Magazine article Medical Economics

On Imaging Studies, and Why I Order Lots

Magazine article Medical Economics

On Imaging Studies, and Why I Order Lots

Article excerpt


Recently, the medical director of one of the bigger HMOs in my area came to visit-I was ordering too many imaging studies. I pulled a number of cases in preparation for the meeting.

The first was of a young man with chronic low back pain but no radicular findings. I decided to order an MRI anyway; it showed an ependymoma of the meninges, which has the potential to become malignant if undetected. He had surgery and did well.

The next case was that of a woman who, recovering from an MI, developed midepigastric pain radiating to the right flank. She had imaging scans and dye studies of everything in the area. GI and rheumatology consults found nothing. Four months later, a repeat CT scan of the abdomen showed pancreatic cancer. She died in hospice. Earlier detection would have made no difference, but the patient and family were satisfied that everything that could have been done had been done.

The last case was that of a middle-aged man who came to the office complaining of pain in the right groin with intercourse. His BP was normal, and my exam was negative. I suggested a urology consult, but he never went. Two weeks later, he visited the ED complaining of pain from the right flank to the lower quadrant. There were some red cells in his urine, and the radiologist thought he could see a fleck of calcium at the ureteropelvic junction on IVP. His pain was treated with Toradol and he was told to follow up with me on Monday morning.

In the office, his vital signs were normal and he was comfortable on the medication. …

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