Agree, pretty offensive statement regarding our friends in the out-patient clinics.
Imagine sitting down with a 68 year old diabetic, hypertensive, who is rather non-compliant, and isn't the sharpest tack in the shed. You have 15 minutes to convince them why it is important to take care of diabetes, and hypertension, and to come up with a simple, affordable plan that will keep them from dying in the next 5 years (or their family will probably sue you for their death).
When we see a sick patient, it is easy for us- stabilize and treat. Those in-patient and out-patient docs realize that patients can't be in the hospital forever and that there is a time to cut bait and let the patient go home. I think this out-patient business is a true art that we should never down-play.
Many serious disorders can present with disturbingly minimal symptoms initially (all pathology is a spectrum of disease, and starts somewhere). So, catching things early, yet not ordering too many out-patient lab tests, is an art that ER docs will never have. ER docs rule out emergencies. Out-patient docs are (should be) better at getting to the most likely explanation and actually improving the chances of making patients better. We tend to shotgun tests, and boot them, "Follow-up with PCP ASAP."
If you think out-patient medicine is non-stressful, you've probably never been in a truly hectic office for a significant period of time. If you have been in an extremely busy clinic, you haven't been the person responsible for moving meat, dealing with needy, vague complaints, and the all to frequent "I have 20 vague complaints that are completely unrelated (intermittent transient paresthesias in left hand, occasional blurry vision, fatigue, indigestion, abdominal pain, dyspnea, etc.) Think of all those complaints from an out-patient doc's perspective. The differential diagnosis is unending, the yeild on testing is exceedingly low, and your gut instinct is the patient is fine, but you miss something and the patient will own you. You have minimal access to testing in the office, and you are faced with the decision of how much to do. In the ER, we have basically unlimited resources, which we wantonly waste in an effort to rule out all emergencies.
Handing out z-pacs is a common practice in an out-patient clinic, because they don't have access to CBC, chest x-rays, influenza tests, etc., that we would tend to do in a patient with cough and a fever. They can waste massive amounts of money like we do in the ER, in an effort to ensure that we don't give unneccessary antibiotics, or they can just document left lower lobe crackles, normal sats, and send them home with a z-pac for community acquired clinically diagnosed pneumonia.
Even chest x-rays aren't perfect. I've seen several pneumonias this year that both myself and radiology read as normal, but a PE CT caught, and after admission, bloomed into florid lobar pneumonia.
