No ER doc is getting any sort of kick back from ordering you a CT. It is at worst, a way for them to cover their own asses. Let’s face it, in our sue heavy culture, it isn’t a bad idea.

Although he did not lose consciousness or vomit, I took him to the hospital because, hey, it’s a baby that fell three feet and hit his head on cement. I took him to one of the top children’s hospitals in the U.S. They checked on us constantly and monitored him. We asked for a CT scan to make sure he was okay. The doctor said she would order it, but did not believe it was necessary based on her observation. We pushed for it because, hey, it’s a baby that fell three feet and hit his head on the cement. We plan on being more conservative with such scans as our kids get older, but I’ve known people who have died after taking a blow to the head and then walked around for an hour or two.

The doctor said that she would not choose to do a CT scan on her own child in this instance (we asked her that question), but said it was a reasonable request given the facts of the case.

The CT scan revealed no problems, but I still stayed up all night watching him breathe.

Geez last time I checked I never heard an MD ask me which CT exam he should order based on cost. Hate to destroy the fantasy but hospitals make money when people PAY their ER bills.

I literally wrapped up watching all eleven seasons of M*A*S*H today, finishing with the overlength “Goodbye, Farewell, and Amen”. We’ve been going through it for the better part of two years. I tend lately to think of a lot of medical foolishness with his voice I guess…

Every patient that an ER doc sees is a stranger and often an hysterical stranger. It creates an atmosphere.

It takes me *much* longer to explain to mom & dad why I don’t think that its right thing to do the CT just now, be it for a concussion or abdominal pain. A lot of the time they’re irritated and insist on the scan regardless.

The stance, “Understand that I’m not refusing, but I have to tell you, I wouldn’t scan my own child for this; I would keep a close eye on her and come back if she seems worse in any way or if she’s not getting better” doesn’t work nearly as often as you might think, even when you sit there and show them pictures of your own kids in the same age range. 

Alas, its only about one family in five who says, “Wow, thanks for taking the time to explain your thinking. Now that I understand your concerns about chances of cancer on a population basis, I can see why you would recommend watchful waiting, particularly since my little one’s story and exam are somewhat equivocal.”

The population who reads boingboing (and the subpopulation who reads comments) is not the population who calls my medical director and administration complaining that their child didn’t get the test that they wanted for her. 

Whereas we are not pressured to do studies one way or the other, we are most certainly pressured to make people happy, and yes, for many of us there is a non-trivial chunk of our compensation attached to that. I don’t mind foregoing that part in favor of Doing the Right Thing, but a lot of my colleagues do.

And when mom or dad assert that should I decline to scan their child for her concussion or tummy-ache then they will simply come back in a few hours, what then? “I refuse to be blackmailed” only gets a clinician so far, particularly in this setting.

So choose… best profit or best results, but you can’t have both.

Any person with any functional morals would choose results IMHO…

Male breast cancer is pretty rare, but radiation exposure increases the odds for it second to heredity.

It seems to me that ultrasound would be a viable alternative to CT scans.

And personally I am totally comfortable with abdominal palpation, as it’s statistical success at diagnosis of appendicitis is also quite good. I’d only want a CT if there’s a valid medical reason.

Don't delude yourself this is in your best interests.. you'll get the most profitable treatment for the doctors, even if it's the worst possible treatment for you*….

*Sorry to politicize this, but it does need to be pointed out why privatisation is the worst possible solution ever invented…