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.
Asthma
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.
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)
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.”