| December 22, 2005
So, why do surgeons ask for abdominal CT’s in patients with abdominal pain suspicious for appy?
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I asked a surgeon friend this exact question, or to be precise, why does it seem that the number if CT’s requested by surgeons to rule out appy has gone up? I was told there has been a recent rash of lawsuits for removing normal appendices, thus a reluctance by surgeons to take a patient to the OR without a CT diagnosis. SOme surgeons won’t even accept a phoned-in CT result. They require a signed official CT Report that they can hold up in court if there’s any problems. So much for an acceptable false positive rate.
also a convenient stalling tactic at 0200 am.
The hospital should have a clear policy on who should get a CT and this should be agreed upon by the medical staff and approved by administration or the hospital board in order to take the load off these poor ER docs and also to assure consistent quality care.
When one of our ED physicians called me about his own RLQ pain with a classic history, he made no bones about it — he wanted his appendix out, and had no interest in a CT. And I agreed wholeheartedly with him. I feel that CTs are overused for the diagnosis of appendicitis, particularly in males, but I suspect I am swimming against the tide.
I was called to see a 17 y/o female patient with right lower quadrant abdominal pain, leukocytosis, and CT scan findings of “early appendicitis” (I didn’t order the scan). Took her to the OR and found right ovarian cysts and normal appendix (but took it out anyway). Parents wanted to sue me for misdiagnosis. You can’t win whichever method you choose. CYA medicine does increase the cost of health care!Dr. Dagny T.
“Parents wanted to sue me for misdiagnosis.” There’s your answer. Ther is no longer an acceptable false positive appendectomy rate in american medicine. Merry XMAS to you surgeons from the American Trial Lawyers Association.
“I was told there has been a recent rash of lawsuits for removing normal appendices, thus a reluctance by surgeons to take a patient to the OR without a CT diagnosis”
Got news for ya, a “normal” or “negative” CT does not rule out appendicitis. It makes it less likely but does not rule it out.
“Got news for ya, a “normal” or “negative” CT does not rule out appendicitis. It makes it less likely but does not rule it out.”
Who cares. You won’t lose too many lawsuits if you get a normal CT Scan, I mean one where a normal, filling appendix with no CT signs of appendicitis is seen. That’s all that counts in my 5 patients an hour world.
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