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Only planning for the common case is an insane thing to do in healthcare. We don't train doctors for 12 years so that they are faster or more efficient at diagn

Only planning for the common case is an insane thing to do in healthcare. We don't train doctors for 12 years so that they are faster or more efficient at diagnosing the common cold, we train them so that they have a wide breadth of knowledge, experience, and skills. People already have difficulty getting satisfying diagnoses from MDs with 12 years of training + Epic, imagine how much worse it would be if the person had no clue illnesses other than what Epic spits out even exist.

FireBeyond 3y ago
Exactly. Not everything is a zebra, plenty of horses, but... When I teach new EMTs, there's a common topic that comes up. For clarity, EMTs undergo about 200 hours of training, for what is called BLS (basic life support) - essentially non-invasive processes. Generally they can only administer about 5 medicines (oxygen, aspirin, epinephrine, glucose, nitroglycerin). Paramedics undergo up to 1600 hours of training, for ALS (advanced life support), and can start IVs, administer ~40 medications, and do a variety of invasive procedures. So our local EMS protocols say that if you administer a caloric supplement (i.e. glucose) for someone with hypoglycemia, you must "upgrade" that call to ALS and have a paramedic respond. "But what if the patient is getting better?" As expected, as hoped. And if the hypoglycemia is really just that, then 99% of those patients won't need, or want, further care/transport. And for 99% of that 99% (arbitrary, but very high, percentages), it's probably entirely reasonable. "So if they're getting better, why do we want a higher level of care?" For the zebras. For the person with endocrine issues, or for whom hypoglycemia isn't a simple diabetes-related thing, but actually symptomatic of early organ failure, or other things, to get a deeper review to make sure we don't say "Sure thing, Mrs Smith, just stay home and have your husband make you a PB&J or two for some complex carbs" to the patient who has something more serious going on.

FireBeyond 3y ago

Exactly. Not everything is a zebra, plenty of horses, but... When I teach new EMTs, there's a common topic that comes up. For clarity, EMTs undergo about 200 hours of training, for what is called BLS (basic life support) - essentially non-invasive processes. Generally they can only administer about 5 medicines (oxygen, aspirin, epinephrine, glucose, nitroglycerin). Paramedics undergo up to 1600 hours of training, for ALS (advanced life support), and can start IVs, administer ~40 medications, and do a variety of invasive procedures. So our local EMS protocols say that if you administer a caloric supplement (i.e. glucose) for someone with hypoglycemia, you must "upgrade" that call to ALS and have a paramedic respond. "But what if the patient is getting better?" As expected, as hoped. And if the hypoglycemia is really just that, then 99% of those patients won't need, or want, further care/transport. And for 99% of that 99% (arbitrary, but very high, percentages), it's probably entirely reasonable. "So if they're getting better, why do we want a higher level of care?" For the zebras. For the person with endocrine issues, or for whom hypoglycemia isn't a simple diabetes-related thing, but actually symptomatic of early organ failure, or other things, to get a deeper review to make sure we don't say "Sure thing, Mrs Smith, just stay home and have your husband make you a PB&J or two for some complex carbs" to the patient who has something more serious going on.