I was just in the Emergency Room seeing a consult when I overheard the ED attending say the following to one of the patients:
"Your test results are back. Your chest x-ray is normal, your EKG is normal, your white blood cell count is normal, your electrolytes are normal and your D-dimer is normal."
At this point, I glanced over towards the curtain he was standing at, and in the bed I see a young girl who couldn't have been more than 22!
Clearly, she had complained of chest pain...and had gotten a million dollar (okay, probably more like a few thousand dollar) work-up. What's wrong with that, you say?
Here's what wrong with it:
1. It's 2 in the morning and this is not an emergency.
2. She is not having a heart attack...nor does she have pneumonia, or a pulmonary embolism...
3. ALL of the above should be ruled out by history and physical exam in such a young girl.
Maybe when I am practicing on my own I will feel differently, but there is no way this work-up was justified. Clearly, he was trying to cover his ass on the one-in-a-billion (and it really is one-in-a-billion) chance that there was something wrong with her. And someone (her, you, me, the hospital) is paying for it.
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