Published in the February 2005 issue of Today’s Hospitalist
As a physician, you’re told over and over to think of horses, not zebras. But as a hospitalist, you treat patients who are some of the most complex in our health care system. Sometimes, the zebra really is a zebra, and not a horse wearing a striped suit.
A case in point can be found in this month’s cover story on heparin-induced thrombocytopenia (HIT). Experts say the syndrome is often overlooked, in part because it is the biggest risk in surgical patients, and not medical patients.
The truth, however, is that patients undergoing other types of surgery “most notably, orthopedic procedures “can be affected by the syndrome.
And while it’s not as common in medical patients, individuals who have been exposed to heparin even in low doses from a catheter flush can develop HIT.
For hospitalists who co-manage surgical patients, HIT is obviously an important safety issue. Miss this diagnosis, and your patient may lose a limb or die from the syndrome.
But what about inpatient physicians who are treating patients whose exposure to heparin comes solely from prophylactic therapy or catheter flushes? HIT is certainly less common, making a diagnosis of the syndrome not only less likely, but more difficult for hospitalists.
No physician wants to give a potentially devastating diagnosis like HIT without being sure. You don’t want to upset the patient, and there are cost considerations of aggressively ordering lab tests or keeping a patient in the hospital for a few extra days to confirm a diagnosis that isn’t exactly common.
As hospitalists, you’re charged with both making patient care more efficient and paying attention to patient safety issues. Because HIT can be such a debilitating condition, even if it is not something you see every day, it makes you choose sides.
I hope this month’s article gives you some perspective on when to suspect HIT, and how to confirm the diagnosis. Particularly for the complex medical patients that are the hallmark of hospital medicine, it can be a tough call.
Editor and Publisher