Comments on: Why the unnecessary CT scans? http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Cedric http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-108437 Cedric Fri, 24 Jul 2009 17:35:48 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-108437 So how much does defensive medicine add to health care costs? Or will we never know? So how much does defensive medicine add to health care costs? Or will we never know?

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-90727 Anonymous Mon, 06 Apr 2009 18:53:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-90727 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)?<br/><br/>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... 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…

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-83861 Anonymous Wed, 27 Feb 2008 19:13:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-83861 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. 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.

]]> By: Diora http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82513 Diora Fri, 04 Jan 2008 19:43:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82513 <i>Risk of cancer to patient(Small but frightening)<br/>Risk of missed diagnosis for patient( small but significant)<br/></i><br/>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.<br/><br/>"I would also argue that patients often WANT testing. "<br/>Some patients do. This one doesn't. <br/>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. <br/><br/>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? <br/><br/>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? 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?

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82508 Anonymous Fri, 04 Jan 2008 16:06:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82508 "radiology seeking" patients<br/><br/>I Love it! “radiology seeking” patients

I Love it!

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82505 Anonymous Fri, 04 Jan 2008 06:32:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82505 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82503 Anonymous Fri, 04 Jan 2008 05:08:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82503 For you pinhead lawyers,<br/><br/>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.<br/><br/>I have had several bogus lawsuits. They suck. Why would I invite another if I had a chance to mitigate it?<br/><br/>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.<br/><br/>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 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

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82502 Anonymous Fri, 04 Jan 2008 03:35:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82502 My doctor said I had heartburn and gave me antacids. It was a heart attack.<br/><br/>Scumbag bottomfeeder made them pay.<br/><br/>That commercial runs in my area. Over. And over. And over. And over. And over. And over. And over.<br/><br/>Day and night.<br/><br/>And you wonder why the docs order the extra tests. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82500 Anonymous Fri, 04 Jan 2008 02:58:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82500 >>How much more likely is it?<br/><br/>37.345%<br/><br/>I channeled that number from John Edwards. >>How much more likely is it?

37.345%

I channeled that number from John Edwards.

]]> By: DDx:dx http://www.kevinmd.com/blog/2008/01/unnecessary-ct-scans.html/comment-page-1#comment-82498 DDx:dx Fri, 04 Jan 2008 02:43:00 +0000 http://clients.emmense.com/kevinmd/2008/01/why-the-unnecessary-ct-scans.html#comment-82498 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.<br/>Risk to doc of lawsuit. (Small but perceived as huge)<br/>Risk of cancer to patient(Small but frightening)<br/>Risk of missed diagnosis for patient( small but significant)<br/>Balancing these well in a state of fear is impossible. So let's keep pounding the lawsuit drums.... 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….

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