We recently had to take my father-in-law to hospital. He is in his mid-80s and has what is effectively terminal ischaemic heart disease. The cardiologist on call decided to be aggressive in his approach and carried out a number of investigations. Unfortunately, none of them really contributed to my father-in-law's management - particularly the CT scan, which was also very uncomfortable and provoked a lot of anxiety. At the end of all this the medical aid paid only for hospitalisation, quite rightly saying that the investigations were only done to confirm a clinical suspicion.
One of the articles in this week's newsletter covers a study in the US that backs up what other UK studies showed a while ago - scans of all kinds - play no part in the management of acute lower back pain. The source article points out that the number of CT and MRI scans carried out for acute lower back pain has increased markedly in the past few years, according to Medicare statistics. The authors go on to say that these scans are being carried out largely because patients request them and doctors are essentially covering themselves.
I was taught that the most important part of any patient intervention was a good history, followed by a meticulous physical examination and only then - if really necessary - would you start to think about a few directed investigations. The investigations were chosen to actively aid in the management of the patients, not just to confirm a clinical suspicion or to cover your back.
Medical costs are spiralling out of control - you only have to look at what your medical aid is charging you this year in comparison to last year to see that. Doctors need to start to trust the old-fashioned approach to medicine, which is largely about listening to the patient and patients need to start trusting that doctors have skills that allow them to make diagnoses and clinical decisions based on physical examination and, only occassionally, special investigations.
Medical technology is a wonderful thing, but only when it is used appropriately.
