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Hey JB: lets dissect your Post and point out where you are totally wrong:
1. You glorify ED physicians. According to you the only doctors with diagnostic powers, seemingly without the aid of diagnostic testing such as imaging. WRONG: you failed to read POST #1 and you would see that this man's diagnosis was botched by the ED! We wouldnt even have had this thread if he had been treated properly on that first visit.
Now before I get any more flames from people saying I am denegrating ED pysicians let me say again, like all specialties, there are some good, and some not so good. Same can be said of institutions. But it's the Cowboy-type ED doc that you glorify that wants to rule out my DDXs with intuition or percentages as opposed to highly specific diagnostic testing that I want to avoid.
I happen to know the city that the OP lives in quite well ( where I went to college), and am all too familiar with the chance of wrong diagnosis a certain institutions in that area. Medicine is not equal. Exertional chest pain generally means something bad, heart or lungs. Could have had lung cancer as easily as blocked coronary. Not going to diagnosis by guessing.
2. Fact as CT usage has increased in the ED, hospital admissions have dropped. Great medical study just published
Study Links Increased CT Scan Usage,Lower Hospital Admission Rates
by Julie Ritzer Ross Posted: August 10, 2011
A new study shows a correlation between volume of CT scans administered to hospital admission rates, with the latter falling as the former increase.
According to the study, which was published online in the August 9 issue of Annals of Emergency Medicine, the use of CT scans in emergency departments increased by 330% between 1996 and 2007, from 3.2% of patient
visits to 13.9% of patient visits. Rates of growth were highest for patients with symptoms that can be indicative of life-threatening emergencies, including abdominal pain, flank pain, chest pain, and shortness of breath.
But just as CT scan usage rates in emergency rooms rose during the time period studied, the rate of hospitalization fell. In 1996, the rate of hospitalization following CT scan was 26%. However, over the five-year time span, this figure dropped by more than 50%, to just 12.1% at the conclusion of the study in 2007.
Researchers also identify a similar pattern of declining risk of admission or transfer to intensive care units during the period studied.
3. Myth: CT scans cause cancer, you say increasing percentage by 15%??? Show me the data. In fact if you go to the American Cancer Society you sill see that Cancer rates have dropped over the past two decades (20 years) about !% per year!!! Wait a second: CT usage since its invention in 1972 has increased by several orders of magnitutde , if your Myth were correct Cancer rates would be growing like mad! Fact: Death rates have also dropped primarily do to early detection, and in the case of you mention, primarily due to X-ray mammagraphy usage. Oh, theres that X-ray word again! And number 2 because treatments have gotten better, especially radiation treatment (IGRT: Image guided radiation treatment). Ooops theres that radiation word again.
If you are so concerned with Cancer you would be better to wage war against Cigarettes as opposed to Medical Imaging!
4. If you cared enough to do your homeword re Heart attack you would also see some cutting edge new data coming out of UCLA and others showing that 50% or more of heart Attacks were in patients with 'passing" Cholesterol stats. There has been much to do re cholesterol, fueled by big pharma (hardly a night goes by without some TV advertisment for Lipitor, etc). Listen to thes Ads closely and you will hear stuff like " FDA has not found this drug to lower your chance of Heart Attack or Stroke" HMMMM...interesting. Now again I am not waging war on cholestrol monitoring or treatment but trying to open up your eyes that there is more than meets the eye here as t owhy some people "clog" there coraonary arteries and others dont. Best way to detect is by seeing A) Invasively such as by catherization ($$$, risk) or B) non-invasive: through brand new cutting edge imaging techniques such as Cardiac CT.
I had been trying to get the OP over to MUSC and option B.
5) I was concerned re the OP post treatment about other "clogs " he can get. I am happy that he had a good Doppler U/S but I urge him to stay vigilant. My good friend and attorney has done just that post bypass surgery 15 years ago. Despite diet, exercise, statins, etc he continues to have problems all over his vascular system (legs, coratids, etc.) He has had several sugeries that are bound to extend his life through the vigilance of early detection and imaging studies.
6) FACT: For every person admitted with a heart attack there is a patient admitted for chest pain without a heart attack! That is a huge number. If we can better our ED diagnosis surrounding chest pain think of the massive amount of money we can save from the healthcare system. We are closer to achieving that than many of you know.
Conclusion: Should we just willy nilly start to image patients like crazy.?? Absolutely not. But there are many that are sent home without studies, that presented with symptoms that good scientific data that would call for some form of diagnostic study. Medicine is slow to change (maybe thats a good thing) and takes time to catch up to new technology and therapies. (hey maybe like Scuba Diving thinks the same way!). I have tried to raise the awareness to what is going on in the cutting edge in my field of diagnostic imaging but seem to just get flamed by the ignorant and un-informed.
