Opinion
LESS IS MORE PERSPECTIVE
Randi Redmond Oster, MBA Well Path Press, Fairfield, Connecticut.
Corresponding Author: Randi Redmond Oster, MBA, Well Path Press, 2860 North St, Fairfield, CT 06824 (randioster @hotmail.com; http://www .RandiRedmondOster .com).
Questioning Protocol My 15-year-old son Gary is saying there are spasms in his intestines that won’t stop. He’s in so much pain that he’s beyond crying. He sits in the car silently, as if he’s entered a soundproof room from which I am banished, as I drive him to the emergency department (ED). This makes the sixth trip to the ED in a year. Less than a month ago, he had surgery to remove sections of his small and large intestine because of Crohn disease. But he’s never been in this much pain. I am terrified. One of the things that scares me the most is all that I know can go wrong whenever Gary goes to the hospital. I know from experience that his various physicians may not talk to each other and that each will see only the specific body part in which they specialize. I also know, as an electrical engineer who has worked on aircraft engines, that people who work on systems as complex as aircraft engines and human bodies must think about the whole, not just their special part. Gary staggers into the ED clutching his side. I hear a booming voice giving orders that carries through the bustling ED. Its source is the ED physician on call. He’s young, loud, and confident. Gary is placed in the same partition area as the last time. He whispers to me that even if he wanted to do homework, like he did while we waited and waited the last time he was here, this time he can’t muster the strength. These are the first words I’ve heard from him since leaving the house. I feel sick to my stomach. I try to comfort him, but he’s not hearing anything. It’s like he is having labor pains but much, much worse. The nurses take his vitals and within minutes the confident doctor stops by. He suggests a pain medicine that he assures me is powerful. I can’t even pronounce its name. Gary yells, “Give it to me! I can’t take this anymore.” Usually I would ask about the risks of the medication, or its spelling so I can Google it. This time, I just have to trust this physician, who I don’t know and have never seen before. All I can do is hope that he’ll care for my son. My heart begins to race. The physician takes a syringe
Published Online: March 10, 2014. doi:10.1001/jamainternmed.2014.107. Conflict of Interest Disclosures: None reported.
jamainternalmedicine.com
and injects Gary’s arm. I don’t think he’s even done with the injection when I see Gary’s face muscles relax. Once the syringe empties, Gary sighs with relief. As he lies on the bed, he smiles at me. The physician announces he needs to take a computed tomographic (CT) scan to see what is causing the pain. Another CT scan? I think. Now that Gary has found a little relief, I find the strength to think again as a systems engineer. How much radiation is this child getting? When Gary was hospitalized a month ago for surgery, I asked to be involved every step of the way for his treatment, unless it was a life-threatening situation. The next thing I knew, he was placed on steroids, something I’d never approved of, and which Gary’s internist, who was away at a conference, said he didn’t need. I was skeptical of hasty hospital decisions. I blurt out, “Does he really need another CT scan? Can you think of another way to see what is happening?” To my surprise, this ED physician did not reject my concern. Instead, he considered the question. “Yes, CT scans do have a lot of radiation,” he said. “They can be like 1000 X-rays. We don’t need the full definition at this point. We can do an X-ray instead.” One thousand X-rays! I didn’t know that. My trust for this physician soared. Yet I wondered to myself, if I had not spoken up, would he have automatically ordered the CT scan? The X-ray film showed the blockage in Gary’s gut— adhesions from the surgery, it turned out. That was the information we needed to get appropriate care. Later, I looked up the statistics. According to a study from the National Cancer Institute,1 Americans had approximately 72 million CT scans in 2007. The radiation from these CT scans are likely to result in about 29 000 future cancers. I wonder how many people could have just had an X-ray examination. After my many experiences with health care, I’m glad I’ve learned to ask questions and look for alternatives to overtreatment, and I am grateful to this physician for educating me.
1. Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-2077.
