My colleague and I are in a dispute over Medical Decision Making with a physician.
He is part of a Pediatric Cardiology practice and is arguing that basically all his cases are level 5's. The reasoning behind it is that he feels his risk level (table of risk) is always high because the children are coming in with a presenting problem of an “Acute illness that may pose a threat to life or bodily function” (e.g.; chest pain, fainting episode, f/u of patent ductus arteriosus, abnormal EKG). He is doing a lot of testing (EKG, Holter, Echo, Pulse Ox) and is adamant that each patient is treated as if they could die from a cardiac issue, hence the high risk.
So our question is when you are determining a level in the Table of Risk, are you judging the problem after the patient has been seen and nothing came of it (chest pain, ruled out to musculoskeletal), or are you taking into account the risk involved when the patient presents (chest pain).