We often assume that diagnostic procedures will help patients. A lot of training goes into learning how to do these procedures. Procedures are dramatic. We like performing them. Patients are impressed, perceiving that we are “doing” something for them. Everything is awesome. However, when strict evidence-based medicine is applied to procedures, they are often less impressive. One example in critical care is the Swan-Ganz catheter, which has generally failed to demonstrate meaningful improvements in patient outcome (despite valiant attempts to prove benefit). Likewise, the usefulness of bronchoscopy for pneumonia has been disappointing in patients without substantial immunocompromise.

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