Pretty amazing analysis of what the horns of the dilemma are on which an emergency room physician is impaled:
If we don’t perform the CT scans and there is a fracture present, the radiology reports can be thrown in our faces as “proof” that we were negligent for not doing the scans. After all, if we ordered an x-ray to rule out a fracture, our suspicion for a fracture must have been “high,” right?
If we perform the CT scans and they are negative for fracture, non-clinicians publish studies that ED physicians are “unnecessarily” running up the cost of medical care and are causing cancer with all of the excess radiation.
Oh, and if we perform the CT scans and they are positive for a fracture, everyone asks the ED physician why he didn’t just order the CT scan in the first place.
The reason for the dilemma is that radiologist return reports that are masterpieces of ambiguity. Go to the Whitecoat Rants blog entry to see samples. It looks like everyone is playing a game of hot potato where each person is trying to make sure that the record shows that he or she is not the person responsible for making a risky decision.
And that’s the issue in a nutshell. Making a decision requires the willingness to either accept risk or spend an endless amount of money. And the price of accepting risk has become way too high. So the defensive medicine continues.
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