From: jim.zisfein@factory.com (Jim Zisfein) 
Subject: Re: Migraines and scans
Distribution: world
Organization: Invention Factory's BBS - New York City, NY - 212-274-8298v.32bis
Reply-To: jim.zisfein@factory.com (Jim Zisfein) 
Lines: 37

DN> From: nyeda@cnsvax.uwec.edu (David Nye)
DN> A neurology
DN> consultation is cheaper than a scan.

And also better, because a neurologist can make a differential
diagnosis between migraine, tension-type headache, cluster, benign
intracranial hypertension, chronic paroxysmal hemicrania, and other
headache syndromes that all appear normal on a scan.  A neurologist
can also recommend a course of treatment that is appropriate to the
diagnosis.

DN> >>Also, since many people are convinced they have brain tumors or other
DN> >>serious pathology, it may be cheaper to just get a CT scan then have
DN> >>them come into the ER every few weeks.
DN> And easier than taking the time to reassure the patient, right?
DN> Personally, I don't think this can ever be justified.

Sigh.  It may never be justifiable, but I sometimes do it.  Even
after I try to show thoroughness with a detailed history, neurologic
examination, and discussion with the patient about my diagnosis,
salted with lots of reassurance, patients still ask "why can't you
order a scan, so we can be absolutely sure?"  Aunt Millie often gets
into the conversation, as in "they ignored Aunt Millie's headaches
for years", and then she died of a brain tumor, aneurysm, or
whatever.  If you can get away without ever ordering imaging for a
patient with an obviously benign headache syndrome, I'd like to hear
what your magic is.

Every once in a while I am able to bypass imaging by getting an EEG.
Mind you, I don't think EEG is terribly sensitive for brain tumor,
but the patient feels like "something is being done" (as if the
hours I spent talking with and examining the patient were
"nothing"), the EEG has no ionizing radiation, it's *much* cheaper
than CT or MRI, and the EEG brings in some money to my department.
---
 . SLMR 2.1 . E-mail: jim.zisfein@factory.com (Jim Zisfein)
                                                                         
