I am in Iowa to give Grand Rounds today.  Last night I had a wonderful time at dinner with several University of Iowa faculty – both inpatient and outpatient physicians.  One person there happens to be the author of a classic diagnostic textbook – DeGowin’s Diagnostic Examination [Paperback] – he is Dr. Richard LeBlond (using his name with his permission).  So not surprisingly I asked the group the question I posed last week.  Dr. LeBlond was unaware that physicians ordered orthostatics.  A teaching hospitalist opined that sometimes his residents order them, but do not follow up on the results.

As you can guess, because I am writing this post, the group agreed with my position.  As I have thought about this issue for the past week, I have remained confused.  One student or resident called orthostatic measurements scut work.  When I was a student and resident, scut work was drawing our own bloods and carrying them to the lab.  Doing our own gram stains was not scut work – we learned something that could help the patient.  Starting IVs was generally scut work.

lf we do not do our own history and physical examinations, then I wonder what our role becomes.  I thought we made diagnoses through H&P and appropriate use of tests.

As I often say (not original though), when in doubt go to the bedside.  I love discussing patient problems at the board, but sometimes you have to talk with the patient and examine that patient.  That will never be scut work.

Dr. LeBlond (who studies these things) assured me that the presence of orthostatic hypotension (or even orthostatic tachycardia) does give very useful information.  I believe him.