On 2014 Mar 06, David Keller commented:

Patient safety trumps cost containment

Professor Horowitz is to be congratulated for correctly diagnosing his sister's transient global amnesia (TGA) over the telephone, and for predicting the benign and self-limited course it would take. In my 16 years of practice as a general internist, plus my years of residency training and medical school, I did not encounter a single patient with this condition. Therefore, I sympathize with the internist who was called in to the ER to evaluate this patient. Given an elderly woman who, at first, exhibited total amnesia, including complete disorientation regarding her own identity and surroundings, I would have ordered the same thorough workup that her admitting physician did, unless an experienced neurologist examined her in person and was confident enough of a benign diagnosis to write her discharge orders. If the admitting internist could not obtain a neurological consultation, and did not feel comfortable sending the patient home based on his own findings, then I cannot blame him for ordering an extensive workup to rule out atherosclerotic vascular disease or embolism as the cause of these dramatic symptoms in an elderly patient. When in doubt, patient safety should trump cost containment.

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On 2014 Mar 06, David Keller commented:

Patient safety trumps cost containment

Professor Horowitz is to be congratulated for correctly diagnosing his sister's transient global amnesia (TGA) over the telephone, and for predicting the benign and self-limited course it would take. In my 16 years of practice as a general internist, plus my years of residency training and medical school, I did not encounter a single patient with this condition. Therefore, I sympathize with the internist who was called in to the ER to evaluate this patient. Given an elderly woman who, at first, exhibited total amnesia, including complete disorientation regarding her own identity and surroundings, I would have ordered the same thorough workup that her admitting physician did, unless an experienced neurologist examined her in person and was confident enough of a benign diagnosis to write her discharge orders. If the admitting internist could not obtain a neurological consultation, and did not feel comfortable sending the patient home based on his own findings, then I cannot blame him for ordering an extensive workup to rule out atherosclerotic vascular disease or embolism as the cause of these dramatic symptoms in an elderly patient. When in doubt, patient safety should trump cost containment.

To facilitate discussion, I respectfully request the person who found this comment "not helpful" to state their reason