Saturday, February 18, 2012

Family Medicine: Radiation Safety Miracle- Informed Consent

Radiation Safety:  Another first on Emergency Department visit report, "Discussed with____(patient) criteria for CT head and facial bones giving exposure radiation versus benefit of imaging study. After considering that ___(patient) has decided against CT scans."

Could we ACTUALLY be discussing benefits and harms of CT scans and documenting informed consent for them in emergency departments?  I have NEVER seen such a statement in a report from an adult emergency department in the Dayton, Ohio area before today.  I have many patients in ED's for episodes of trauma, dizziness, confusion, etc who get CT scans. This has NEVER happened in a report about any of my patients in Emergency Departments before today.

I don't have enough children going to Dayton Children's Hospital to know what is happening there, so my comments only apply to adult emergency departments.

It's like a miracle has happened.  I'm encouraged.  What do you think?


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  3. Thanks, SeaSpray,
    Your story is a great one to heighten our sensitivity to getting informed consent from patients before CT scans.
    I hope we stay sensitive and get better at skillful communication about benefits and harms of CT scans. Good luck with the ureter situation.

  4. I hope you don't mind, I decided to delete what I wrote. Sometimes I 2nd guess what I've posted and my blogger's remorse causes me to delete or put back into drafts.

    The thing is ...what do people do that have to have these things? Seems they and physicians are between a rock and a hard place.

    Like I said ..I give it to God.

    In looking back at my experience ..not just with CTs, but other medical things ...even front office or medications , sometimes seems everyone is so busy and they are only aware of the job in front of them ...but not the big picture ...and information gets lost in the mix.

    My impression is that no one considers the cumulative experiences a patient may've had with testing. No one ever asked me about radiologic history. Not that it would've made a difference ..but maybe. And as I previously stated one informed me of anything and I was surprised and alarmed to learn about this in a med blog. I don't think that knowledge would've stopped me from finding out about the incidental nodule that was nothing. I just had to know. But ..had I been aware ..I may've tried to make a point about not having as many in the future. Or I may've felt intimidated or maybe it was way to go. I did try that one ED visit and told them I had this chronic condition, probably had sepsis(I did) and ureter blocked because I was having same symptoms as I did the 1st time. But, I can also appreciate they have to make their own assessments. Knowing what I know now ...I should've insisted I knew what it was and asked to talk with my doc 1st.

    My question is ..why don't they just go to the CT with contrast ..if there is a chance a pt will have to have that? And then save them from having 2 back to back contrasts?

    Thank you for your well wishes Dr S. :)

    Look I wrote more anyway. Delete if too much. :)

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