Dr. Throwback

In the USA Today, Dr. Marc Siegel, an internist in New York, attacks the US Preventive Services Task Force for its “simplistic” approach and seemingly disapproves of evidence-based medicine. (Task-force thinking doesn’t deliver my kind of medicine.)

It’s interesting to see how Dr. Siegel practices:

Today, I use my own checklist based on 20 years in practice. When my female patients are younger than 21 and sexually active, I refer them to a gynecologist for a yearly pelvic examination and a Pap test. At 40, I order a mammogram as well. All patients over 50 are sent for a colonoscopy. Elderly patients are prone to both depression and falls, so I screen them for these issues.

Unfortunately, in my examination room of the near future, my hands may be tied. I will want to order the same screening tests and procedures, but I might need another checklist of the services that my patients can’t receive because Medicare or private insurance will no longer pay for them.

Sounds like common sense. But what is the basis for this checklist? How did Dr. Siegel determine the age 21 cut-off? How about age 40? Is he rationing care to people who don’t fall into those groups? How does he define elderly? Has his checklist changes over the years?

And what about doctors with less than 20 years of experience? What checklist should they use when they get into practice or after 5 years?

Should everyone have the same checklist?

I have sympathy for Dr. Siegel’s Marcus Welby-style approach, but it sounds like whining to me.

December 16, 2009

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