We used to diagnose all sorts of stuff before we had any technology, so don’t we just go back to that era?

Yes, technology is over-used and it drives up healthcare costs in many ways but I don’t thin the ED use of technology is really a big piece of the pie. It is what happens to the patients after they are admitted that account for the largest portion. (i.e. end of life care)

There are risks other than the cost to the system with unnecessary ABD CT’s, such as rads for the patient. A confused & emergent environment, such as an ED, is notthe place to start refusing simple diagnostic tests because we are afraid of driving up the bill. There are many places in medicine costs can be improved but the ED is one of the last places we need to start cutting back.

ScutMonkey –

I must take issue with your contention that emergency department use of technology and imaging is “not a really big piece of the pie” of healthcare cost increases — the underlying sentiment is that focused intervention on utilization reduction should be directed elsewhere (i.e., end-of-life care).

Healthcare costs are so out of control that we will never begin to solve the problem by only attacking the largest contributing factor — any reasonably sizable contributing factor is worthy of attention and intervention. My own home institution has witnessed an explosion in abdominal CT imaging volume and thoracic CT angiography volume since these technologies became available, and the vast majority of these studies are negative (internal QI data).

How much litigation is there over a botched appendicitis diagnosis? For that matter, how many cases are there where a doctor can reasonably fail to diagnose appendicitis following the taking of a history, a physical examination and a review of lab test results? If Josh is correct, a big culprit here would appear to be a loss of skill or (for lack of a better word) laziness on the part of the surgeon – that’s not reassuring.

The last time I spoke to a medical malpractice lawyer about the misdiagnosis of appendicitis as a possible cause of action, his response was that there’s not enough money in it. “Tort reform” measures make it so costly to bring a malpractice case that, even with obvious malpractice resulting in a ruptured appendix, it’s not economically viable to bring a lawsuit. The patient usually ends up with pretty much the same scar and, even assuming a day or two in the hospital to recover from a more serious surgery or infection, that doesn’t translate into appreciable damages.

Are malpractice lawsuits truly more common in clinics or hospitals with limited access to CT scans, as opposed to those which have a surfeit of available machines? It has always been my impression that those hospitals most apt to order the type of CT scan or MRI you would deem “unnecessary” is significantly more interested in maximizing the return on its capital investment than in avoiding malpractice litigation.

Anyone who criticizes technology overuse as a waste of $ that does not account for savings due to decreased unnecessary surgery is not worth the bandwidth. This was a retrospective non-randomized study that implies that the 2 groups were similar because the WBC were the same. Possibly the patients who appeared sicker were sent to CT to evaluate for diverticulitis (can present with RLQ symptoms). Maybe there were more women in the sicker group- harder to tell what’s PID and what is an appendicitis. In my experience, complications from appendicitis, even if ruptured, are rare. Dr Chen must be under severe pressure to publish a paper, any paper. GIGO.