Health Buzz: Use of Medical Scans in the ER Soaring

Imaging use has increased for several reasons. In our practice, "screening MRI" scans are used to rule out tumor. Our expected rate of finding tumor is about 1% but may be less. Not only do we lack statistical information to guide when we can safely avoid the imaging, we also face malpractice litigation for "failure to diagnose" if we don't do the imaging. Faced with a low but readily understandable risk, patients want to know, too. It is quite likely that ER use of imaging has a similar multifaceted basis.

In addition, we are using imaging more often for hearing loss and ear infection than we did in the past as newer diagnoses like "dehiscent semicircular canal" have become a new concern. Imaging is so much more accurate that details about the hearing bones can often be sorted out which could not be in the past. A diagnosis of something called "monopodal stapes", generally thought to be quite rare, has been seen more often than expected. Ears thought in the past to be candidates for "middle ear exploration" to fix presumed problems with the hearing bones can now often be found not to be candidates for surgery. I.e. using a good deal more imaging, we are avoiding some operations which would have been fruitless in the past. And, we are elucidating cause for hearing loss in ways not possible in the past.

We are also sending a lot more child-bearing age or younger folks for expensive genetics testing for hearing loss. Many of these tests were not available in the past except as research tools. They are now available commercially. Patients usually, but not always, want to know if they have a genetic hearing loss. And, failure to diagnose a genetic defect has been used as a litigation basis in Florida. So, very expensive genetic testing is increasing, as well.

So, yes, a good deal more imaging and other tests are now being done. Some of it helps us reduce litigation risk but we think that in the vast majority of those cases, the patients would want to know, anyway. If we had real time, computer assisted, patient specific ability to give patients odds that imaging or other testing would reveal something important, I think we could trim the use of imaging. Alas, this is probably the direction which has the greatest potential to reduce health care costs but I have not seen any, not ANY, major legislative or news interest in doing this. Regional Health Information Organizations are being organized but how to utilize them to create an electronic medical record tool for the purpose of assisting with diagnosis and management decisions has not been discussed where I can see it.

If the USA wants to reduce health care expense, and reverse a growing imaging trend, EMRs need to become active statistics-based assistants rather than primarily a passive repository of data.

Loren J Bartels, MD, FACS of FL 8:20AM February 21, 2010