Case discussions

Moderator (Green room): Robert Janett, MD, Network Health
Moderator (Red room): Ted Herwig, MD, FAAFP, Chairman, New England Quality Care Alliance

This session will present patient cases that illustrate some of the decisions providers must grapple with on a daily basis. Often overtreatment occurs as the result of a cascade of well-intentioned decisions. Sometimes the decisions that lead to unnecessary care are glaringly obvious (for example, antibiotics for acute sinusitis), and at other times are more subtle (should this elderly, frail patient with a fever be admitted?). How do we find the path towards appropriate use and reduce unnecessary utilization? We welcome case studies from participants – please post them here for discussion.

Conference Cases:

Cardiology Case I
Cardiology Case II

End of Life Case

Surgery Case I
Surgery Case II


Please share additional cases for discussion below.

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A new hip for an 87 year old: the surgeon’s Siren song

April 24, 2012   Ted Herwig MD   No comments

I saw an elder gent a month ago;  his hip pain was getting worse ….  He’d seen a surgeon.

“You’ll be out of the hospital and rehab, home in 3 weeks” the surgeon said.

“You’ll be doing nothing but rehab and exercises for 3 MONTHS;   you’ll be at limited power for six months;  it will be a year to be 95%” I said.

He came in today for a preop evaluation.  Even though he’s been out mowing his lawn and doing most of what he wants, he thinks surgery will make him “better.”  He has “good insurance” and has chosen to proceed.

I’m reasonably confident he will “do well” perioperatively but I’m dubious that he’ll be “better” in the long run.

– excerpt from this afternoon’s office hours

Ted Herwig MD, family physician

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