If You Do, Or If You Don't....2/6

Enough traffic has come back on the ER/CT issue that it gets its own post. One video tracker lists the 'reports' that are on the news channels. I solicited the following from some of those in the field:

Years ago, it was often said that radiology and lab was used to "rule out" this or that ailment because the doctor's didn't know how to make a clinical diagnosis. As a kid, I had right lower stomach pain and the family doctor did a simple blood test, pressed on the area that was hurting and told my parents to get me to the hospital ASAP and the surgeon would be waiting to take my appendix out. Today, it's lot's of lab work, plus a CT and then surgery. I think we can thank in large part of this particular dog and pony show to trial lawyers for driving up the price of a simple diagnosis. That's a whole different topic for another time!

On the plus side, CT has eliminated so many x-ray studies I couldn't count them. The numbers must be huge. Plus, the difference in radiation dose in a minimally invasive CT versus an angiogram (name your study) has to be significantly lower. And, many of these exams are performed on an outpatient basis eliminating lengthy hospital stays while recovering from such procedures. The diagnostic results are far, far superior to the "old" methods and techniques once touted as leading edge technology.

In a nutshell, CT may be over used by some physicians as a CYA defense, but on the whole, it's such a valuable tool that it has become the standard of care in medicine.

And:

CT is a great thing. It lets us see into areas of the body that "the sun don't shine". And that's good. However, the over-use of radiation in any form is not. If you go into the ER, and I mean virtually any ER, and you have a cold, headache, miscellaneous pain, or trouble with your bowels (too active, or not enough), you will have an X-ray, and/or a CT. And, if you go there the next day, or a week later, the likelihood is that you will get the exact same treatment.

It doesn't mean that the treatment you will receive is bad, it just means that an emergency room is for EMERGENCIES. So, that's why you are directed to follow-up with your family physician. Without knowing you, the ER performs the same general screening time after time.

Last:

All xrays and lab tests are overused in the ER. I know this because I have a good friend who is a board certified ER doc and he would tell you: ER docs are the whores of the hospital. They are hired to do the dirty job that staff physcians don't want to do (ER coverage) but when the fecal matter hits the rotating blades, the staff docs won't hesitate to let the ER docs hang in the wind. So to cover their bottoms, they order more lab and xray, CT, etc than they really need, because it all comes down to our lawsuit happy society. CT is a great tool and it is over used, but it's either that or lawsuits every day and no more ER docs to cover.

Links to further reading:
Consumer Reports
The Washington Post
US News and World Report
Wellness.com
Common Good
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