file.newsgroup.med.58069 Maven / Gradle / Ivy
From: [email protected] (Jim Zisfein)
Subject: Re: Migraines and scans
DN> From: [email protected] (David Nye)
DN> A neurology
DN> consultation is cheaper than a scan.
And also better, because a neurologist can make a differential
diagnosis between migraine, tension-type headache, cluster, benign
intracranial hypertension, chronic paroxysmal hemicrania, and other
headache syndromes that all appear normal on a scan. A neurologist
can also recommend a course of treatment that is appropriate to the
diagnosis.
DN> >>Also, since many people are convinced they have brain tumors or other
DN> >>serious pathology, it may be cheaper to just get a CT scan then have
DN> >>them come into the ER every few weeks.
DN> And easier than taking the time to reassure the patient, right?
DN> Personally, I don't think this can ever be justified.
Sigh. It may never be justifiable, but I sometimes do it. Even
after I try to show thoroughness with a detailed history, neurologic
examination, and discussion with the patient about my diagnosis,
salted with lots of reassurance, patients still ask "why can't you
order a scan, so we can be absolutely sure?" Aunt Millie often gets
into the conversation, as in "they ignored Aunt Millie's headaches
for years", and then she died of a brain tumor, aneurysm, or
whatever. If you can get away without ever ordering imaging for a
patient with an obviously benign headache syndrome, I'd like to hear
what your magic is.
Every once in a while I am able to bypass imaging by getting an EEG.
Mind you, I don't think EEG is terribly sensitive for brain tumor,
but the patient feels like "something is being done" (as if the
hours I spent talking with and examining the patient were
"nothing"), the EEG has no ionizing radiation, it's *much* cheaper
than CT or MRI, and the EEG brings in some money to my department.
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. SLMR 2.1 . E-mail: [email protected] (Jim Zisfein)