It’s the best way to help curb the rampant ordering of these tests. Unfortunately, we aren’t doing a very good job.
In a study from the Annals of Emergency Medicine, most patients underestimate their risk from radiation.
When asked to compare the amount of radiation from a CT scan to the amount that Hiroshima survivors were exposed to,
… half [of patients] said they had very little faith in the comparison between Hiroshima survivors and patients who had CT scans, rating their agreement at 13 on a scale from 0 to a perfect 100.
The majority of patients also tended to disagree that the scans would up their cancer risk. And three-quarters underestimated the x-ray radiation from a CT scan compared with traditional chest x-rays, which are at least 100 times weaker.
A government study says that CT scans done in a single year can potentially cause about 29,000 and kill 15,000 Americans. But these macro numbers resonate very little in the setting of an emergency department, or in a primary care office.
Although it’s getting better, there is significant more publicity aimed at a missed diagnosis from not ordering a scan than there is from cancer stemming from CT scan radiation.
And, as the chief investigator of the Annals study notes, “when [patients] go to the emergency department, they’re not really happy if all you do is speak to them; they want more.”
The best we can hope for is to explain to patients the risks and benefits of ordering such scans, and together come up with a shared, informed decision. Of course, our health system isn’t set up for such conversations. There is much more incentive — from a reimbursement, malpractice, and customer service standpoint — to simply order the test.
Until those incentives change, it’s unlikely that studies like these will make a significant impact in physician ordering patterns.