In reply

Abstract

I thank Dr. Schwartz for his thoughtful correspondence about the 2009 update of the “2007 Model of the Clinical Practice of Emergency Medicine.”1Perina D.G. Beeson M.S. Char D.M. et al.2009 EM Model Review Task ForceThe 2007 model of the clinical practice of emergency medicine: the 2009 update.Ann Emerg Med. 2011; 57: e1-e15Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The model was born out of a collaboration between emergency medicine stakeholders, ABEM, ACEP, SAEM, CORD, EMRA, and the RRC-EM and was built with practice analysis data. The model describes the breadth of practice of the specialty of emergency medicine, as well as defining physician tasks inherent in practice. Since first being published in 2001, the model has periodically undergone an extensive review process by the abovementioned organizations to ensure that it continues to remain current and relevant. Dr. Schwarz noted a significant omission in the model because he finds no mention of radiology or diagnostic imaging in the most recent revision. He observed that knowledge of appropriate use and interpretation of diagnostic imaging tests is a basic skill for emergency physicians. I could not agree more. Indeed, the model task force believed this was such an important skill that it is listed under diagnostic studies in the physician tasks section, where it is specifically mentioned as selection of the most appropriate diagnostic study and interpretation of radiographic tests. Appendix 1 also contains diagnostic and procedural bedside ultrasonography as an essential procedural skill for the practice of emergency medicine. The model of the clinical practice of emergency medicine is a 3-dimensional description of our practice. The model has multiple components, including the matrix and listing of conditions and components, which are meant to be integrated to fully describe our practice. The matrix includes physician tasks (or steps) integral to practice. All tasks are considered and performed simultaneously when caring for patients. Each task may alter the direction of patient management, depending on the outcome of that task. Radiographic imaging is included as part of the “Diagnostic Studies” section in Table 1, which includes physician task definitions of the model. This component task should be considered in every patient encounter. Whether a physician decides to use imaging or not for a specific patient encounter, consideration of the appropriateness or need for radiographic imaging is an essential part of ultimately arriving at a diagnosis. If imaging is ordered, review and preliminary interpretation of the radiographic image is included as part of the definition of this physician task. The initial inclusion of this task in the original “Model of the Clinical Practice of Emergency Medicine,” as well as in all subsequent revisions, including the most recent 2009 version, underscores that emergency physicians should understand the indications for diagnostic imaging and be able to make preliminary interpretations of such studies in the clinical practice of emergency medicine. Diagnostic Imaging and the Clinical Practice Model of Emergency MedicineAnnals of Emergency MedicineVol. 58Issue 4PreviewI would like to bring to your attention a significant omission in the recently published 2009 update of the “2007 Model of the Clinical Practice of Emergency Medicine.”1 There is no mention of radiology or diagnostic imaging, even though they play an important role in the evaluation of a large proportion of emergency department (ED) patients. According to the most recent National Hospital Ambulatory Medical Care Survey of ED visits, 44% of ED patients undergo diagnostic imaging tests: 35% receive conventional radiography and 12% receive computed tomography. Full-Text PDF