Good luck RetNav. Hopefully you'll get back to diving soon!
1. You glorify ED physicians. According to you the only doctors with diagnostic powers, seemingly without the aid of diagnostic testing such as imaging. WRONG: you failed to read POST #1 and you would see that this man's diagnosis was botched by the ED! We wouldnt even have had this thread if he had been treated properly on that first visit.
Now before I get any more flames from people saying I am denegrating ED pysicians let me say again, like all specialties, there are some good, and some not so good. Same can be said of institutions. But it's the Cowboy-type ED doc that you glorify that wants to rule out my DDXs with intuition or percentages as opposed to highly specific diagnostic testing that I want to avoid.
I happen to know the city that the OP lives in quite well ( where I went to college), and am all too familiar with the chance of wrong diagnosis a certain institutions in that area. Medicine is not equal. Exertional chest pain generally means something bad, heart or lungs. Could have had lung cancer as easily as blocked coronary. Not going to diagnosis by guessing.
2. Fact as CT usage has increased in the ED, hospital admissions have dropped. Great medical study just published
Study Links Increased CT Scan Usage,Lower Hospital Admission Rates
by Julie Ritzer Ross Posted: August 10, 2011
A new study shows a correlation between volume of CT scans administered to hospital admission rates, with the latter falling as the former increase.
According to the study, which was published online in the August 9 issue of Annals of Emergency Medicine, the use of CT scans in emergency departments increased by 330% between 1996 and 2007, from 3.2% of patient
visits to 13.9% of patient visits. Rates of growth were highest for patients with symptoms that can be indicative of life-threatening emergencies, including abdominal pain, flank pain, chest pain, and shortness of breath.
But just as CT scan usage rates in emergency rooms rose during the time period studied, the rate of hospitalization fell. In 1996, the rate of hospitalization following CT scan was 26%. However, over the five-year time span, this figure dropped by more than 50%, to just 12.1% at the conclusion of the study in 2007.
Researchers also identify a similar pattern of declining risk of admission or transfer to intensive care units during the period studied.
3. Myth: CT scans cause cancer, you say increasing percentage by 15%??? Show me the data. In fact if you go to the American Cancer Society you sill see that Cancer rates have dropped over the past two decades (20 years) about !% per year!!! Wait a second: CT usage since its invention in 1972 has increased by several orders of magnitutde , if your Myth were correct Cancer rates would be growing like mad! Fact: Death rates have also dropped primarily do to early detection, and in the case of you mention, primarily due to X-ray mammagraphy usage. Oh, theres that X-ray word again! And number 2 because treatments have gotten better, especially radiation treatment (IGRT: Image guided radiation treatment). Ooops theres that radiation word again.
If you are so concerned with Cancer you would be better to wage war against Cigarettes as opposed to Medical Imaging!
4. If you cared enough to do your homeword re Heart attack you would also see some cutting edge new data coming out of UCLA and others showing that 50% or more of heart Attacks were in patients with 'passing" Cholesterol stats. There has been much to do re cholesterol, fueled by big pharma (hardly a night goes by without some TV advertisment for Lipitor, etc). Listen to thes Ads closely and you will hear stuff like " FDA has not found this drug to lower your chance of Heart Attack or Stroke" HMMMM...interesting. Now again I am not waging war on cholestrol monitoring or treatment but trying to open up your eyes that there is more than meets the eye here as t owhy some people "clog" there coraonary arteries and others dont. Best way to detect is by seeing A) Invasively such as by catherization ($$$, risk) or B) non-invasive: through brand new cutting edge imaging techniques such as Cardiac CT.
I had been trying to get the OP over to MUSC and option B.
5) I was concerned re the OP post treatment about other "clogs " he can get. I am happy that he had a good Doppler U/S but I urge him to stay vigilant. My good friend and attorney has done just that post bypass surgery 15 years ago. Despite diet, exercise, statins, etc he continues to have problems all over his vascular system (legs, coratids, etc.) He has had several sugeries that are bound to extend his life through the vigilance of early detection and imaging studies.
6) FACT: For every person admitted with a heart attack there is a patient admitted for chest pain without a heart attack! That is a huge number. If we can better our ED diagnosis surrounding chest pain think of the massive amount of money we can save from the healthcare system. We are closer to achieving that than many of you know.
Conclusion: Should we just willy nilly start to image patients like crazy.?? Absolutely not. But there are many that are sent home without studies, that presented with symptoms that good scientific data that would call for some form of diagnostic study. Medicine is slow to change (maybe thats a good thing) and takes time to catch up to new technology and therapies. (hey maybe like Scuba Diving thinks the same way!). I have tried to raise the awareness to what is going on in the cutting edge in my field of diagnostic imaging but seem to just get flamed by the ignorant and un-informed.
Good luck RetNav. Hopefully you'll get back to diving soon!
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