It is ironic that, in a time of incredible medical science, some patient reject science out of hand.  This is nowhere more evident than in the area of imaging.  I have had several patients with back pain, neck pain or abdominal pain who ended up having CT scans done.  When I came to them with the good news that the CT showed no abnormality, they were indignant.  ‘You mean to tell me there’s nothing wrong?  I don’t believe it.  Something’s wrong.  The CT missed my brother’s appendicitis and my slipped disc.’

My response is usually, ‘I’m not saying you don’t have pain, or that something isn’t wrong, I’m just saying we can’t see anything abnormal on the scan.’

Oddly, as we move ever forward in our imaging capacity in medicine, people seem to desire more and more clarity (for less and less cost, of course).  Even our small emergency department has the capacity to do magnetic resonance angiograms to look for cerebral aneurysms; a thing that not so long ago would have been remarkable in even the largest center.  And yet, a subset of patients simply can’t accept the results.

Granted, imaging can be wrong.  I’ve seen it happen.  But on the whole, what we do is quite incredible.  What we can see is amazing.  And frequently, when we find nothing, it’s because nothing is there.

This leaves me with two conclusions; we need a scanner that evaluates the patient’s life, heart and soul included, to find the true source of their discomfort (which may well have to do with depression).

Next, perhaps if people are unwilling to believe the extremely costly testing we do, it may be time to simply do less.  If we want to cut costs, maybe this era of disbelief, this time of widespread skepticism at even the best science, is the perfect time to stop doing as much in the interest of cheaper, simpler evaluations and interventions.

If only we could get the malpractice attorneys on  board!

Edwin

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