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Letter to the NY Times Editor – We are Giving Ourselves Cancer

The recent article titled “We Are Giving Ourselves Cancer” seems to have ignored some very basic reasons for overutilization of imaging. The emergency department is particularly known for it’s overuse, but the rationale behind it is never explored by Dr Redberg or Dr Smith-Bindman. Many emergency room physicians are worried about malpractice claims, so utilizing high end imaging to rule out any potential catastrophe that could kill a patient, however unlikely, is a daily part of their practice. The answer to this is not to decrease the availability of imaging, but to actually have a discussion about tort reform. Next, the pressures that all physicians, particularly emergency room physicians, have on quickly moving patients along is enormous. Times are recorded down to the second from the moment a patient enters the door to the moment they leave the hospital. In very simple terms, the faster the turnaround, the more money for the hospital. Why would a physician observe and examine a patient with 25 year old with abdominal pain for 8 hours to see if they develop something worrisome for appendicitis when they can have the answer with a CT scan where a image of the patients internal anatomy and pathology can be obtained in as little as 5 minutes. Until we address malpractice reform and the pressures on physicians to quickly move patients along, CT use will always be not just prevalent, but endemic.

Sahil Mehta MD
Diagnostic Radiology Resident at Beth Israel Deaconess Medical Center, Clinical Fellow at Harvard Medical School, Founder of MedSchoolCoach.com