>I can't answer that without research. I'm sure some require tests for verification, but it should still be the doctor's call or do you disagree? If not the doctor, who do you think is the best person to make that decision?
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>OK, if it is the doctor making the decision then why is the US physician's decision to test left right and center immediately seen as superior in this case, especially when the outcome boiled down to "keep taking the pain pills?"
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>People have this idea that physicians want/need to be autonomous gods. Actually all evidence is that physicians appreciate guidance from credible sources, preferably on difficult rather than obvious topics. I know this leads towards the "cookbook medicine" FUD and there are problems with treatment protocols, not least because they tend to pop up in areas where there is little dissent such as adult acute respiratory or fractured neck of femur rather than more difficult topics. But there's nothing wrong with evidence-based care. For example, if somebody has all the clinical and biochemical signs of gout, how often should you CT? Twice a year? Once a year? Once? Never? What if the answer is "never"? What if elderly women all over the US are having annual CT scans at a cost of a billion $ when there is absolutely no evidence that it does a shred of good? Why wouldn't physicians, public and administrators want that $ freed up for use elsewhere?
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>My point is that "excellent care" isn't a matter of ticking every box on the order sheet. "House" is an extreme example but when I trained, being a canny diagnostician was a huge driver. A physician who winkled out a diagnosis and then ordered the single test to confirm it rather than using a blunderbuss was a hero/ine. Perhaps the UK physician in this case was such a heroine and rather than scoffing at her, the writer should be asking how you can get that sort of parsimony back into fashion.

How do we know she was prescribed NSAIDS and not Colchicine or steroids?

I think that the symptoms determine what tests to run of course. You are asking me ridiculous questions now. Should every person suffering arthritis take those tests every year? That is a ridiculous question. If someone shows up with a very swollen arm and severe pain though then it is realistic if all other possibilities have been ruled out. How do we know it wasn't a simple arthrocentesis test? How do we know her arm wasn't swollen until it looked like a balloon (some gout does that, but then as a doctor, you know that)?