Took a 4 th year medical student and a 2 nd year family medicine resident with me today to care for a patient with pancreatitis and dehydration/renal insufficiency at the local rural critical access hospital. We reviewed the management plan and quickly rattled off the basics such as IV fluids, pain control, and anti-emetics. Like I usually do with patients or students I asked, "Anything else?"
They rattled off some urine electrolyte studies to further sort out the cause of renal failure. Unfortunately, the lab couldn't do those at the hospital. No matter, we had a pretty good idea that dehydration was the cause of the impaired kidney function. Order an ultrasound to see if there's any gallstones. Sorry, no ultrasound; the story was wrong for gallstone pancreatitis anyway. Prescribe an expensive IV proton pump inhibitor. Good idea, but it wasn't on formulary. We decided to go for a less expensive option.
Through this exercise all of us gained a new perspective on separating the medical wheat from the chaff. It again showed us how technology has given rise to such soaring health care costs. It is so easy to just start ordring tests when they are readily available, but we can often provide quality medical care without a lot of bells and whistles. How much less would health care costs if every now and then we all had to practice in at a rural hospital?
They rattled off some urine electrolyte studies to further sort out the cause of renal failure. Unfortunately, the lab couldn't do those at the hospital. No matter, we had a pretty good idea that dehydration was the cause of the impaired kidney function. Order an ultrasound to see if there's any gallstones. Sorry, no ultrasound; the story was wrong for gallstone pancreatitis anyway. Prescribe an expensive IV proton pump inhibitor. Good idea, but it wasn't on formulary. We decided to go for a less expensive option.
Through this exercise all of us gained a new perspective on separating the medical wheat from the chaff. It again showed us how technology has given rise to such soaring health care costs. It is so easy to just start ordring tests when they are readily available, but we can often provide quality medical care without a lot of bells and whistles. How much less would health care costs if every now and then we all had to practice in at a rural hospital?
The Country Doctor