Last updated on January 6th, 2024 at 08:34 am
Another physician caused health problem?
For example, with an estimated 500,000 concussions a year (and an estimate cost of $5 billion dollars), 90% of whom may come to the ER, by given these patients a CT scan to detect blood in the brain, exposes perhaps 98 percent of those concussion patients without blood in the brain to needless exposure to radiation and a hefty charge as well to the insurance company or the patient. Rather than continue the status quo why not do some fairly simple research for possible alternative strategies. For example, to determine if there is a problem why not at random take 100 concussion cases coming to ER to determine if the CT scan contained blood or not? The presence or absence of blood in the brain is the only reason for the CT scan. If I am right in my projection that positive CT findings of brain blood would be 2% or fewer, then from a patient safety and cost standpoint giving every concussion patient a CT scan is unwarranted. The next step would be to devise a protocol, one consisting of a clinical neurological assessment by the ER physician and some type of brief cognitive test such as the Ruthven Impairment Assessment (RIA) or other neurocognitive test, and on the basis of the clinical and objective test data determine whether to add CT or not. If the RIA or other test diagnoses normal cognition consistent with a clean neurological examination why go ahead with CT. If there was any doubt about the decision based on the preliminary evaluation one should go ahead with the CT scan. In such a study in time one would be able to correlate the clinical and objective test data with the positive CT scans of these concussion patients. I suspects there are dozens of current health practices that result in costly and many times poor healthcare that could be changed and improved through such controlled experiments.
The safety mentioned in the above is because CT exposes the concussion and other patients to cancer causing radiation and if we are able to reduce unwarranted CT exposure we would not only save precious healthcare dollars but would save tens of thousands of lives annually.
I offered an ER the RIA without cost for clinical and research use but my offer was declined. Actually current MCOs at little cost could determine the extent to which CT, MRI and other diagnostic technology were and were not warranted. For each technology (CT and others) we want to find out the percentage of scans giving negative and positive findings, the later indicating presence of pathology. The greater the frequency of negative to positive findings the more the procedure was unwarranted in those cases. Many physicians tell me that they are aware of the great waste but they defend the practice because of the risk of a malpractice suits if the presence of a brain tumor, for example, is undiagnosed. Most PCPs make these referrals every day for these expensive procedures and these physicians do so without the necessary training or expertise to make such referral decisions. Current MCOs (with the needed expertise) should be making these referral decisions and not the individual physician and the MCO and not the individual physician would be exposed to any risk of a malpractice suit. Even though CT exposes the patient to cancer causing radiation it is an excellent diagnostic tool and worth the financial cost but let’s come up with a system to insure when these procedure are indeed needed by improving their diagnostic “hit rates” in identifying pathology and positive findings. We can only make a diagnosis through positive findings and a normal CT or MRI is worthless money wise and diagnostically because even negative findings cannot rule out all brain pathology.
In regard to the above my appeal is for the application of science to improve the quality of healthcare and to lower its cost. Unfortunately popular healthcare opinion to often drives health practices and we need the application of more science to large areas of healthcare.
