Why it makes sense to consult ER patients before sending them to CT

It’s all too easy to reduce medicine to facts, practices to technology. Patients need to be consulted when it comes to making decisions involving the use of CT, according to a recent emergency room survey, even when time is in short supply and the answers seem obvious.

A study published in the November issue of the American Journal of Roentgenology finds that patients widely accept that CT is the way to go when answering questions that arise in the emergency room. They also accept that the use of this x-ray–based modality is more important than any associated risk of radiation exposure. What many patients don’t accept is being cut out of the decision loop.

The study found that two-thirds of patients want to be part of a discussion about the risks and benefits of CT before a scan is ordered, according to the study’s lead author, Dr. Kevin M. Takakuwa.

In a survey performed at Thomas Jefferson University Hospital in Philadelphia, 383 emergency department patients answered questions regarding their attitudes and knowledge about radiation coming from CT. Patients preferred a diagnostic test that delivered better results, even when those tests involved more radiation, according to Takakuwa.

This preference was apparent in the 74% of patients who indicated that having their condition diagnosed with CT was more important than radiation concerns. But nearly as many, 68%, wanted their physician to take the time to discuss the risks and benefits rather than leave it to the physician's judgment to order the best test.

“Because patients drive their care to some degree, it is important for physicians to understand patients’ knowledge and attitudes about radiation exposure, particularly as they relate to CT,” Takakuwa said.

The survey revealed certain differences in attitude and knowledge. These differences were associated with the patient’s background, ethnicity, and clinical circumstances.

Privately insured patients preferred to have their condition diagnosed with CT rather than worry about radiation. Whites tended to prefer a more definitive test at the expense of more radiation. Blacks and patients with less pain wanted the risks and benefits explained at the expense of time.

The more educated patients tended to know that CT delivered more radiation than chest x-rays; only 34% of patients knew this.

“Our results suggest that we may help emergency department patients better with targeted teaching about radiation, decreasing [patients’] pain, discussing risks and benefits, and asking [patients] to participate in the ordering of their diagnostic tests," Takakuwa said.