He was 70 with critical aortic stenosis and ejection fraction of 10%, coronary artery disease and history of 5-vessel bypass in 2001, a history of Stage D colon cancer with lung mets resected 18 months ago, obesity, diabetes mellitus, chronic renal insufficiency and was recently extubated after a failed aortic valvuloplasty. He later developed a wide complex tachycardia at 150 beats per minute for which I was asked to consult. The SVT looked just like his underlying left bundle branch block and would start and stop – usually with a PAC. He was administered 2.5mg metoprolol intravenously and loaded with Amiodarone. His SVT became a non-issue thereafter.
But I didn’t check his HbA1c.
I didn’t check his LDL lipid level.
I didn’t do a diabetic fundoscopic exam.
I didn’t refer him to a neurologist for his mild peripheral neuropathy.
I didn’t get him an evaluation of his footwear.
I didn’t give him an implantable defibrillator or biventricular pacemaker.
I didn’t do universal weight screening.
Instead, I just practiced medicine.
I wonder what my PQRI measure score sheet will look like? I probably won't get my 1.5% bonus from Medicare, I guess. * Sigh *
Too bad there’s no box on that scoresheet for how much money careful judgment could save our healthcare system.