Emergency Physicians “When in doubt, they image.”

Or so says Internist Robert Centor at DB’s Medical Rants. He then goes on to offer the predictable rationale of malpractice risk as the driver for this behavior. KevinMD weighs in and cites GruntDoc who advances the economic calculation which suggests there’s little benefit to attention to this phenomenon. A lengthy and continuing exchange of comments can be found on DB’s and GruntDoc’s sites.

At least some emergency physicians order the imaging we do because other physicians want us to do so. The ED has become the defacto “unfocused factory” where the emergency physician is expected to work up the patient to the point that the patient can be admitted to or referred to the specific focused factory for definitive care.

Today our hospitals and physician practices manifest a myriad of focused factories, the chest pain-ACS focused factory, the joint-replacement focused factory, the respiratory distress-COPD-CAP focused factory and I could go on at length. This is exactly what the specalist medical environment wants–indeed insists that the hospital deliver and we emergency physicians respond.

Furthermore, hospitals have come to realize that with approximately half of revenue generated by patients admitted through the ED it makes sense to concentrate resources on the workup of these patients. Thus hospital diagnostic, treatment and support services focus on ED patients–not the least because those patients arrive to the hospital 168 hours every week. Hospitals, including my own, have installed the most sophisticated 64-detector, dual-source CT-scanner in the ED so that we will use them to better define which of our patients require which specialized services.

When physicians stop pointing fingers and start accepting the reality of industrialization of our once professional, cottage practice we may be able to generate intelligent patient-centered alternatives to the financial policy driven managerial practices we presently experience.