altThis is the additional cost in money and radiation exposure of Dr. Patel’s care as compared to Dr. Silva’s Care. There is no benefit for the patient. The hospital brings in revenue. Who are we working for? Are we harming patients to benefit ourselves?

The average annual amount of radiation exposure a person receives in 1 year from environmental sources is 320. The Nuclear Regulatory Commission limits occupational radiation exposure to adults working with radioactive material to 5,000 mrem per year. Mary received close to the annual limit in a couple of hours. The Archives of Internal Medicine concluded that 29,000 new cancers would result from CT scans performed in 2007 alone. The majority of those cancers (14,000), not surprisingly, would result from scans of the abdomen and pelvis. Another 4,100 would come from chest scans; 4,000 from head scans; and 2,700 from CT angiograms. The most vulnerable populations include younger adults and women.



# what about #3neil 2013-02-27 07:00
How about a course of action where the ems provider doesnt even take her in? relatively young healthy women self extracts and no high risk complaints whose vital signs normalize after adrenaline subsides.
# JAMES W MEADE MD FACEP 2013-02-27 09:09
Dr Patel did the right thing; I had a similar patient that was found to have at laparotomy to have a rupture of the retro-peritonea l portion of the 4th part of the duodenum. This is a rare, but fatal injury.

The prices of the labs and xrays are exorbitant. I have had an emergency CT chest with contrast: the cost to the insurance company was less that $3000, who reduced payment to about 40%. A urinalysis charge for $114 is absurd.

The figure of 29,000 cancers from CT scans is without any scientific validity, and has been disputed by the ACR.

The documented number of cancers caused by the Chernobyl nuclear accident is 9. (I have been there and have read the UN reports on the subject)
# Interesting articleMark 2013-02-28 05:43
An interesting article. Dr Silva's approach is more akin to the Emergency Medicine I practiced in the UK prior to a move to Australia. Here in Australia it seems more like Dr Patel's approach. Whilst I tend towards Dr Silva's approach, everybody has a story like Dr Meade's of the injury that was missed. Our consiciences, employers and patients do not accept misses well.

My question to Dr Meade would be, would the patient with the rupture of the RP portion of D4 have been sent home and this injury missed, or would serial examination have revealed pain and tenderness which would then have resulted in either CT or laparotomy? Not rushing to pan-scan is not the same as hasty disposition out the door.
# DO, FACEPJoe DeLucia 2013-02-28 13:48
In response to the second comment by Dr. Meade; I once saw a preacher slap a paralyzed women on the head and she got up and walked. I don't go around smacking paralyzed people on the head expecting them to walk. When did testimonials replace science?

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