A new survey, published in Academic Emergency Medicine, reveals that 97% of emergency room physicians admit to ordering unnecessary advanced imaging studies (like CT and MRI scans), to the tune of $210 billion, in order to protect themselves from malpractice suits. The other 3% of ER docs surveyed are deluding themselves.

Aside from the monetary costs of wasteful imaging scans, they are often not as benign as doctors and other providers may reveal when getting a patient’s consent. Some imaging studies have the potential to cause pain and injury to patients undergoing them. Dennis Thompson says the results of a procedure done in an emergency room can inadvertently open up a can of worms, leading to more tests, more pain, and more fear:

An unneeded scan might find a “false positive” — a test result that suggests a person might have a medical problem that they don’t really have. The patient could end up getting biopsies, tests, and even potentially harmful treatments, for a disease they don’t have, he said.

There’s also the risk that an imaging scan will uncover a medical problem that isn’t causing any symptoms or illness. Doctors will feel pressure to treat the condition, even if the treatment harms the patient’s quality of life even more than the undetected disease did, Kanzaria added.

“I would encourage patients to ask their physicians what the chance of them having the disease that’s getting worked up is,” Kanzaria said. “Ask if the tests are needed. I would also encourage patients to think about both the potential benefits and the potential harms.”


There is a saying that doctors learn early in medical school: “The most common things occur most commonly.” But rare things also happen, and all doctors need to keep those rare things not in the back of their minds, but in the front. That may be more true for the emergency physician who is working in a tense, emergency, sometimes life-or-death, “I’ve-got-to-be-sure-NOW!” situation than it is for a primary care provider (PCP) or specialist seeing patients in a quiet, comfortable office.

The other thing that should be said is that, in most cases, emergency room providers (physicians, nurse practitioners, and physician assistants) don’t have any relationships with their patients other than at the time they are being evaluated and treated. Past medical histories  — including problem lists, medication lists, and allergic history — are often scarce or non-existent. This always puts a treating physician who is trying to make a diagnosis at a great disadvantage. Once the patient leaves the emergency department (discharged to home or, as a result of the second most expensive decision an ED doctor has to make: to a hospital bed), they’re gone. The patient’s case is not reconsidered and there is no opportunity for easy followup. Such continuity is left to PCP’s who will need critical information obtained in the emergency department to either carry on care seamlessly or, in some unfortunate cases, pick up the pieces. In many cases, emergency room providers want to make sure that information is as complete as possible so additional tests (or additional ER visits) at a later date can be avoided. In many other cases, patients don’t have primary care providers for followup in the first place. Making a correct diagnosis — right here, right now — may give a patient the only chance of having their medical condition evaluated and treated.

In any case, emergency room physicians want to do the very best to help you. The day they are forced to put the cost of care ahead of the quality of care will be a sad day, indeed. We’ve all been waiting — for many years, despite countless promises — for malpractice reform. Whether we practice defensive medicine or not, 100% of doctors are still waiting.