"Rush to treatment"

Hess, Dr. Donald dhess at SUSQUEHANNAHEALTH.ORG
Wed Nov 30 17:58:33 UTC 2016


Greetings:

Patients presenting to the ED with acute STEMI, CVA or sepsis are managed according to standardized, time-sensitive, treatment protocols. I wonder to what extent the "rush-to-treatment" contributes to the diagnostic discordance seen between admission & discharge. These protocols ensure that making the diagnosis becomes secondary to determining whether or not the patient meets inclusion criteria for treatment. It's easier to treat now and diagnose later. I recall that this is a cognitive strategy mentioned in Kahneman's Thinking, Fast & Slow. If a question is too difficult to answer (making the best diagnosis given the available information), then simply transform it into a question that is easier to answer (does this patient meet inclusion criteria for treatment?)

I realize that these emergent situations are fraught with uncertainty and that often the risks are unknown. Nevertheless, I suspect that the rush-to-treatment also precludes a meaningful discussion with the patient & family regarding risks, benefits, alternatives, uncertainties, & possible outcomes.

Regards, Don

DONALD W. HESS, MD, MPH
Director, Continuing Medical Education
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