients anyway. It is insanity.


2 Responses to “Clinical judgement and experience”

  1. Strong One January 25, 2009 at 21:52 #

    Yes, defensive medicine is the ‘new term’ or Politically Correct term for CYA.
    It’s a shame

  2. seejanenurse January 26, 2009 at 20:27 #

    True. CYA wastes alot of my time. Time that could be better spent in the rooms with my patients. 🙂

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