CT angiograms are not the same as cts of the head in the ER however both are defensive in nature. Whenever a patient is seen by a cardiologist, the concern is that there is a coronary artery blockage. The old standard was to take the patient to the angio suite and do a coronary angiogram which has a mortality and morbitidy all in its self. So rather than injure the patient with this invasive test, ct angiograms were designed. Now here is the problem. If you are a cardiologist and you see a patient with chest pain and don't get a scan and they later get a MI are you exposed to liability. Absolutely! So, if we want to decrease the number of defensive scans and to prevent them from creating excessive profit, lets look carefully at evidence based guidelines that say when you should and should not get a scan. Then lets make sure that these guidelines are held up in court. Otherwise, you will be getting more and more scans and the cost of medicine will continue to go up. Defensive medicine drives the economics of medicine.

Any suggestions on how to prevent unscrupulous docs from running these tests just to make a buck?

The way to control costs is to only order tests that are truly needed. To do this it is essential to establish a true standard of care. For this it is important to decide on what percentage of missed diagnoses we will accept. We cant say in court that even though he had no signs of heart disease his cardiologist should have ordered a scan. You don't get sued for scanning, you get sued if you didnt. If we look at ct angiograms, anyone has a potential to have coronary artery disease. We must determine what criteria are needed to get a scan. If a patient meets that criteria, a scan is done. If the patient does not meet the criteria then it is up to the patient if they want a scan or not. This is a very important point. Many times tests are ordered at the insistance of the patient. This is very true of ct angiograms. As to doctors ordered the tests just because they have a scanner. The easiest way to limit this action is to limit the payment for the scans. If the patient does not meed the criteria, they dont get paid. Now this comes back to the economics of medicine. It is way to the insurance companies benefit if more scans are done as it means more eventual money into thier pockets in the form of interest. So, again the answer is defined criteria on who should get scanned that can not be overturned in court. We are again back to defensive medicine. If we continue to expect every test for every condition in court, we will get all the ramifications of costly tests done for little or no indications. Define the standard and hold that standard in court.

Throckmorton is exactly correct. Of course in creating such standards you are making the case for Federal Preemption. I have found that the plaintiff bar hates standards because without actual standards being established, they can ALWAYS argue negligence no matter how frivilous the case

Justinian - I do worry about the unethical doctors but if we removed all of the unethical doctors and unethical personal injury attorneys, we would be minus 3% of our doctors and 97% of the personal injury bar (a good trade-off when you think about it!)

3% of doctors and 97% of attorneys.... how did you get so biased?

Justinian: Be honest. Isn't Eric a real dirtbag?

Eric who?

It isn't bias if it's true. Unfortunately today's lawyer entered law school in order to make it rich - love of the law or concern for justice is seldom the motivating factor for choosing law as a profession. Often the newly graduated law student carries with him a staggering amount of debt. Personal injury law and divorce law are the two easiest ways to make a lot of money quickly.

I don't handle claims any more but I spent years dealing with doctors and personal injury attorneys.

Doctors are egotistical at times, yes, but consider this: Anyone smart enough to get admitted to medical school would be admitted to law school. Most law school students simply aren't smart enough to get admitted to medical school. I have encountered unethical behavior by physicians - it's rare and it usually involves ego, not greed

There are ethical personal injury attorney firms - I can name five such firms here in Florida alone and I'm sure there are a few more I have yet to encounter, so my 97% number was a exaggeration for comic effect (I forgot that no one running this site has a sense of humor)but I have encountered far more unethical personal injury attorneys than I have encountered ethical ones. I could name names were it not for the fact that these dirtbags would sue me for defamation - I'd win every case but go broke in the process, since we don't have a "loser pays" rule.

Paul, you might want to have a chat with Justice Scalia. He thinks that the smartest minds go to law school, not medical school.

Maybe it used to be easy to make a lot of money doing PI work, but that must have been a long time ago. Most of the PI lawyers I know make less money than the starting salary for biglaw defense lawyers. This is especially so in states like Texas which have enacted so many "reforms" it's difficult to make anything off of PI. I personally worked a couple of cases where the insurers offered us less than the medical bills, which were only a few grand. They believed, correctly, that small cases weren't worth taking to trial for us. So, we talked it over with the client and caved, getting them something like 80 cents on the dollar for their bills, and waiving our fee except for the expenses (couple hundred bucks) we had. That's hardly a way to get rich.

Doctors generally graduated with more debt than lawyers, so I would imagine the temptation has to be equal or greater to engage in unethical behavior like running improper tests just to make a buck.

