This is a blog about how lack of common sense leads to common nonsense in medical practice. The result is often Status Iatrogenicus, or a vicious cycle of complications, burdensome care, wasted resources, and missed opportunities. This blog aims a critical eye at various aspects of medical practice that just plain don't make sense - because the cure for common nonsense is uncommon sense.
During MICU rounds last month, there were a lot of troponins ordered, and most of them should not have been. Invariably when abnormal troponin values are reported on rounds, there is no mention of whether the patient had anginal chest pain, whether there were ischemic EKG changes, or whether this information was sought at the time the troponin was drawn. This is because troponins are being used as a screening test, rather than as a diagnostic test. "Not so!" exclaims the resident, eager to convince me that he has not engaged in the kind of mindless testing he knows I loathe. I am told that because the first troponin was mildly elevated in a little old lady with cirrhosis, overdose, right heart failure and urinary tract infection, that we need to follow it to see where it "peaks".