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A recent issue of Practical Neurology had a brief article titled, "CT Scans for Dizziness May Not be Cost Effective" (January/February 2012, p. 6). The article described a study that found that less than 1% of CT scans of 1,681 emergency department patients presenting with "dizziness" showed a serious cause, leaving the scan’s cost effectiveness questionable.
(Although "dizziness" might not be very specific to you, it’s what the article said, and what patients say, and what gets listed on the admitting sheet.)
How many times have we seen studies like this? There are a lot of them. And how many times do they really change physician behavior? Any hands? Nope.
The issue here is not that doing a head CT in these cases is pointless. I think most neurologists and ED docs would agree the scan is pretty low yield in generic dizziness (assuming no other significant symptoms or exam findings).
The real issue here is the practice of defensive medicine in America. Just because the CT scan probably won’t show anything significant doesn’t change the fact that it could. It’s like a serious surgical complication: There may be only a 1% chance of something going wrong, but if it happens to you the incidence just went up to 100% for your case, and you may be in some deep trouble.
We all live in fear of being sued, and a routine CT scan is a simple, reasonably safe, and quick study. Unless there’s a legislative sea change that protects doctors who don’t order one (and we all know that isn’t going to happen), I don’t see their use for routine dizziness decreasing anytime soon.
Yes, this is the sort of behavior that drives costs up. It’s defensive medicine. And I don’t know any doctors who don’t do it. In the current climate, protecting ourselves always trumps saving money for an insurance company, because it won’t be the one on the hook if a disaster is missed.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.
A recent issue of Practical Neurology had a brief article titled, "CT Scans for Dizziness May Not be Cost Effective" (January/February 2012, p. 6). The article described a study that found that less than 1% of CT scans of 1,681 emergency department patients presenting with "dizziness" showed a serious cause, leaving the scan’s cost effectiveness questionable.
(Although "dizziness" might not be very specific to you, it’s what the article said, and what patients say, and what gets listed on the admitting sheet.)
How many times have we seen studies like this? There are a lot of them. And how many times do they really change physician behavior? Any hands? Nope.
The issue here is not that doing a head CT in these cases is pointless. I think most neurologists and ED docs would agree the scan is pretty low yield in generic dizziness (assuming no other significant symptoms or exam findings).
The real issue here is the practice of defensive medicine in America. Just because the CT scan probably won’t show anything significant doesn’t change the fact that it could. It’s like a serious surgical complication: There may be only a 1% chance of something going wrong, but if it happens to you the incidence just went up to 100% for your case, and you may be in some deep trouble.
We all live in fear of being sued, and a routine CT scan is a simple, reasonably safe, and quick study. Unless there’s a legislative sea change that protects doctors who don’t order one (and we all know that isn’t going to happen), I don’t see their use for routine dizziness decreasing anytime soon.
Yes, this is the sort of behavior that drives costs up. It’s defensive medicine. And I don’t know any doctors who don’t do it. In the current climate, protecting ourselves always trumps saving money for an insurance company, because it won’t be the one on the hook if a disaster is missed.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.
A recent issue of Practical Neurology had a brief article titled, "CT Scans for Dizziness May Not be Cost Effective" (January/February 2012, p. 6). The article described a study that found that less than 1% of CT scans of 1,681 emergency department patients presenting with "dizziness" showed a serious cause, leaving the scan’s cost effectiveness questionable.
(Although "dizziness" might not be very specific to you, it’s what the article said, and what patients say, and what gets listed on the admitting sheet.)
How many times have we seen studies like this? There are a lot of them. And how many times do they really change physician behavior? Any hands? Nope.
The issue here is not that doing a head CT in these cases is pointless. I think most neurologists and ED docs would agree the scan is pretty low yield in generic dizziness (assuming no other significant symptoms or exam findings).
The real issue here is the practice of defensive medicine in America. Just because the CT scan probably won’t show anything significant doesn’t change the fact that it could. It’s like a serious surgical complication: There may be only a 1% chance of something going wrong, but if it happens to you the incidence just went up to 100% for your case, and you may be in some deep trouble.
We all live in fear of being sued, and a routine CT scan is a simple, reasonably safe, and quick study. Unless there’s a legislative sea change that protects doctors who don’t order one (and we all know that isn’t going to happen), I don’t see their use for routine dizziness decreasing anytime soon.
Yes, this is the sort of behavior that drives costs up. It’s defensive medicine. And I don’t know any doctors who don’t do it. In the current climate, protecting ourselves always trumps saving money for an insurance company, because it won’t be the one on the hook if a disaster is missed.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.