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Short Stay Management of Chest Pain

      When I was a medical student, a common debate among us was, “Is medicine a science or an art?” The more enlightened of us thought it a combination of the two; unfortunately, we were wrong. Medicine is a business. Although there may be some scientific basis for what we do and a lot of art in the practice of medicine, the bottom line is what rules. The days of admitting patients to the hospital for a week to rule out a myocardial infarction (MI) are long gone. Hospital administrators are pushing for shorter and shorter stays, regardless of whether we make the diagnosis, educate the patient, or begin therapy. Modern technology has replaced experience and gestalt. Missed MI accounts for the single highest malpractice award; every juror knows that chest pain equals MI. The population is aging, people are more obese, glucose and cholesterol are rising, coronary arteries are closing, emergency departments (EDs) are filling up, and people are dying.
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