Comments on: DB’s is Dead Wrong on ED CT Overuse

By: GruntDoc » Blog Archive » DB cannot help himself. He hates ER docs, and won’t stop talking about it

Sun, 02 Aug 2009 04:51:46 +0000

[...] the first, or second, time he’s gone out of his way to cast aspersions on EM docs (see here and here), but this might be the [...]

By: GruntDoc » Blog Archive » DB’s Med Rants slurs EP’s

GruntDoc » Blog Archive » DB’s Med Rants slurs EP’s — Tue, 13 Jan 2009 19:48:39 +0000

[...] of scans done in EDs? Yes. I’ve called Dr. Centor on this bias hobby horse of his before, but he doesn’t want to hear [...]

By: michiganemdoc

michiganemdoc — Sat, 28 Jul 2007 19:21:27 +0000

Yo.

By: Capt Kirk

Capt Kirk — Thu, 12 Jul 2007 20:19:01 +0000

Too many CT’s? I’ve had one radiologist tell me I did too many in the ER. But for r/o appy, I’ve been very surprised how many positive appy’s I’ve discovered when the history and exam pointed far away – RUQ pain (not preg), no fever, normal WBC, no RLQ tenderness or rebound – but CT positive for early appy! I’ve found and admitted 5 (FIVE) early appy’s in the last 2 months alone by using CT as a final screen rather than sending pt home with recheck in 12 hours. I have 20 years experience in emergency medicine, and I’m a good enough clinician to know it’s not my exam.

On the other hand, all my general surg calls start with “… And what did the CT show?” I work mostly nights, and found most general surgeons will delay coming in by asking for the CT in the most obvious cases (17K WBC, fever 102, periumbilical pain moved to RLQ, pronounced rebound RLQ, etc.) So I start antibiotics and get the CT (delaying their need to come in and evaluate the pt by an hour or more), call them back, and they admit the pt and schedule the case for the morning! Surgeons at both hospitals I work at now are holding off surgery until 7 am on patients coming in after midnight. Good thing cardiologists haven’t followed with their STEMI pts.

By: Jen N. RN

Jen N. RN — Sun, 08 Jul 2007 18:44:05 +0000

Here is a link that to an article that talks about it….
http://www.acep.org/webportal/Newsroom/NR/general/2007/062207.htm

Here are a few excerts…
…”The Government’s Response to the Nation’s Emergency Room Crisis” hearing is being held today by the U.S. House of Representatives Committee on Oversight and Government Reform, chaired by Rep. Henry Waxman (D-CA).

In addition, U.S. Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) have introduced the Access to Emergency Medical Services Act of 2007 (H.R. 882) in the House of Representatives, and U.S. Senators Debbie Stabenow (D-MI) and Arlen Specter (R-PA) have sponsored a companion bill (S. 1003) in the Senate. This proposed legislation seeks to address the dangerous trends outlined by the 2006 IOM reports, including specifically the widespread lack of preparedness for disaster.

Hopefully that gives you an idea of who is doing what. The whole hearing was really interesting and talked about just the sad state EM is in in general.

Here is a link I found to buy the hearing from CSPAN….
http://www.c-spanarchives.org/videolibrary/index.php?main_page=product_video_info&cPath=6_11&products_id=199372-1

By: shadowfax

shadowfax — Sun, 08 Jul 2007 17:35:56 +0000

Jen,

Can you give me a citation, bill name, or anything else?

Was it House or Senate?

By: Jen N. RN

Jen N. RN — Sun, 08 Jul 2007 16:30:02 +0000

I watched a congessional hearing on CSPAN the other day about Emergency Medicine. They are actually entertaining the idea of passing legislation that makes it more difficult to sue ER Docs and personnel. It would be similar to prehospital stuff where the person has to prove “Gross Negligence.” Wouldn’t that be nice! The 3 ER Docs on there sure thought it was!

By: casapinka

casapinka — Thu, 21 Jun 2007 03:53:15 +0000

Unofortunately, I rarely call the surgeon for an appy withouth a scan. Prio to CT, surgeons were allowed (even expected) a 25-30% negative rate. With CT it’s now below 5% and any deviation from this percentage causes them trouble. I’ve also been burned twice now by terminal ileitis in young males without an IBD history. It’s all down to one thing, America: LAWYERS.

By: jrobatc

jrobatc — Wed, 06 Jun 2007 06:10:14 +0000

Good point GruntDoc. My experience has been that, in most cases, the ultradramatic are being so for secondary gain and rarely have any true findings. I give them the benefit of the doubt, especially since many have several risk factors and co-morbidities, but often I am reasonably sure I’m not going to find anything when I roder the tests.

PS I love the site. I am a TrenchDoc refugee and recall Trenchy referencing your site as well as the recent reference to both of your sites in Annals.

By: GruntDoc

GruntDoc — Tue, 05 Jun 2007 22:52:45 +0000

However, we do see very ultradramatic patients who you can’t even touch without them screaming in pain, poor historians etc limiting our bedside abilities and forcing us to rely on tests which often times are, in retrospect, unnecessary.

I doubt they were unnecessary, it’s just that when they come back negative it’s normal to ask ‘did I really need that test’ and the answer is yes, you did. (The other way is, had the test shown something actionable, would you still say it had been unnecessary)?