At 12:31 PM 1/14/99 -0600, you wrote:
>I sawa a young woman on TV news yesterday. She was in a wheel chair
sitting in a
>court room before several serious looking jury and a judge along with TV new
>crew and with near tears she said" For 4 years I told my doctor about my
>headache and he did nothing - now they have detected a brain tumor."
Everybody
>seem to agree that the diagnostic test should have been done long ago and the
>doctor didnot know his job.
>The law is being changed in Minnesota as a result of this trial and they say
>that now a patient can sue a doctor as late as 2 years after the diagnosis is
>made, as opposed to the previous law - which stated that a doctor can not be
>sued after 2 yrs of patient's last visit.
>Apparantly this law is in effect in 47 other states in the US.
>I find news like these making my life so much more difficult in teaching
medical
>students about the choice of optimal diagnostic test and often unnecessary
tests
>., ie CT scan to evaluate for headache.I am afraid that people will see this
>case , avoid good history taking and physical exam or might just get that
test
>for " I document that there is no tumor in this case- I dont care if
there is
>an microscopic one, I could always say that there was no macroscopic tumor!!"
>I hope TV news does not impair our ability to practise EBM. How would the EBM
>pundits tackle this situation or answer these kind of questions.
>
>Amit Ghosh, MD
>General Internal Medicine
>University of Minnesota
>Minneapolis, MN 55455
>
>
I am not a primary care physician, so take what I write with a grain of
salt.
Clearly, a CT as a routine screen for headaches is excessive. However, I
would think that if a pt had a history of headache for more than one year,
someone should have the sense to work the pt up. What does the evidence
say about constant headache (versus episodic tension-type headache or
migraine headache) as a harbinger of a tumor, aneurysm, et al?
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Gaetano Lombardo, MA, PT, OCS
Assistant Professor
Division of Physical Therapy, HS 201
Long Island University
One University Plaza
Brooklyn, NY 11201
phone: (718)488-1490
fax: (718)780-4524
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