Tuesday, May 12, 2009

So Thats What Obama Was Talking About...

A 13 year old boy was transferred to our trauma center yesterday for neurosurgical evaluation. He fell off the back of a golf cart and suffered a skull fracture with a small amount of bleeding in his brain. The docs at the outside hospital did a great job copying his chart and burning a CD with all of his cat scans. When he arrived I paged neurosurgery. Just as I was expecting....they wanted a new cat scan of his head and neck before they saw him. I explained to them he had a CD with his scan from 2 hours ago that was perfectly fine, plus there was no need to radiate a child unnecessarily. They balked at this, said they needed one to be able to look on their computer system whenever they needed, and said they would not see him until the scans were done. So after much debate....a couple thousand more dollars in tests and more radiation was eventually ordered.

Yesterday policy makers announced a new plan on health care reform that is aimed to reduce wasteful spending. One way proposed to do this is to eliminate ordering duplicate or unnecessary tests. This was a great example on how we waste money in medicine. I am all for this kind of reform....but its going to take way more to make a big impact on health care. I think we should also start with end of life care....but we will save that for another day

-ER Doc


SeaSpray said...

If I were that child's parent and I knew he was getting, excessive needless radiation...I'd be angry.

If it was for life saving purposes...do what you have to do... but convenience or CYA... just wrong.

Of course I am not a medical person... but I have read where children are more susceptible to the effects of radiation. No one knows if he will need another head ct in the future and so WHY subject him to radiation..needlessly? It can have a cumulative effect on the body.

Mel said...

If they don't do another CT, they can't bill for it. Clearly it was necessary.

Anonymous said...


Unless the Neurosurgeon owns the CT scanner(very unlikely in the ER/Hospital setting) he won't make any money off the CT scan itself. He'll get 2 points credit on his H&P or consult note which he could get off the CD one anyway.

So financially the extra CT is worth nada to the Neurosurgeon in normal cases here.

I think his stated reason is probably his real reason. He wants to directly compare images without having to load the images off the CD(possibly done on different software so unable to load it into the system). Is it a waste of money? Sure. But I do understand the desire.

And no,I am not a radiologist, neurosurgeon, or orthopedist.

Me said...

"I think we should also start with end of life care"

My father in law is an aging hematological pathologist and talks about this from time to time. He thinks it's ridiculous the amount that is spent to prolong a terminal patient's life by a few days.

Carol said...

So.... explain to me please exactly how Obama would have magically prevented that second CT?

Is he going to get a law going that says a neurosurgeon must operate on a kid with a CT from another facility as long as the CT is less than a couple of hours old or the surgeon will get a spanking?

I think you've made a spurious connection.

The surgeon wanted a right-then-CT. Even if your hospital and the outside hospital had electronically linked med systems, there's no reason to assume that the surgeon would have been OK with a CT from another source when he was about to chop open a kid's brain.

Anonymous said...

I am all for saving money but as a nurse at a neuro hospital cant tell you how many transfers from other hospitals we got with a bleed and scanned them and nada! their scanner was old and detected a shadow that wasnt there

Nursey said...

The same with dental x-rays. Within three days I went to three different specialists - general dentist, dental surgeon, and additional denist - for the same broken tooth. They all insisted on new xrays, despite my having xrays with me. Of course, I had to pay for each new set. Craziness.