Dear collective wisdom of Meddit,
We had a new registrar this week on the ward. They just got back from a couple of years in research. Their lack of clinical confidence was pretty evident and despite our best efforts to calm, convince and cajole, they essentially engaged in some of the most abhorrently defensive medicine I've seen since starting as a doc.
tiny adrenal incidentaloma on that CTCAP (described as "of doubtful significance" by radiologist) with normal biochem in a 90 lady done to r/o malignant causes of her obviously age-related swallow difficulties? Needs urgent endocrine opinion +/- MRI today
isolated minor derangement of a single LFT in the context of nuking our patients with infected broad spectrum antibiotics and the rest? MRCP!
'biliary sludge' on a week old USS in patient admitted with alc hep (no fevers, no rigors, no RUQ pain) = we've missed cholecystitis, inform the family of our error and the liver surgeons must come now!
Essentially just a catalogue of looking at imaging or test results in total isolation from the clinical context, with certainly no regard to the tolerability of intensive investigation in elderly patients or even bothering to confirm any kind of occult symptoms that might corroborate the findings.
So I'm wondering if you might recommend some books or papers that make a persuasive, evidenced based argument for non-defensive medicine? Or a medicine that focusses on the basics? Basically what GPs and geriatricians do so well?
The two that come to mind which I've read is:
Jerome Groopman's "How Doctors Think" – but that's more about recognising the kind of cognitive errors that lead to misdiagnosis
Gigerenzer's "Risk Savvy" – again might be a bit too stats oriented
All thoughts greatly appreciated! (edit: formatting)
Source: Original link