The pointless end-of-life CT scan

Chris Rangel wonders why he’s ordering a CT scan on this 95-year old:

Physicians are trained to do react to symptoms with tests and treatments and to proceed in this direction until a cure is achieved, the problem resolves, comfort is attained, or a terminal/incurable condition is found. But this 95 year old had dementia, diabetes, hypertension, and unexplained anemia. I was in a gray zone here. Was being 95 and in poor health enough to consider this a ““terminal condition”?

The other parts of this problem of “do everything” medical care is the lack of restrictions on test ordering (the lack of a “stick”) and the presence of motivational factors like patient/family expectations and so-called defensive medicine (the plethora of “carrots”). For the physician, patient, and family there are few downsides to ordering tests that are noninvasive and relatively harmless. But we don’t practice in a vacuum. The real harm is to the system that must sustain an enormous amount of unrealistic and often unnecessary and pointless spending.

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