It's nice to know that Scalia can be wrong about something, after all. He is a brlliant jurist and perhaps that is his ego speaking. Or perhaps he is accustomed to dealing with the top 5% of attorneys and not the run-of-the mill ambulance chaser and TV advertiser. Even today, the grades necessary to get admitted to law school are far lower than those needed to get into medical school. I will admit that the lawyers usually are better conversationalists than are dctors (so for that matter are used car salesmen and most con artists)

It's also nice to know that there are states where being a personal injury lawyer isn't a license to print money. We need to enact such reforms in Florida

The best defense lawyers make millions, the worst are unemployed. The best personal injury lawyers make even more than their defense counterparts, the worst moan about making only $100K.

Frankly, the doctors that can make the extra money off additional testing are those who own their own clinics and testing facilities - those are not the guys just out of medical school, saddled with debt and who would face the temptation to pad their income.

abve comment was mine

Because the criminal cult controls the three branches of government, it has rigged the justice system airtight. There is no substantive legal recourse against the cult criminal.

Only self-help remains against the world's largest criminal syndicate. It should start with a black list. All product and service providers refuse to serve these criminals.

Within the law, all plaintiff lawyers and their running dog judges should undergo total e-discovery to seek evidence of bias, conflicts of interest and improper motive. Publish all content to the web so future defendant do not have to start from scratch, and may deepen their investigations of these cult criminals.

Whenever attacked by the cult criminal, and by a government thug, demand e-discovery of all electronic equipment ever touched by the cult criminal. Have a forensic computer expert go over their equipment. If the slightest sign of resistance is expressed, demand a mistrial and all court costs assessed to the personal assets of the cult criminal. Break these government and cult criminal thugs as they seek to break all productive sectors of economy.

Justinian, try to stay off the list. No quarter will be shown, once payback begins, as they show no quarter.

Supremacy claus is the one who needs a ct scan!

Is there evidence that a CT saves lives? No. No diagnostic/laboratory test ever has. This is not what it does.

What is the appropriate standard to judge medical tests?

1. Efficacy (use of tests improves clinical outcomes)

2. Accuracy (the test accurately measures what they are purported to measure)

Diagnostic/laboratory tests are judged by accuracy and reproducibility and never by their effect upon treatment outcomes. Most tests used today have comparable "sensitivities" and "specificities."

Pet Scans were not approved because they saved lives in a controlled clinical trial that compared the outcome of patients who received care with or without the benefit of a Pet Scan. They were approved because their performance characteristics (sensitivity/specificity) are reproducible, favorable and provide information to treating physicians.

In cancer medicine, no test in oncology has ever been shown in prospective randomized clinical trials to improve patient outcomes. The existing standard has always been the "accuracy" of the test. This is true for every single test used in cancer medicine, from estrogen receptors to panels of immunohistochemical stains (IHC) to diagnosing and classifying tumor to Her2/neu and CA-125 to cell culture assays to MRI's, CT Scans, Pet Scans and so on.

Even when you get to the new genetic/molecular tests, the validation standard that private insurance companies is accepting is "accuracy" and not "efficacy." The essential "proof" is that all they have to do for these tests is that the test has a useful degree of "accuracy," not that the use of the diagnostic test improves clinical outcomes.

However, that's not the validation standard the American Society of Clinical Oncology (ASCO) wants for cell-based profiling tests. It looked at "efficacy" in their 2004 tech assessment. The cell-based profiling tests have the same entitlement to be judged by the same validation standard as genetic/molecular profiling and all other diagnostic tests. ASCO needs to update their tech assessment on cell-based profiling assays. And do it transparently.

A cardiac CT provides anatomic information regarding the presence or absence of blockages in coronary arteries. Such findings alone do not determine whether or not a patient requires an invasive procedure such as an angiogram or angioplasty/stent. Such decisions should be based on physiologic indicators such as presence of angina or, more importantly, an abnormal stress test. A cardiac CT by itself will never be proven to save lives. However, it is yet another tool in the arsenal that must be used properly.

In cancer medicine, the CT is used to follow the size of the patient's tumor while the patient is receiving repeated courses of chemotherapy to determine whether or not the treatment is working and whether or not different drugs should be given, instead. This is an entirely unproven benefit, and were appropriate studies ever to be performed, there wouldn't be any measurable benefit at all, in terms of improving patient response to chemotherapy or patient survival with chemotherapy.

One reason medical costs are getting way out of control: GE employs too many good salesmen.