Imagine two patients arriving in the emergency department ofa Maine hospital at midnight. The first has a presentation consistentwith pulmonary embolism; the second, appendicitis. A decadeago, the first patient might have been started on heparin therapyand scheduled for an early-morning ventilation–perfusionscan. The second patient would have been seen by a surgeon,who would have made a judgment call regarding the diagnosisof appendicitis and the need for surgery.
Today, both of these patients and hundreds of others like themwould receive middle-of-the-night CT scans, taxing the hospital'sradiologists. But midnight in Bangor, Maine, is 10:30 . . . [Full Text of this Article]
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Dr. Wachter is associate chairman of the Department of Medicine, University of California, San Francisco.
An interview with Dr. Wachter can be heard at www.nejm.org.
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