• Michael B Weinstock, Amal Mattu, and Erik P Hess.
• Department of Emergency Medicine, Adena Regional Medical Center, Chillicothe, Ohio; Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio.
• J Emerg Med. 2017 Oct 1; 53 (4): 583-585.

BackgroundThere is a wide variation in practice patterns among emergency medicine physicians; many factors weigh into the medical decision-making process including the health of the patient as well as short-term risk to the physician.ObjectiveThe objective of our discussion is to illustrate specific scenarios where medical decisions are focused on the physician's short-term risk, then to propose an approach to shifting the balance to the patient's long-term health.MethodsUsing recent data on the evaluation, disposition, and outcomes of patients with low-risk chest pain in the emergency department, we calculate the risk of outpatient evaluation compared to the common practice of admission or observation.ResultsPatients with low-risk chest pain and negative initial evaluation in the emergency department with 2 normal cardiac biomarkers, normal vital signs, and non-ischemic, interpretable ECGs, have an extremely low-risk of a short term clinically relevant adverse cardiac event. There is a suggestion of a higher patient risk from admission, prompting consideration that continued evaluation of the chest pain as an outpatient may be safer than admission or observation.ConclusionA test/intervention should be done if the risk of a missed diagnosis or adverse outcome is greater that the risk of the test/intervention. Involving the patient in the decision-making process may help to shift the management balance from the physician's short-term concern of their own risk, to the patient's long-term health.Copyright © 2017 Elsevier Inc. All rights reserved.

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