A Patient-Doctor’s thoughts on CT scans

Here we are able to benefit from the thoughts of a physician who gets a dose of medicine and does not like the results. This is the type of nitty gritty information we need to develop a truly effective health care system.

the excerpt below is written by William J. Casarella, MD and published in Radiology
…What is often missing from radiologists’ thoughts is firsthand experience with the clinical drama that follows screening or diagnostic tests.

My personal anecdote is an example of the clinical aphorism that the only “normal” patient is one who has not yet undergone a complete work-up.

It began innocently enough with a negative CT colonographic examination that was requested following my routine annual physical examination. Lurking outside the colon were a renal lesion, a 2-cm hepatic mass, and multiple 9–10-mm noncalcified nodules at both lung bases. Our observant radiologists saw them all….

… 1. Despite the absolutely best care by superb practitioners and great hospital care, an extremely painful and costly major procedure was performed that resulted in a 4-week disability.

2. We as radiologists do not fully appreciate the invasive nature of pulmonary nodule resections. They are not comparable to breast biopsies or colonoscopic polyp removals. Patients who have undergone thoracotomies have such an appreciation.

3. Despite our best efforts, we cannot be very specific in diagnosing new small noncalcified pulmonary nodules; and the presence of such lesions in problematic clinical settings creates an almost irresistible urge to make a definitive diagnosis with surgical resection, thereby avoiding the anxiety of 2-year follow-up CT scans. Relatively high false-positive rates have a major negative effect….

read the whole article via A Patient’s Viewpoint on a Current Controversy

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