PSRO May Doom Medical Profession


“Here, it’s for you,” I said, handing the large package to S. Q. Lapius.  He fondled the cardboard container, then measured its heft.


“It must be the book I ordered,” he said, then went to his toolbox and got a pliers, and sharp linoleum knife to try to scratch through the innocent looking tape that held the box together.  After a few huffs and puffs, he finally got it opened, and held it up triumphantly.  “At last,” he said. 


“What, at last?” I asked expectantly. 


He showed me the book.  It was entitles, “Model Screening Criteria to Assist Professional Standards Review Organizations.” 


“Beautiful,” he said.  “A living document financed by the Department of Health, Education and Welfare, directed in its preparation by the American Medical Association that may finally doom the profession of medicine as we know it.” 


He leafed through the pages.  They numbered 815, and the volume weighed four and a half pounds on our bathroom scale. 


“It is heaver than the Bible,” Lapius said wondrously.  “Here, Harry, look at the significant passages.” 


I looked. I saw.  I was conquered.  I read, “Model Screening Format for Use in PSRO Review. 




I.          Justification for Admission


A.        Failure of patient to obtain sustained relief by outpatient therapy with bronchodilator drugs.


B.        Status Asthmaticus


C.        Pulmonary complications


D.        Suspicion  of or diagnosis of associated problems complicating the management of asthma.


E.        Preparation of asthmatic patient for elective surgery.


II.         Length of Stay


            A.        Initial length of stay assignment for primary diagnosis of problem.


            B.        Extended length of stay assignment


                        1.         Reasons for extending initial length of stay


                                  a.         Failure to respond to therapy


                                   b.         Pulmonary complications (e.g. as defined by significant

                                                hypoxia, hypercapnia, atelectasis or pneumothorax)


c.                  Persistent fever of infection.


d.                  Tracheostomy


                                   e.         Adverse reactions to therapy.


III.        Validation of:


            A.        Diagnosis


                        1.  Documentation of characteristic historical features (e.g. recurrent tight chest, dyspnea, wheezing) or cyanosis


    2.         Characteristic physical findings (e.g. Wheezing and labored breathing or tachypnea with prolonged expiratory phase with or without distant breath sounds)


B.                    Reasons for Admission


1.   Wheezing and dyspnea, unimproved or recurrent without therapy (I A, B)


2.   Chest x-ray characteristic of pulmonary infection, pneumonothorax or atelectasis (1 C)


3.         Arterial blood gases characteristic of hypoxia and hypercapnia (1 C)


4.         Evidence of associated medical or surgical disease (e.g. cardiac, unfavorable reactions to medications, preparations for elective surgery)


I found that I couldn’t go on.  Lapius was snoring.  I prodded him.  “You heard this, Simon, why the haste to buy the book, why the glee to have received it.”


“Harry, old friend, I am, as you know, getting old and tired.  They don’t need me anymore.  All of medicine is now spelled out.  Isn’t it wonderful.  To find out why a patient should be hospitalized, simply look the disease up in the index and, if the shoe fits, if the criteria are there, why simply have the patient admitted.”


“But how about treatment, Simon?” I said aghast.


“Fear not, Harry, that will be in volume two.  That is if the patient has complicating miseracordia, add cherry cordial to the digoxin elixir and a dollop of whipped K-Lyte.  A pinch of salt, some basil, put in blender, and mix for three minutes.  Administer slowly; keep the oven at 98.6 degrees Fahrenheit.”