Tuesday, June 19, 2007

On Radiation Risks and What's Appropriate

Although I've commented on this before, it's good to see that others are taking notice about the potential problems with excessive use of diagnostic imaging.

But I take issue with this part of the article:
There are several steps patients can take to protect themselves, and they should not be shy about asking questions, doctors and other experts say.

“They can always inquire of the referring physician, ‘Is this test necessary?’ ” said Richard Morin, chairman of the radiology college’s quality and safety committee, adding that “exams are often done for reasons that are not quite appropriate.”

Doctors should be familiar with the radiology college index of appropriateness criteria, which rates the imaging procedures for some 200 medical conditions. Dr. Morin suggests asking the doctor ordering the test about its rating for a given condition.

Scores range from 1 to 9, he said, and “if the number turns out to be 1 or 2, you should look for some other exam.”
Whaaa? Wow, I learned something new... I now have to remember the contents of a 22-page document to see if a test is appropriate or not. I even learned there's a downloadable PDA version of the software, just to make it easy! So watch out docs, patients now might be asking you to consult your PDA while writhing in pain from an acute abdomen: "Gosh, is it acute appendicitis or a kidney stone? Let me check my handy PDA to see if I need to order this CT scan. Gee, there it is! Hot damn, he's a 9 on my handy-dandy xray scale! Okay, Wilma, take him away!"

But "appropriateness" for a test is in the eyes of the beholder. Just ask any emergency room doctor versus the obstetrician selecting a screening test for a preganant mother - each have a different take on the short- and long-term liability risks of such tests. And just for the record, I've never seen an ER doctor whip out his PDA to make such a decision about the "appropriateness" of a radiological test - especially when he's under an ever-mounting pressure to see more patients in less time while trying to never miss a diagnosis for fears of significant liability retribution.

-Wes

1 comment:

Vegan Doc said...

Interesting now that we have cardiac CT which can rapidly "rule out" CAD. It's a lot of radiation, and potentially could be overused.