Comments on: The decision not to test is often the more difficult choice

By: Heather

Heather — Thu, 19 Nov 2009 17:15:04 +0000

Here in Canada the local health authorities in each province/territory decide the number of MRI and CT scans that will be performed annually based on their fixed budgets.
Across the country cuts are being made to accommodate budget shortfalls. In September, the Vancouver Island Health Authority (VIHA) in British Columbia cut their MRI scans by 20% (4,400 less) to assist with their budget shortfall of $45 million. The decision not to test is made easy by a government-run health care system but its rationing process results in more difficult choices for Canadian doctors and some deadly results for Canadian patients.

By: AK

AK — Sun, 15 Nov 2009 18:42:30 +0000

Forget about the malpractice;
10-15 minutes to talk to saavy worried parents and child about risk and benefit; Its longer if they arent educated;
Another 20 minutes (if you are lucky) tracking down the PCP, if you are even kind to do so in a busy ER. What if the PCP disagrees with you? another 5 minutes on the phone
Another 10 minutes documenting risk/benefits, full, proper neuro exam, this on paper or EMR
Ordering a Head CT: seconds; CT results come back 30 minutes later; if negative, PCP not called and pt sent home;
You could have seen 2-3 patients in the mean time.
I am not an ER doc, but the incentive is too strong to order a CT just based on time alone

By: jsmith

jsmith — Sat, 14 Nov 2009 03:50:42 +0000

What the heck wins the best comment award.

By: what the heck

what the heck — Fri, 13 Nov 2009 19:05:17 +0000

The more fundamental question is this: why is an asymptomatic patient in the emergency department?

By: jsmith

jsmith — Fri, 13 Nov 2009 01:46:05 +0000

I thought standard guidelines (New Orleans, Canadian, etc )do not recommend CT in these cases. What am I missing?

By: Anonymous

Anonymous — Thu, 12 Nov 2009 17:40:27 +0000

If cost is not an issue, get an MRI.

By: andrew tang

andrew tang — Thu, 12 Nov 2009 17:26:50 +0000

I wouldn’t say it creeps, I’d say it lunges. “Defensive” medicine” is a large and still relatively unrecognized cost in healthcare today. Until this is adressed in some rational way, costs will continue to climb.

By: Michael Rack, MD

Michael Rack, MD — Thu, 12 Nov 2009 17:10:05 +0000

not ordering a CT scan of the brain isn’t too difficult of a decision- you can always discuss with the patient/parents that the radiation risk outweighs the possible benefits of a CT scan. But what if a MRI machine is available and the patient asks for an MRI?? Then cost/rationing come into play.

By: Michael Kirsch, M.D.

Michael Kirsch, M.D. — Thu, 12 Nov 2009 14:01:44 +0000

I agree that cost is not a factor as the physician will not be enriched by ordering the CAT scan. However, in cases like this, I suspect that the medical malpractice issue creeps into the decision process.