A Maximis Ad Minima (from the maximum to the minimum) by Pat Conrad MD

Remember in residency training when you learned to do minimal workups in order to save $$ and (drum roll) improve quality?  Neither do I.  I remember being coached, badgered, cajoled, and threatened to construct an exhaustive differential that would get the damn diagnosis. 

Now the Archives of Internal Medicine is recommending just the opposite.  As reported by the American Medical News, a panel compiled a "top-five 'don't' list(s) of ...activities that are wasteful [and] not supported by evidence."  Included in the resource wasters are annual blood chemistry and urinalysis screening, as well as EKG's in asymptomatic patients.  Of the 255 primary care physicians surveyed "the vast majority agree with the recommendations." 

I was waiting for the punchline, and there it was:  Dr. Stephen Smith, the author of these recommendations, is both a professor at Brown Univeristy, and a member of the National Physicians Alliance.  Visit the website of this bunch and you will see that they favor universal, affordable health coverage, as well as support ObamaCare.  Presumably they are also in favor of puppies and sunshine, which are also free.  The first statement on their Guiding Principles:  "We place the best interests of our patients above all others and avoid conflicts of interest and financial entanglements." 

So a liberal academician favors a minimalist approach in diagnosis to promote both savings and quality, no doubt to support his vision of universal care.  I'll bet Dr. Stephens won't take the rap for an FP who misses an asymptomatic, NSAID-induced renal failure, or an internist sued to the wall by the widow of a middle-aged marathon runner whose chart did not include a normal EKG.