Anyway, no one mentioned VQ lung scans in nuclear medicine in the CT vs MRI controversy. In the data I’ve seen, nuclear has a slight edge in terms of sensitivity for finding PE over CT (the new 64 slice spiral CT might have improved on the sensitivity). Also, the radiation dose is much lower with nuclear medicine (xrays vs gamma rays, at lower numbers of millirads).

I was interested in the discussion on D-Dimers, and the inaccuracy. Isn’t the d-dimer test a 98% accurate negative predictor of PE, i.e. if your d-dimers aren’t elevated, there’s a less than 2% chance of PE?

It’s easy to post any idiotic comment and pretend knowledge in this medium but there is a price for it. Your feelings might get hurt. Some will ignore you but some will expose your stupidity.
Go play doctor somewhere else.

It’s not that. It’s the know-it-all arrogance you display, all the while making an idiot out yourself trying to teach us about something you are ignorant about. Why can’t you just admit that you know nothing about CT, MRI, and the diagnosis of PE and just move on?

No you wouldn’t. You’d probably fume, maybe stamp around a little, but anyone who talks as tough as you do all the time doesn’t really want to back it up.

well, anon 11.16, I am the “patient” above and take your best shot–but I am a black belt in tae kwon do.

your reaction–and virtually all the other reactions to my post–are bizarre and really demonstrate the near pathological self-absorption of doctors.

Hit me because I threaten to sue?! Doctor, you are providing a service, just like a builder or accountant or prostitute. We have a contractual relationship. If I have to use all the leverage at my disposal to obtain what I want, why is that evil or impinge upon your personhood. It’s called the market.

As for all the other doctors who stated I recommend MRI for PE–I did nothing of the sort. Only asked why MRI could not be used in PE–an idea that occurred to me given my own experience in which both modalities were acceptable (which as the article I cite is true for numerous conditions). Well, I suppose any health care customer who threatens physicians’ fragile little egos must face their mob-like wrath.

If the whole issue was simple and easy it wouldn’t take 4 years of medical school and 3+ years of indentured servitude residency training to practice medicine.

It seems to me, If the only alternative is to miss cases of PE, CT’s should not be deemed “unecessary” simply because the result is negative.

To what level must the index of suspicion rise before you order one?

Anonymous 11:16 PM:

Thanks for that extra bit of history, I was in fact wondering to myself “did anyone ask her about birth control pills.” Patients are not always that good at connecting dots, and she probably never considered that her anxiety could be related to a side effect of BCP – and patients incorrectly figure if something could be significant, they will be asked about it, and so don’t bring it up. Big mistake…

In her defense, in my own experience, aides who do intake frequently fail to accurately record what I tell them – and fail to ask important questions, such as meds recently taken or recently discontinued and why.

I thought it was well-settled that BCP increased the risk of blood clots in some women who use them, especially smokers and older women?

Not according to CJD and Dr. Elliot. They routinely point out how cut and dried the whole process is and how much doctors don’t know about the realities of practicing medicine. They’re the experts here, doncha know?