Concern Over Excessive CT Scans Beyond Radiation

Consumer Health Quality Council
The use of technology in medicine has increased drastically in recent years. More than 70 million CT scans are performed annually in the U.S. as compared to only 3 million in 1980. It’s undeniable that technology has been a critical tool in advancing medical science and improving many patients’ health and outcomes. However, it’s also a reality that our current health care system has come to over-rely on high cost, at times risky, tests, such as CT scans. A study published in the New England Journal of Medicine found that as many as one-third of all CT scans performed in the U.S. are unnecessary.

HCFA’s Consumer Health Quality Council is currently working to address the overutilization of CT scans in our health care system. We’ve authored a bill titled “An Act Regulating the Use of CT Scans.” Sponsored by Representative Stephen Kulik, the bill would have the Advisory Council on Radiation Protection, which sits in the Department of Public Health, investigate the use of and risk from CT scans, as well as file a report with recommendations for reducing and tracking risk. Learn more about this bill and the other bills supported by the Consumer Council here. on the HCFA website.

Such overuse of CT scans has often been framed in the context of the increased risk to health due to radiation and the resulting increases in the cost of care. However, such reliance on technology can also negatively impact patient-doctor relationships, and patient outcomes, a concern Dr. Abraham Verghese raises in his op-ed “Treat the Patient, Not the CT Scan,” published in Sunday’s New York Times.

Verghese points out that as many doctors rely more on diagnostic tests, they perform fewer physical examinations, essentially losing basic medical skills. Out of practice, doctors are then less able to identify simple bodily clues that can lead to early diagnosis. These missed opportunities result in delayed diagnosis, and riskier tests, such as CT scans.

They represent a type of error that stems from not making use of basic bedside skills, not asking the patient to fully disrobe. It is a more subtle kind of error than operating on the wrong limb; indeed, this sort of mistake is not always recognized, and yet the consequences can be grave.

The disintegration of the physical exam also has consequences for doctor-patient relationships. Verghese highlights that, for many patients, receiving an old fashioned physical examination is an important ritual in establishing trust and confidence in their doctors, and that when the physical exam is not given its fair due, patients take note.

I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds.

Verghese brings to light the expansive impact overutilization of technology has in our health care system. Not only does it contribute to rising health care costs and at times subject patients to greater health risk, it takes the emphasis away from where it should be- on the body, and the doctor-patient relationship.

We urge you to contact your legislator and ask for support of this important bill.
-Lydia Mitts

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