Worth pondering

I saw a patient today with a sore ankle, who'd been limping four four days since an inversion. I evaluated him, applied the trusty Ottawa Ankle Rules, and decided he didn't need an X-ray. Since his joint was stable, chances were very good all he needed was rest, ice, compression, and elevation.

When I told my attending, he smiled and reminded me that the Ottawa rules were about cost-containment in Canada -- "and in our country, I can't afford not to get an X-ray."

I thought about that exchange when I read Cut-to-Cure tonight:

An older physician brought this up the other day during a discussion about liability premiums and declining reimbursement. It is a good, simple expression about the frustration many physicians feel:

"Why am I worth so little when I do my job right, and worth so much when I make a mistake?"

Damn. Something tells me I'm going to miss these care-free, evidence-based med student days. Especially if I'm ever an attending who's worth a lot.

Bard-Parker, by the way, has listed Lingual Nerve under "Group Therapy" on his blogroll. It really works, on several levels.