ER-Forum Blog

Is your emergency department a radiation hotbed?

By Joel A. Stettner, MD

As an emergency physician, I’ve certainly had to deal with patients who seem to equate more tests with better medicine. “What’s that you say, you bumped your head last week and you’ve heard that a CT scan is needed to make sure there's no serious injury?”

For patients like these – and you know the one’s I’m talking about – I have no problem drawing the line with a gentle but firm “no” accompanied by an explanation.  Granted, denying unnecessary tests that most patients in the United States are accustomed to requesting is not always the easiest road to take. But it’s the right road. And it’s one more emergency docs need to take.

According to a recent story reported by the Associated Press, the U.S. accounts for half of the world’s most advanced procedures that use radiation, and the average American’s radiation dose has grown six-fold over the last couple of decades. That also means that American patients receive the most radiation in the world.

To which I say let’s help get a grip on this problem.

I understand the reticence to say no, with fears of malpractice lawsuits driving a good portion of unnecessary tests. However, there’s a real danger since it is almost impossible to keep track of the number of CT scans and other exposures to radiation patients accumulate. A patient with, for example, renal colic symptoms could easily accumulate multiple scans over a short period of time, especially if multiple ED visits are required for evaluation and pain control. We now know that up to 2% of cancers are due to radiation from diagnostic tests, so these patients could well be at high risk for malignancy later in life. 

In my view, managing a patient’s testing expectations and warning them about the dangers of potential high levels of radiation due to non-mandatory tests should be emphasized. 

Efforts to do so must go beyond the ED and extend to private physician offices, health-related publications, and the popular press. Of course it would be helpful to reduce litigation fears, and the associated defensive testing, but healthcare tort reform remains an elusive goal, at least for now.

Please let me know how you deal with this problem in your practices.