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Differences in Diagnostic Approach Between Family Physicians and Other Specialists in Patients with Unintentional Body Weight Loss

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Abstract

Background. Unintentional weight loss is a diagnostic dilemma with diverse diagnostic possibilities for physicians.

Objectives. Our study focused on the evaluation of differences in diagnostic approach between family physicians and physicians in other specialties.

Methods. Outpatients who visited National Taiwan University Hospital from January 1996 to December 1996 with unintentional weight loss of 5% or more within 6 months were recruited by a computer search. All data were obtained from a structured medical record audit.

Results. There was no significant difference in the utilization of common diagnostic laboratory tests between the two groups. However, other specialists ordered more carcinoembryonic antigen tests (P < 0.01) and hepatitis B antigen tests (P < 0.05), but fewer upper gastrointestinal tract barium studies (P < 0.05) than family physicians. For patients without a definite final diagnosis, the diagnostic total costs for laboratory tests and imaging studies were lower for family physicians than other specialists (P < 0.01). For patients with biomedical disorders, the diagnostic cost was not significantly different between the two groups. For patients

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Description and Recognition of an Out-of-Hospital Cardiac Arrest in an Emergency Call

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The first link in the chain of survival,1 early call, includes the dispatchers’ recognition of a cardiac arrest. It takes a relatively long time for the emergency medical dispatcher to recognize a cardiac arrest. In Seattle, the average recognition time from the start of the call to the start of cardiopulmonary resuscitation (CPR) instructions is 75 seconds. Factors contributing to no or delayed recognition of cardiac arrest include vague description of breathing and agonal breathing, unnecessary questions, and little experience in call taking.2–5 As a result, dispatching may be unduly delayed, the wrong level of ambulance is sent, and no telephone CPR instructions are offered.6 Current guidelines call for CPR in unconscious patients when breathing is not normal.7 A similar rule is applied in dispatcher protocols to recognize a cardiac arrest for ambulance dispatch and telephone-instructed CPR. In 1986, Eisenberg et al8 suggested almost 100% sensitivity when those questions were asked to identify a cardiac arrest. However, this was never confirmed by other studies....

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