I read an article in the New York Times (NYT) earlier this week which alarmed me.
But firstly a “Health Warning”: the contents of this article use figures that are from America and do NOT necessarily reflect current Australian practices. However, as we do tend to follow what happens in the US, this offers a great chance for us to learn from their mistakes.
So what’s the issue? Well, the thrust of the NYT article was that we doctors may actually be “irradiating our patients to death”! Radiation, we all know, comes from the sun in our solar system - without which you wouldn’t be reading this article and I wouldn’t be sitting here writing it either. And the lesson that we can learn from that is that all radiation is NOT necessarily bad radiation! But nuclear radiation generally has a bad rap in our societies, and most people are extremely keen to keep it as far away as we can from our communities. So it might come as a real surprise to learn how much nuclear material is right at the heart of the places we go to when we’re really sick: our hospitals.
But it’s not just hospitals now where you find x-ray machines. Many suburbs will have a private x-ray facility where you can pop in for your normal x-rays and CT scans. And it’s the CT scan usage that has our US colleagues concerned. Here are some of the figures quoted (again, these are NOT Australian figures):
- “Exposure to medical radiation has increased more than six fold between the 1980s and 2006, according to the National Council on Radiation Protection & Measurements. The radiation doses of CT scans (a series of x-ray images from multiple angles) are 100 to 1,000 times higher than conventional X-rays.”
- “One in 10 Americans undergo a CT scan every year, and many of them get more than one.”
- “The National Cancer Institute estimates that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed.”
Now before everyone presses the panic button and refuses to have one of these tests, the answer lies not in responding with fear, but in balancing the equation of “Will the benefit of this test outweigh any possible harm to me, considering the medical conditions that I have”? And this doesn’t just apply to CT scans, but to any long term screening test whether it be x-rays, endoscopies or even simple blood tests.
To get the right balance, there should be effective, standardised guidelines in place wherever these very expensive machines are used. Patients should be informed as to the benefits, the need for, the costs of, and the associated potential harm that they may cause before the test is agreed to. Also, patients should be allowed to ask whether other imaging devices such as an MRI scan or an ultrasound would be able to provide the same information, instead of a CT scan. This will take extra time, but then getting cancer is not something we anticipate doing when we go to hospital!
The advent of CT scanners has been a massive boost to the armoury of medicine in the last 20 years. The quality of the images produced is superb, and no one would ever suggest a return to the pre-CT scan era but we do need to be on our guard that we “first do no harm” when treating patients.
Another article I read in the European College of Lifestyle Medicine reported that there is still a very big problem with the overuse of, and inappropriate use of, antibiotics in our communities. This is an issue that I have written on several times before, but it is one that we need to keep high up in our consciousness with the burgeoning load that antibiotic resistant bacteria are putting on our hospital systems - and threatening the very lives of some of our most fragile patients.
Antibiotics do NOT work on viral infections and neither GPs nor their patients should consider using them once the diagnosis of a viral infection has been made. 99.9% of us have a perfectly good immune system that will deal with the vast majority of head colds and influenzas, and antibiotics will be a complete waste of time and money if prescribed.
Antibiotics are indicated when a bacterial infection is confirmed - by swab or collection of appropriate specimens - which then allows the correct type of antibiotic to be selected and prescribed. This is a relatively fast process so will not delay treatment by more than 24 hours in most cases, and is much the better way of treating these infections. Don’t bother asking for a “stronger” antibiotic - there really is no such thing. The best antibiotic to be given is the CORRECT antibiotic - and that comes with performing cultures and sensitivities on the bacteria themselves.
We all have our parts to play. Doctors should always be striving to do the very best by their patients, and patients should always be striving to do the very best for themselves. The result of this cooperation will result in better outcomes for everyone.