As societal desire to bend the health care cost curve mounts, there is increasing attention to determining the appropriateness and value of clinical interventions. Procedures and other types of tests performed in settings not deemed appropriate by relevant professional societies raise concern about low value and unnecessary spending.1 It is postulated that the magnitude of inappropriate use is such that reduction of low value care and elimination of no value care could lead to a marked reduction in overall health care spending. In this context, the study reported in this issue of JAMA by Liu and colleagues evaluating the provision of anesthesia care for low-risk patients undergoing colonoscopy and endoscopic procedures in the United States deserves careful consideration.2
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The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Can the Clinical History Distinguish Between Organic and Functional Dyspepsia?
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