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Emergency Room Doctors Say They Order Tests Out Of Fear, New Survey Shows

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EMERGENCY CARE REFORM
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In the past, when children with minor head injuries arrived in his emergency room, Dr. Arlo Weltge almost always ordered CT scans. The Texas-based ER doc says it didn't matter if the patients were alert and walking around, or even if he felt certain that the injuries were minor -- he ran the tests for fear of being sued.

Weltge is not alone. According to a recent survey of more than 1,700 emergency room doctors conducted by the American College of Emergency Physicians (ACEP), 53 percent of respondents said the main reason they conduct the number of tests they do is fear of lawsuits. Another 44 percent said that very fear was the biggest hindrance to cutting emergency department costs.

The issue is not strictly financial. In addition to driving up costs, many physicians believe that medical imaging tests have potential long-term repercussions on patients' health.

"We do a lot of these tests to cover ourselves that then give people an awful lot of radiation," said Dr. Sandra Schneider, president of ACEP. "We have to err on the side of the test, which could be harmful in the long term."

Indeed, numerous studies have highlighted the potential dangers of too much radiation exposure from medical imaging. A 2009 report from the National Council on Radiation Protection and Measurements estimated that exposure to ionizing radiation across the U.S. has increased six-fold since 1980, and around half of that increase stemmed from CT scans. (CT scans combine a series of X-ray views and expose patients to more radiation than plain X-rays.) An estimate in the Archives of Internal Medicine suggested that 29,000 future cancers could be related to CT scans performed in the U.S. in 2007 alone.

Groups like the American Association of Physicists emphasize that the risks associated with medical imaging radiation are small but do exist, which is why a recent report concluded that "CT examinations should be performed only when a net patient benefit is anticipated." And that, ACEP argues, is not always the case, particularly when ER doctors order such tests out of fear.

This week, ACEP led hundreds of emergency room physicians, including Schneider and Weltge (ACEP's council speaker), to Capitol Hill to push for medical liability reform. The organization backs two legislative efforts, H.R. 5 and H.R. 157, both of which aim to institute medical liability reform measures.

In a press release, ACEP emphasized the issue of CT scans, calling for doctors who stick to guidelines developed by the Centers for Medicare and Medicaid Services (which suggest limiting the number of head CT scans) in order to be protected against litigation.

"Fewer head CTs will mean that physicians miss maybe one percent of serious head bleeds," Schneider said in the release. "So a small percentage of people with head bleeds will be missed, and there are no liability protections for those physicians who may be sued as a result."

ACEP also drew attention to the efforts of states like Texas, where a 2003 tort reform included measures such as capping non-economic damages, such as emotional distress, at $250,000.

Weltge said his state's reforms have made a major difference in how he practices medicine, a difference he believes directly affects his patients' health.

"Now if a young patient comes in with what is essentially a bonked head, I feel like I can have a reasonable discussion with the parents without feeling pressured to order a test," he said. "That's a very real thought that has gone through my head at least twice while seeing patients in the last week."

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