CT’s in the ED

Two posts on the topic:

From TimeRoundtable: Can We Reduce CT Radiation In the ER?

Last week, the Medical Insider column explained why doctors have so much trouble managing patients with abdominal pain in the emergency department (ED). Not least among the challenges: the multiplicity of causes of belly pain, the lack of clarity on which tests and treatments are best for which patients, and high cost.

This week we sought solutions — both to these issues and to the questions that readers submitted on TIME.com’s Facebook page over the last week. We put the matter to a roundtable of medical experts — all of whom conduct research or practice emergency medicine first-hand — and what ensued was a lively conversation, an edited version of which appears below.

From The Central LineWhy H&P When You Can Just CT?

Dr. Centor is at it again, with more bashing of the Emergency Department, this time because we order too many CTs. He cites this great study, by my friends/colleagues Jarone and Jonathan at my own institution, showing that CT imaging has risen in our own ED over time. And why has use of CT gone up? According to Dr. Centor, an academic hospitalist, it’s due to (his words, not mine):

  • Emergency physicians practice in the “fog of war”.
  • It appears that too often CT scanning takes the place of a careful history and physical examination. This can occur when the emergency physician is drowning in patients.
  • I believe that emergency physicians need more inpatient experiences to better understand the natural history of disease.

Okay, first, Fog of War. I like this. I agree. We are, I’d argue, the only physicians who are really comfortable managing the acutely ill undifferentiated patient. You never know which way a case is going to go, you never know what the labs are going to show, so you make sure you have that 2nd line, and you change your pathway as things develop. The Fog of War is lifted once you get your workup done (that’s called hindsight bias).

But these two other points? Wowzers.

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