Hyman Gaylis, MD, FRCS
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Gaylis H.; Implications of Regional Differences in Spending. Ann Intern Med. 2004;140:147. doi: 10.7326/0003-4819-140-2-200401200-00023
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Published: Ann Intern Med. 2004;140(2):147.
TO THE EDITOR:
With regard to the escalating costs in Medicare spending (1) and efforts to reduce them, the thought to reward physicians who practice high-quality conservative medicine (2) is interesting but begs the question of what should be characterized as “high-quality.” Apart from the outcomes of treatment, in my view, one feature of high-quality medicine is thorough clinical evaluation of patients, a time-honored and rapidly disappearing art that has been relegated to a secondary role with dependence and reliance on new technology, such as imaging and laboratory testing. This reliance on technology for diagnostic work is to some extent institutionally mandated and is also driven by a desire for “objective” hard data to fend off malpractice suits (Brown B. Personal communication). Instead of using noninvasive tests to complement clinical examination, they are often used to supplant it. Neglect of clinical examination leads to declining standards in clinical examination and evaluation.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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