Repeat after me: there is no such thing as zero risk. We all have heard “about that one case” – and sure, there are patients with negative d-dimers & PERC negative that have PEs. There are “clean cath” patients that die the next week. Septic patients that do not make a lactate – etc, etc. And so, this largely hypothetical study, suggests that, if there was an acceptable 1-2% miss rate, physicians would admit 29% less acute coronary syndrome rule outs (based on physician surveys of 259 cases).
I have to wonder whether or not this would play out in practice. We’ve seen that tort reform has not really changed the decision making process, why would an acceptable miss rate? I suspect providers “are just saying that” – and would actually still admit many of these patients. It’s been ingrained in providers from their forefathers that lawyers lurk behind every chart. During training, we have all been exposed to the excessively conservative provider – and I suspect unconsciously they rub off on us. Throw in the human aspect of the torment of missing a catastrophe, and you’ve got overtesting that we will likely continue to do for decades, regardless of attempts to change the medicolegal landscape.