I recently saw a 14-year-old male patient for an emergency room (ER) follow-up visit. While the office staff was securing a copy of the patient’s medical record, I took his history.
The patient reported that he began to feel sick about two days prior to visiting the ER. On the first day of illness, he had a tickly throat and congestion. By the second day, the patient had developed a little cough and felt he might have a fever (he did not have a thermometer in his home). The patient’s mother brought him to the community hospital ER. This community hospital happens to be owned by a for-profit hospital corporation.
The patient was sent home with the diagnosis of viral upper respiratory infection. He had not received any prescriptions. Although the patient made an unnecessary trip to the ER, I was relieved that he got an appropriate diagnosis and received the appropriate level of care.
During his follow-up visit with me, the patient reported that his symptoms had mostly resolved and he was doing well. We proceeded with an annual check up, which he was due for, and I am happy to report that the patient agreed to receive the first dose of the HPV vaccine.
Later, I received the note from the patient’s ER visit and was shocked. Call me naïve. The patient underwent a battery of tests, despite documentation that he was afebrile and had a normal physical exam, including no adventitious lung sounds. A chest x-ray was done, a rapid strep test was run, and a CBC was drawn. All tests came back negative or normal.
Since when does a less than 48-hour history of upper respiratory symptoms, no fever and a negative physical exam in an otherwise healthy adolescent require anything other than reassurance?
I can only guess what this one visit will end up costing the insurance provider (in this case one that manages Medicaid), or in other cases the patient. When my own adult son went to the ER last month for an asthma exacerbation, he also received similar excessive testing and his bill was more than $2,000. It is no wonder the United States has the most expensive health care in the world.
A step towards correcting this problem, although very small, is the American Board of Internal Medicine Foundation’s (ABIMF) recently announced Choose Wisely campaign. Composed of nine medical specialty boards, the ABIMF has identified 45 overused tests and procedures, a list of which can be found online at ChooseWisely.org.
Unfortunately, the American College of Radiology, one of the participating members, failed to include performing fewer chest x-rays when a patient’s clinical exam is sufficient on its list of unnecessary procedures. But at least the Choose Wisely campaign is a start.
Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.