How and when do new medical technologies become the standard of care?

A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.

The only thing that surprises me about this is that it’s not more.

Way more.

I remember the first time I actually ordered a CT scan on a patient all by myself, in 1997. I remember signing the order in the patient’s hospital chart, and feeling with some trepidation that I had just moved from the sidelines of the medical world into the main arena–the one floored and wallpapered with health care dollars.

Back then, quaint as it seems, we used to really deliberate about ordering tests like CT scans. They were deemed expensive and inconvenient, and in the (paradoxically-named) internist’s armamentarium, it was a sort of holy grail of diagnostics — it lets us see your insides.

One of the faculty doctors who trained me had the following shtick that has stuck with me:

“Know what the most expensive thing is in health care?” he would mischievously ask.

MRIs?

Open heart surgery?

ICU care for moribund elders?

“The doctor’s pen,” was the answer, whereupon he’d pull out a Mont Blanc fountain pen and flash it around with panache.

The implication of future wealth coupled with fiduciary-medical responsibility was unmistakable.

Somewhere along the way, our collective reticence at using such “big guns” like CT scans and MRIs have fallen by the wayside. As the technologies have become faster, better, and more detailed, they have become altogether more commonplace, such that they are darn near routine.

In the ER with a headache? You’re likely to get a CT scan. Abdominal pain? Belly CT, you betcha! I don’t mean to pick on the ER. Come to my office and there’s a good likelihood the same fate awaits.

Partly it’s the legitimate fear of missing something, of being a bad doctor, and of course the fear of a lawsuit. It’s also partly because patients have come to expect imaging tests because they’ve read about them, seen them on television, had their loved ones go through them. Heck, you can even get your own screening CT scan with no doctor’s order necessary.

Well, we’re through the looking glass now. When everybody gets exposed to the amounts of radiation in a CT scan, bad side effects start getting reported. These horror stories mostly occurred in the setting of improper use and repeated CT scans.

I guess my point is, before asking for/being asked to get a CT scan, ask your doctor to really think through the need for the test “like they did in the old days.”

John Schumann is an internal medicine physician at the University of Chicago who blogs at GlassHospital.

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