About 10 years ago, I was working as an emergency room doctor at a small community hospital. A 25 year-old gentleman came in with a bump on his head. It seems that while he was working, he turned around and hit his head on a metal pole. The gentleman had a small goose egg in the middle of his forehead, otherwise known as a hematoma. I asked all of the important questions and the patient said “no” to all of them. I gave him all of the warnings of what to look for that would be cause for concern. Then, I wrote a prescription for pain and discharged him.
If you could have witnessed the scene that man put on in the emergency room. He complained that I didn’t know anything, that I was a quack. He said he was seriously injured and that I needed to do some tests.
The standard of care is to get a CT scan on all patients who experience a loss of consciousness. Most physicians do not want the scene that I described above. It is faster for them to order the CT scan, get the normal results back, then talk to the patient armed with a negative CT scan. Most patients come to the hospital with expectation; They want the physician’s time and they want tests. This is reality.
Also, the fear of lawsuits is real. A physician exam is subjective. A CT scan is objective (for the most part). It is something that you can show the jury that will save a physician’s butt.
There is a new AP article that suggests that insurance companies are taking a closer look at what scans need to be ordered. Look for the medical community to push back big time. The medical community may join with patient advocacy groups to take on the insurance companies. Physicians must be able examine their patients and discuss a course of action that will lead to a diagnosis. Insurance companies should not be allowed to insert themselves between the physicians and the patients (any more than they already are).
Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there’s emerging evidence that these scans are being over-prescribed.
“Costs are soaring in this area, quality concerns are mounting and safety concerns are mounting,” said Karen Ignagni, chief executive officer of the trade group America’s Health Insurance Plan.
Health insurers are requiring more preauthorizations before patients can receive these scans, and setting other restrictions including mandating that the imaging equipment and medical staff operating it be credentialed in advance. (more…)