IN DEPTH: CT Scans and the Fear of Being Sued Comments on "CT Scans May Get Overused"
Joe Pellicer
Olympian, August 18, 2004
Last year alone, over 60 million CT scans were performed in the United States. Are CT scans overused?
It's a complex social and medical question that doctors must wrestle with in their daily practice. The answer will ultimately impact not only the cost of health care in America--and the availability of funds to treat those who cannot afford health insurance. It will also impact the health of the patients who undergo the tests, which involve significant radiation exposure.
More than a social and medical question, however, for doctors it is also a legal question--if something goes wrong in a patient's treatment, will a jury understand why a supposedly simple test wasn't ordered? With CT scans, as in other areas, a pervasive fear of being sued has become a sizable hurdle to finding the right answers--and the right balance--for our society and for our health.
Physician Joe Pellicer described his own experience with CT scanning in a recent "Notes from the ER" column for the Olympian (WA):
Sometimes we jokingly call it [the CT scanner] the Truth Machine. You put a patient into it, turn it on and it tells you what is wrong. ...
Last week, I caught myself telling a patient that we could order a simple test 'like a CT scan.' As soon as I'd said it, I thought to myself: Hold on there, while it is true that the test is easy to obtain, it is not a simple test! In fact, it is a relatively expensive, very sophisticated test that involves radiation exposure and should be used judiciously." ...
Are CT scans overused? The answer depends on who you ask: a seasoned physician or a rookie just out of residency; a legal 'virgin' or one who's been sued a couple of times. These decisions get into that difficult area of medicine densely clouded by the unfortunate status of both our medico-legal system and our lack of a viable health-care financing system.
In my opinion, based on no particular study other than my 20 years of experience, CT scans do get overused. And, yes, I would include myself in that criticism.
Whether this (possible) overuse has serious medical consequences for patients is yet to be determined. In the meantime, patients must rely on their doctors to balance the uncertain risks with the possible gains and the well-known expense. The problem with our unreliable legal system is that it forces the fear of a lawsuit into that already complex equation.
As a consequence of legal fear, doctors sometimes order tests they consider unnecessary--unneeded procedures that contribute to a financial crisis in our health care system and that, in the case of CT scans, may actually harm the patients.
In fact, the most widely cited study of defensive medicine estimates that it may account for up to $100 billion annually in excessive health care costs. And of the risk of CT scanning to patients, Pellicer writes:
We know that excessive radiation is a risk for causing cancer. A CT scan of the abdomen exposes our body to about the same amount of radiation as we would receive from natural sources during three years. All physicians would consider this a reasonable trade-off in the event of a potentially life-threatening emergency. But for greater medico-legal security?"
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