Doctor Goes to the ER Room – His Story About Over Diagnosing First Hand as the Patient
Posted Oct 05 2009 10:01pm
This is an interesting post from a doctor who himself was put through the hoops of what we might call defensive medicine. He has a shingles problem and once he arrived at the ER room, he found out how vulnerable he was after a day at the hospital, 2 MRIs, a CT Scan, visits with specialists, etc. Overall it was over a $9000.00 day and he had the shingles that he thought was his original diagnosis. BD
For years I've heard friends describe experiences of being caught in a web of excessive and unnecessary medical testing. Their doctors ordered test Z to investigate a seemingly incidental finding on test Y, which had come about because of a borderline abnormality on test X.
I often wondered why test X was done in the first place. As a primary care physician, I would have treated them for the likely diagnosis and done diagnostic tests -- especially a series of diagnostic tests -- only if they didn't respond as expected.
By the end of the Easter service, I had a treatment plan firmly in mind: an antiviral drug to fight the culprit, a steroid to decrease inflammation and a very strong pain reliever. Given that it was Sunday morning, and a holiday as well, instead of calling my internist or one of his partners, I decided to visit the emergency room of the teaching hospital where I work to confirm the diagnosis and get my prescriptions. My wife drove. I sat in the car with my eyes closed, wondering how it was possible for me, at age 64, to have turned into one of those elderly people who suffer from shingles.
"Before you go," my colleague mused, "just for completeness' sake, maybe we should have an ophthalmologist and a neurologist take a look at you. What about it, just in case?"
"I don't know . . . I don't think so . . . well, okay . . . maybe it's a good idea."
The neurologist recommended an immediate MRI of my head, just to make sure there was no mass. But why would a brain mass cause symptoms from that particular nerve? It made no sense. But in my morphine-induced drowsiness I thought, okay, it might be interesting to have an MRI scan -- a life experience I'd thus far avoided -- and an hour or so later we walked to the machine.
"What we need to do," the neurologist explained, "is get a CT scan with contrast. This'll clearly define the vascular structures in your brain, so we'll get a good look at the cavernous sinus." Okay, I thought, do it, do it, let's get it over with.
I understand now how all those people could have been so gullible, so easily manipulated by the system.