JAMA Internal Medicine May 2014 Volume 174, Number 5
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ by a Ndsu Library Periodicals User on 05/25/2015
667
LESS IS MORE PERSPECTIVE
Randi Redmond Oster, MBA Well Path Press, Fairfield, Connecticut.
Corresponding Author: Randi Redmond Oster, MBA, Well Path Press, 2860 North St, Fairfield, CT 06824 (randioster @hotmail.com; http://www .RandiRedmondOster .com).
Questioning Protocol My 15-year-old son Gary is saying there are spasms in his intestines that won’t stop. He’s in so much pain that he’s beyond crying. He sits in the car silently, as if he’s entered a soundproof room from which I am banished, as I drive him to the emergency department (ED). This makes the sixth trip to the ED in a year. Less than a month ago, he had surgery to remove sections of his small and large intestine because of Crohn disease. But he’s never been in this much pain. I am terrified. One of the things that scares me the most is all that I know can go wrong whenever Gary goes to the hospital. I know from experience that his various physicians may not talk to each other and that each will see only the specific body part in which they specialize. I also know, as an electrical engineer who has worked on aircraft engines, that people who work on systems as complex as aircraft engines and human bodies must think about the whole, not just their special part. Gary staggers into the ED clutching his side. I hear a booming voice giving orders that carries through the bustling ED. Its source is the ED physician on call. He’s young, loud, and confident. Gary is placed in the same partition area as the last time. He whispers to me that even if he wanted to do homework, like he did while we waited and waited the last time he was here, this time he can’t muster the strength. These are the first words I’ve heard from him since leaving the house. I feel sick to my stomach. I try to comfort him, but he’s not hearing anything. It’s like he is having labor pains but much, much worse. The nurses take his vitals and within minutes the confident doctor stops by. He suggests a pain medicine that he assures me is powerful. I can’t even pronounce its name. Gary yells, “Give it to me! I can’t take this anymore.” Usually I would ask about the risks of the medication, or its spelling so I can Google it. This time, I just have to trust this physician, who I don’t know and have never seen before. All I can do is hope that he’ll care for my son. My heart begins to race. The physician takes a syringe
Published Online: March 10, 2014. doi:10.1001/jamainternmed.2014.107. Conflict of Interest Disclosures: None reported.
jamainternalmedicine.com
and injects Gary’s arm. I don’t think he’s even done with the injection when I see Gary’s face muscles relax. Once the syringe empties, Gary sighs with relief. As he lies on the bed, he smiles at me. The physician announces he needs to take a computed tomographic (CT) scan to see what is causing the pain. Another CT scan? I think. Now that Gary has found a little relief, I find the strength to think again as a systems engineer. How much radiation is this child getting? When Gary was hospitalized a month ago for surgery, I asked to be involved every step of the way for his treatment, unless it was a life-threatening situation. The next thing I knew, he was placed on steroids, something I’d never approved of, and which Gary’s internist, who was away at a conference, said he didn’t need. I was skeptical of hasty hospital decisions. I blurt out, “Does he really need another CT scan? Can you think of another way to see what is happening?” To my surprise, this ED physician did not reject my concern. Instead, he considered the question. “Yes, CT scans do have a lot of radiation,” he said. “They can be like 1000 X-rays. We don’t need the full definition at this point. We can do an X-ray instead.” One thousand X-rays! I didn’t know that. My trust for this physician soared. Yet I wondered to myself, if I had not spoken up, would he have automatically ordered the CT scan? The X-ray film showed the blockage in Gary’s gut— adhesions from the surgery, it turned out. That was the information we needed to get appropriate care. Later, I looked up the statistics. According to a study from the National Cancer Institute,1 Americans had approximately 72 million CT scans in 2007. The radiation from these CT scans are likely to result in about 29 000 future cancers. I wonder how many people could have just had an X-ray examination. After my many experiences with health care, I’m glad I’ve learned to ask questions and look for alternatives to overtreatment, and I am grateful to this physician for educating me.
1. Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-2077.
JAMA Internal Medicine May 2014 Volume 174, Number 5
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ by a Ndsu Library Periodicals User on 05/25/2015
667
