Should FDA Regulate CT Scans?
This one makes my blood boil. Being a doctor, a good doctor, is not easy. It requires a lot of thinking, taking every patient who comes before you not just as a human, but as a clinical care problem. Knowing the facts, making judgments. It is because we have a tendency to abscond this role that “doctor extenders,” cheaper people, rush in to fill the void.
One of the things we have to do is to weigh the advantages and risks of every procedure.
Sure, there are some mechanisms in place to help us. Things like videotaped informed consents. Things like meters and technology and such.
In the case reported above, a woman who had Bell’s Palsy, a fairly common (and often, spontaneously receding) hemifacial paralysis was subjected to a CT scan. She got too much radiation and became quite ill; someone did not notice the excessive radiation noted on a panel somewhere.
For the technician, the error was the problem. There should be a “checklist” whenever someone gets an exam, to make sure that there is not something dangerous and avoidable. She could have been shifted to another CT. This kind of a problem, a technicians error, should be resolved on the checklist level and should not require deep reflection.
For the physician, the understanding of the diagnosis is the problem. The origin of facial paralysis can usually be determined with a really good clinical history; I have taken plenty for that diagnosis in my own career. Mainstream medicine has a few ways of treating this affliction; alternative medicine and I have several more. Mainstream medicine does have some amazingly elaborate ways of measuring facial paralysis, (size of the distance between the eyelids, mouth droop). If someone had simply measured the extent of this woman’s paralysis within a few days of after it had been diagnosed, maybe, just maybe, a CT scan could have been brought into play, but that would be a low yield procedure at best.
Whatever we do, we should NOT get an overworked underfunded and generally disregarded FDA make guidelines. A large number of illnesses, a quasi-infinite number of clinical situations would be affected.
We need to let doctors be doctors. If they do not know how, we need to teach them to be doctors. To navigate a seeming infinity of raw, uncooked data in such a way that they can help patients, make valid clinical decisions, know when to use para-clinical (high-tech) examinations. An oppressive bureaucracy, overwork, and fear of malpractice suits may be making being a doctor more difficult than ever.