Jun 29, 2011

pulmonary embolism: when less is more

got this link up from literature of note.
This is where Dr. Newman and Dr. Schriger, outstanding clinicians and analysts of data, present a compelling case regarding the diagnosis and treatment of pulmonary embolism. The paper in pdf. In brief, the authors try to estimate, based on the limited evidence, both the benefits and harm of diagnosis and treatment of pulmonary embolism. In their review, very few patients were found to benefit from treatment of pulmonary embolism - the existing evidence is weakly supportive of anticoagulation. Additionally, they show a great many patients were harmed by excessive testing and treatment of clinically unimportant pulmonary embolisms.

This is, while a complicated opinion piece, a lovely summation in a nutshell of the concept that finding more "disease" does not equal better outcomes. And, depending on the risks of testing and treatment - the barbaric contrast, radiation, and rat poison that diagnosis of PE typically entails - more people would be alive today if we all stopped testing for pulmonary embolism.
Probably time for us to stand back see things fall into place rather than go all out and create further mayhem.

There's a saying that goes - Please give me the strength to change the things that I can change, the serenity to accept the things that I can't change, and the wisdom to differentiate them.

Likewise, hopefully, we can treat those pulmonary embolism that really requires aggressive management, be expectant in pulmonary embolism to prevent harm in treating, and finally the wisdom to choose the safer path.

Probably Well's criteria is the closest to wisdom we can have, but still, it is not the holy grail to go by absolutely. At least, not yet.

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