Monday, March 30, 2009

CAT Scans - Lighting the Fuse!


The superscan in the prior posting, which showed a ‘freckle’ in the right lung, has now created an anxious patient and family. This patient’s worry will be heightened when he is sent to a pulmonologist, or lung expert, to evaluate the ‘abnormality’, which was found entirely by accident. The lung specialist will then advise the patient to have periodic CAT scans over the next 2 years to assure that they lesion does not enlarge. Obviously, this exercise diminishes quality of life and costs plenty of money that could be used to help truly sick people. And, if the nodule does increase in size – which even benign lesions can do – then the doctor may recommend surgery just in case it is cancerous. Consider what tens of thousands of Americans endure evaluating abnormalities that should never have been discovered or investigated.

Millions of us are walking around with innocent imperfections in our internal organs. In other words, if any of us were to undergo a CAT scan, many of us would have abnormalities described by vigilant radiologists.

Sure, some folks have been saved by having cancers discovered early. If I or a family member were one of them, I might have a different view of this issue than I do now. However, these occasional accidental rescues must be balanced against the enormous financial expenditures, anxiety costs, radiation exposures and direct harm from medical complications that result from these medical cascades. I am convinced that the harm outweighs the good.

So, when your doctor recommends a CAT scan, you may feel that there is no risk from a non-invasive study. Think again. The CAT scan may be the match that lights the fuse.

3 comments:

Anonymous said...

On the other hand, the ER doc / radiologist / hospital could easily have been sued by the patient if a CT scan was not ordered and something was missed.

Until doctors are allowed to practice judgment without fear of unjust medicolegal liability, this will not go away.

Linda said...

I am very interested in the perspective you have put on CAT scans and would like to know what you think about PET scans. I am a nurse and my husband has had a sarcoma removed from his thich nearly 2 years ago. He has had CAT scans every 3 months since then. In January a 8mm sub pleural growth showed up and so it was suggested that a PET scan in 2 months would be the best way to go. After a very worrying 2 months the result of the PET was that there was no sign of any hot spot activity or change in size and he was given the OK. 3 months later the growth that had not changed for six months had suddenly grown to over 3cm. We joked that they had fed it with the PET scan but he is now in the position of having chemotherapy even though he is symptom free and felt fitter than before the leg sarcoma. We know that the lung is the likely place for mets but feel inclined to refuse any further PET scans - is this unfounded?

Michael Kirsch, M.D. said...

Linda, Understandably, I cannot offer any advice or opinion on an individual patient, such as your husband. I encourage you both to discuss your questions with his treating physicians. I wish your husband the very best.

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