Purpose Before Testing
The nurse asked, "What labs do you want?" Like clockwork I
responded, "CBC, iSTAT, POC UA and UPT." I walked away thinking about what I
just ordered. Really? Are those even
necessary? Am I simply in robotic-non-thinking-mode? My suspicions were confirmed
when the supervising physician asked me, "What are those labs going to tell
you?" I pondered for a moment and gave my best answer. It was reasonable. The
doc went with it. But it left me thinking. Testing before purpose makes for an
Emergency medicine is fast and furious. The primary goal is
to rule in or out emergency medical conditions. Yet, it's all too easy to hit
the "pre-select" button in the computerized order entry. Fast and furious can't
be the excuse to rely upon a template. I am a medical professional. I have been
trained with the ability to assess a situation, come up with probable causes,
and choose a path in order to dictate the outcome.
Yet, when I am pulled in many ways, my reasoning becomes
blurred. Recently, I have honed in on the purpose. I pause a moment before I
hit the order button. I explain to the patient the needed tests and why. I
confidently convey my thoughts to the attending physician.
This is not an issue specific to emergency medicine. It
applies globally to medicine. The more we understand the pathophysiology, the better
we can chart our course. We were warned in PA school to order the necessary
items. The true challenge comes when the patient or nurse is waiting for you to
make the decision.
We can cave and say, "We are going to run some generic
tests, that could tell us a number of things not related to your specific
problem." Or we can relate our actual purpose for the "tests." I'm guilty of
this. It takes lots of thought and self-control in the midst of fast-paced
medicine. I hope to make those I work with and for feel as though time has
paused and genuine meaning conveyed.