----- Original Message -----
From: "Howarth, Paul - RCHT"
> Junior doctor, 'I have this little old lady who has had a fall, I am not
> sure if she has had a stroke or has a sub dural and she lives alone' etc
etc
> (long and irrelevant details follow)
> Radiologist, 'Sounds like it can wait' etc
> Sen A/E, 'I have a year 65 old who has had a fall, she has hit her head
and
> has a GCS of 8'
> Radiologist, ' put me back to switch, I'll get the radiographer in to warm
> up the scanner and I'll be there shortly'
I had to laugh when I read your description Paul, how true! Sadly the long
and irrelevant details permeate the modern SHO's notes as well!
Rowley wrote:
> ...why are we wasting an expensive and rare bed on someone when a scan is
cheaper
(there are two papers showing this, one from the States, and one from
Scandinavia) and has a 100%
sensitivity and 100% specificity in this setting? <
Cost will vary markedly from unit to unit, depending on a multitude of
factors. I expect the "marginal" cost of a head scan is probably in the
region of £10 to £20 depending on rotas, call-out protocols etc. The
marginal cost of a simple obs bed is probably similar, most of these beds
are fairly low intensity. But the argument shouldn't centre around costs
(which are nebulous and difficult to calculate). It's about availability and
about quality. In our current climate, we often don't have beds. So I'm a
great believer that a negative scan is still a "result". It's good news for
the patient, who is reassured, and it's good news for us, who save a bed
(Matt, many of us do send patients home following a normal scan, especially
the repeat attender that Rowley described). But even when the scan result
doesn't alter management, diagnosis and prognosis are still incredibly
important, not least for the unfortunate patient and his family.
Adrian Fogarty
P.S. What was your last arcane message about Rowley?!
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