Let me pose a question, from someone who does not order unnecessary tests:

YOUR mother has a swollen leg for two days. She has a history of 
diverticulosis and had a DVT years ago.  She was up alot the last few 
days preparing for the Church bake sale.  But her leg aches a bit now.  
She tells you this at 9 pm when you call her after just returning from 
the ER doing a DVT study for cellulitis. You tell her she better call her 
Doctor who sends her to the ER.

Now, the appropriate response is:

1) admit her to the hospital, put her on heparin

	Then, an US the next day shows a DVT

		OR

	It shows a normal study and after a night of bedrest her leg is 
	not swollen and feels better

2) US her in ER and follow one of the two outcomes above based on US.


The reality of the situation is that it simply is not good patient care 
to put people on drugs that are potentially life threatening (not to 
mention subjecting them to all the pain involved with IVs etc) because it 
is inconvient to do an US.

It is clearly not cost effective.

Just wanted to supply my perspective...

MAR

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Michael A. Ricci, MD			
Assistant Professor of Surgery			Phone:  (802) 656-8455
Vascular and Transplant Surgery			FAX:    (802) 893-0305
University of Vermont College of Medicine

Office: FAHC-University Health Center Campus
	One South Prospect Street
	Burlington, VT  05401
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