For starters, not ordering a CT scan is more likely to have negative repercussions for the physician:
The cancer caused by a CT scan doesn’t generally show up for decades “” and there are all sorts of other intervening reasons why a patient would develop cancer “” so no one is too scared of getting sued for ordering a CT scan. Getting sued for not ordering one is more likely.
{ 13 comments… read them below or add one }
How much more likely is it?
Kevin is right that not getting a test also has dangers for not only physician, but patients as well. I found a good source from UC San Diego that talks about radiation exposure and equivalent risks. Getting a chest X-ray is about as much radiation exposure as flying coast to coast round trip. A CT scan is almost 200 times that radiation exposure. However, the risk of a CT scan is about as dangerous as driving 20,000 miles in a car (my annual commute) or smoking a pack of cigarettes a day for a month. Not a neglible risk, but not a horrific risk either; and likely outweighed by a missed diagnosis. If your doctor recommends a CT, do ask why he or she thinks it is necessary, but don’t delay because of a potential cancer risk.
http://irb.ucsd.edu/RadiationEquivalents.pdf
“How much more likely is it?”
Dumb question: It doesn’t matter.
If physicians are doing it to avoid liability, why is it dumb to ask how much more likely it is that they’ll avoid liability as a result of doing it?
I would think that would be the first question anyone would ask before taking an action to minimize risk - does it work?
People, physicians and patients are horrible at understanding risk. We get the 6 weeks of statistics in 1st year of med school, but then go on to treat the last clinical disaater we have in our memory….So, the question about risk is relevant, but will undoubtedly be ignored, because we are talking about risk to two different entities.
Risk to doc of lawsuit. (Small but perceived as huge)
Risk of cancer to patient(Small but frightening)
Risk of missed diagnosis for patient( small but significant)
Balancing these well in a state of fear is impossible. So let’s keep pounding the lawsuit drums….
>>How much more likely is it?
37.345%
I channeled that number from John Edwards.
My doctor said I had heartburn and gave me antacids. It was a heart attack.
Scumbag bottomfeeder made them pay.
That commercial runs in my area. Over. And over. And over. And over. And over. And over. And over.
Day and night.
And you wonder why the docs order the extra tests.
For you pinhead lawyers,
If the risk of ordering the test to me is zero. And the risk of not ordering it is 10%, 1%, .1%, .01%, or even .0001% if I see 5000pt/year then that is all the incentive I need to order the test.
I have had several bogus lawsuits. They suck. Why would I invite another if I had a chance to mitigate it?
Don’t blame docs for tthe cost, that is the way the system is set up. Now if you want to change the system somehow then maybe I will take more personal risk. For instance pay me a financial incentive NOT to order the test and rely solely on clinical judgement. But in that scenario we would be demonized even more.
The whole problem (besides ambulance chasers) is the relegation of health care by third payers. The individual consumer should pay for their health care and take the judgment of their doctor and decide there own risk
I would also argue that patients often WANT testing. People like technology, and they feel good when doctors order tests. I’ve had far, far more patients come in to see me who are radiology-seeking than are drug-seeking. Couple patients’ desires for tests with the doctors’ desire to avoid lawsuits… When you do miss something as a physician, and you have the patient on the stand saying, “I TOLD them I wanted a Cat Scan. . .!” Bad situation.
“radiology seeking” patients
I Love it!
Risk of cancer to patient(Small but frightening)
Risk of missed diagnosis for patient( small but significant)
Shouldn’t the second sentence read “benefit of not missing diagnosis” rather than “risk of missed diagnosis”? This difference is significant: not every missed diagnosis makes a difference, occasionally “early diagnosis” really represents overdiagnosis i.e. something that wouldn’t become apparent in person’s lifetime. In this case finding something actually harms the patient by subjecting him to unnecessary treatment that may have serious, even life-threatening side effects.
“I would also argue that patients often WANT testing. “
Some patients do. This one doesn’t.
I’d also imagine that patients who have high deductibles or need to pay a certain percentage of cost rather than fixed copayments would like to know how likely is an ordered test to benefit them.
One question I am always curious about. If a) probability that a test benefits the patient is extremely low b) the patient pays out-of-pocket c) if the patient had known about the answer to a), he’d refused the test, how is your ordering the test without disclosing the likelyhood of test’s benefit to the patient different from stealing?
One last thing. I recently got a flier from a newly opened radiology lab. The flier offered a package of three NON-recommended imaging tests for $X, described in scary terms the conditions the tests may detect, but didn’t say anything about tests not being recommended for symptomless people or the risis of tests. Why is this not considered fraud? Where is defensive medicine here? Wouldn’t ads like this cause patients to ask their doctors about these tests?
Lets just hope this is not reminiscent of the early days of tobacco in which EVERYONE said it was not dangerous. I think too much radiation is dangerous…..just use common sense.
If someone things that it is not dangerous, that the benefits outnumber the risks, etc… would they recommend one to their son for the reasons that I got 3 done (a kidney stone and a UTI)?
Aren’t they worry that with this mentality some other selfish/irresponsible doctor will recommend a CT scan to their future wife or son in law (which they still can’t protect yet). What goes around comes around…