“I practiced defensive medicine today.” An ER attending gives just one example of what happens thousands of times per day in every ER around the country (emphasis mine):
An hour later, I asked that my senior resident check in with me regarding the young man with the broken jaw. He explained that they had obtained a CAT scan of the jaw at the request of the oral surgeon, and “since they were there,” also obtained a CAT scan of the head and neck. I asked, “Why?” and the answer was one I have become accustomed to: “That is what everyone else does.” My usual repeat, “But why?” was met with the common words, “Well, if we missed it, we would get sued.” Of course the test results were all normal.
The attending trauma surgeon examined the patient. He insisted on an abdominal CAT scan and a spine service consult. His reasoning was that this man had a broken jaw and that with this distracting pain one could not exclude other injuries. I argued in vain. I described that it had been more than 30 hours and it was hard to imagine that he had any unrecognized serious injuries. But I could not provide a guarantee. The abdominal CAT scan was performed and was normal.
The spine specialists recommended an MRI of the neck because they would not assume the liability of a potentially rare ligamentous injury. I responded that this seemed ridiculous and almost beyond imagination. The trauma and spine surgeons insisted.
I then asked my colleagues whether they would be satisfied if I wrote in the chart that I would assume liability for this patient. They both quickly agreed. Our patient’s testing was halted, and he was discharged home with the follow-up he needed.
(via RangelMD)
