Let’s cut the docs a little slack because sometimes “Stuff Just Happens”.Apr 10, 2021
So about a month ago, I wrote an article about changes in radiology and gave you my view on the subject and how things have changed over my career. In that article, I wrote about how ER docs are ordering lots of tests and given the current way medicine is practiced, you can’t really blame them for doing so.
So today I’m going to expound on that premise and actually defend their position a little bit more.
To start, as technologists and radiologists, we see firsthand how many studies are actually ordered by the ER that turn out to be negative. And in some of our minds, we think that this is a travesty. “It’s over utilization! It’s unnecessary radiation to the patient! It’s unnecessary risk to the patient! The art of examining the patient is dead!”. Many of these sentiments come to mind, and I know I’m preaching to the quire here, but now let’s take a look at the situation from the point of view from an ER physician.
And let’s make this really simple, because my mind works better that way. For example, a patient comes into the ER with a bad headache. Reasonably common scenario for a head CT. Now I get headaches pretty frequently and some of them are pretty bad. But I never actually go to the ER for my headache. I generally just pop a few pills and try to sleep it off and usually by the next day, it’s gone. This is probably how most people handle things in this situation. However, when you think about this a little differently, from the ER doc point of view, if my headache was bad enough to make me drive in to the ER or call an ambulance to have them take me to the ER, that’s a different beast entirely. And it just so happens, that one of the classic medical histories that you’ll find in the textbooks for an acute intracranial hemorrhage, is where the patient states that the headache was “the worst headache of their life”. Or something like, a “really bad headache that just won’t go away”. So what is the ER physician supposed to do a this point?
Get the head CT, prove there’s no bleed and send the patient home right away or… potentially give the patient some pain medication and say go home and come back if the pain gets worse. Well, small undiagnosed bleeds in the brain from let’s say an aneurysm or an AVM, can sometimes lead to an even larger bleed, potentially causing a catastrophic stroke. And if a savvy lawyer looks back at the medical history and finds that the patient came to the ER a few days earlier or a week earlier with the same complaint and it wasn’t worked up properly, then that doc has got a big problem.
Try to think of how this will play out in the court room. The ER doc is up on the stand and the plaintiffs attorney is questioning him. He says to the physician, “Dr. Donothing, patient Bill Headhurts came into the ER with the worst headache of his life and you sent him home with pain medication. Can you open that emergency medicine textbook in front of you and read to the jury what it says on page 87 under history for patient presentation of acute intracranial hemorrhage.” So the ER doc turns to the appropriate page in the textbook and reads aloud to the jury “it says worst headache of my life”. This is where the plaintiffs attorney gets all excited on the inside and the jury gasps out loud like they heard the most offensive thing in their entire lives. His goose is cooked! The lawyer then says, “look I’m not a doctor and I can’t even pretend to imagine what it’s like to be in your difficult shoes, but this patient came into your ER with a classic presentation for an intracranial bleed and you gave him Tylenol”. There probably isn’t one person on that jury that would say the ER doc did the right thing, even though, as you and I both know, 95 times out of a 100, the head CT will be negative.
So what does all this mean? Although sometimes I do get frustrated when I read another negative head CT on top of another negative head CT for a headache, I have to keep in mind that I am not actually clinically responsible for the patient. I’m just responsible for the interpretation of the head CT. The staff in the ER is under tremendous pressure from a lot of different sources and they, like all physicians nowadays, are unfortunately held to a standard where we are never allowed to get anything wrong or miss something. This is a problem with our medical system and society, as we should all understand that sometimes, STUFF JUST HAPPENS. Seriously, sometimes stuff happens for no apparent reason, even despite all our best efforts and intentions. And no one is really to blame, but apparently the lawyers haven’t gotten this memo yet.
Let’s look at a different example. As you probably know, surgeries have complications. Now a good surgeon will work to decrease the rate of their complications over their career, and they have a number of ways for doing this. But that does not change the fact that a certain percentage of surgeries will have a complication, no matter what you do. So you can do an appendectomy a 1000 times and let’s say you do it the same way every single time, but 2% of those patients wind up having a postoperative abscess for one reason or another. No matter everything you try, no matter how many journals you read or other surgeons you’ve studied and worked with or what anabiotic‘s you put the patient on, you just can’t get below that 2% mark. How is that the doctors fault? Well, of course, it’s NOT! Could they potentially he get sued when one of these complications pops up? Absolutely. Is it fair? Absolutely not. But, it still happens.
So although our ER docs and surgeons do the best they can in every situation, at least we hope they do, a certain number of cases of acute intracranial hemorrhage will probably be missed and a certain percentage of surgeries will always have a complication. That’s just the way it is.
So the next time we techs and radiologists start to have ill feelings towards whichever doc is working in the ER that day, maybe we should both try to keep in mind how difficult it is to be on the front lines making these decisions. Yes, I know some docs order a ton more CT’s than others, but we should remember somewhere in the back of our mind, that no matter what you do, and even if you think you’re doing the best thing for the patient, sometimes stuff just happens.
Now on a side note, and with relation to working with the emergency department, my best and senior Techs wouldn’t hesitate for a second to call an ER doc to get some clarification on a scan they ordered. If this intimidates you at all or maybe you have some concerns regarding your role as a CT Technologist, I have a 100% FREE COURSE to put you on the right path that you can try out, no strings attached. This course will help you become one of the most desirable Techs to work with in your institution. No Joke! Just click this link to give it a look, go to www.CTSuperTech.com to check it out.
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