“Everyone with a headache gets a non contrast head CT”

The third part of this continuing series. A reader writes:

Two big practice patterns have emerged over the past years (especially after I was sued in 2001). I order CT scans for almost any complaint and the level of my care is more intensive. Everyone with a headache gets a non contrast head CT. Everyone with any type of abdominal complaint gets a CT scan of the abdomen and pelvis and probably a BE or colonoscopy. Even the most severely demented nursing home patients with a small bed sore gets hospitalized and aggressively treated-even surgery-to treat any decubitus. The (deleted) Law Firm has been going after nursing homes aggressively with lots of TV ads. It’s working – my partner is a local NH director and he’s involved in 3 suits now. Everyone over 50 gets to see a GI doc for a screening colonoscopy. If they refuse, I document it. I refer or work up a lot more complaints earlier rather than watching it. Example – the non smoker with a cough now gets a pulmonary work up after 6 weeks or so, rather than waiting another month or two. I order a lot more lab work than I used to, and tend to use less evidence based medicine to justify testing (PSA, TSH, genetic testing especially). Unfortunately, evidence based medicine may not be the “standard of care” for a jury.

I would estimate that the majority of the head CT scans I order are for defensive purposes (about 3-4 a week). About half of the abdominal CT scans I order are for defensive purposes (about 2-3 a week total). With the head CT scans I’m trying to rule out the rare brain tumor. I’m looking for solid organ cancers with the abd/pelvis scans – ovarian, renal, pancreatic, and carcinomatosis. Never mind that most of these people aren’t curable when they are diagnosed; I know there is some expert who’ll say I could have made a difference if I had diagnosed that pancreatic cancer 2 months earlier.

Defensive medicine is one of the leading factors in driving up health care costs today. The purpose of this series is to breathe some real-life examples into the numbers, and to provide some insight into how the threat of malpractice litigation pervades medical decision making.

Please e-mail me your stories of “how you practiced defensive medicine today”, and it will be posted anonymously as part of this continuing series.

Prev
Next