Clinical Problem-Solving: How Sure Is Sure Enough?

To the Editor: In "How Sure is Sure Enough?" (March 5 issue),* a 40-year-old woman is described as if she had been admitted to the hospital because of sharp left-sided chest pain before any diagnostic efforts were undertaken in the physician's office or the emergency room.The value of the exercise in clinical problem-solving would have been increased had the evaluation of the patient begun in an outpatient setting. The exercise could have been structured so that hospitalization occurred only after sufficient information had been obtained to justify a reasonable suspicion of a myocardial infarction, unstable angina unresponsive to outpatient . . .