In the April/May 2013 issue, there seems to be a disconnect between Editor-in-Chief Dr. Robin Brey's thoughtful comments (“Choosing Wisely”) and the article “A Lot of Nerve.” If the United States is to achieve health care reform, informed judgment must determine what tests are appropriate. To use the case described as an example of good clinical judgment—wherein extensive testing is provided for an 85-year-old patient who is unconscious and with fixed, dilated pupils—is to send the wrong message, in spite of the fact that the outcome for this particular patient was favorable. This is a dilemma we all face, as patients and doctors: either to foster a system that is affordable for as many people as possible; or to promote the most advanced system attainable with modern technology. I'm not sure we can have it both ways.
Ray Hippchen, M.D.