Wiki When would new problem be considered high risk in cases other than lumps, neoplasm of uncertain behavior, etc?

[wynonna]

From AMA guidelines: "A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. An example may be a lump in the breast."
When would a new problem be considered high risk in cases other than lumps, neoplasm of uncertain behavior, etc?
Does anyone in ENT have any ideas about other examples of moderate level for new problems other than the above? Deviated nasal septum, turbinate hypertrophy, tonsilitis, chronic serous otitis media and the like,--so would anyone see these as high risk of morbidity without Rx or Surgery? (Especially if pt has significant pain )
thank you

 

[csperoni]

The statement you quoted from the AMA guidelines are referencing number/complexity of problems - specifically undiagnosed new problem with uncertain prognosis. The 2021 outpatient guidelines no longer consider new problem vs established problem other than that specific example. One chronic stable new vs chronic stable established is still low number/complexity of problems.

For risk, it is really a case by case basis. Don't forget you include management options considered but not selected after shared MDM with patient/family (must be documented). It is "decision regarding" not "decision to have."
A moderate risk example for ENT could be if minor surgery options including risks are discussed, but decided against by patient.
Considering major surgery with risks is high risk.
Treatment significantly limited by social determinants of health applies to all specialties with moderate risk.
Other high risk could be a decision regarding sending patient with significant pain to ER.
For all of the conditions you listed, risk could be minimal, low, moderate or high depending on the severity and the treatment plan being decided for the patient.

Remember that oftentimes there are processes going on in the provider's head that may not be accurately reflected on the page. I have tried to stress to my clinicians that the 2021 changes are to more accurately represent their medical knowledge vs checking a certain number of boxes. Their thought process and decision making needs to be clear in order to credit it.

 

[wynonna]

thank you. Very helpful.