MRI's and MRA's and all our toys are good. They can see stuff we never could, even 5-10 years ago. So, as they get better, they find more.
But that's not always good
I have a lady in her mid-70's. A few years ago her internist did a brain scan on her and found a small aneurysm. It wasn't related to her symptoms, but since he didn't know what to do with it, he sent her to me.
I reassured her that it wasn't anything. But, since some small aneurysms will grow into large ones, I'm stuck following it. Otherwise, if she drops dead of a ruptured aneurysm at some point, her family can sue me because I didn't look to see if it was getting bigger. CYA. This is defensive medicine at its finest, and, once you've been sued, you'll practice it, too.
Of course, she could refuse the test, but most people don't. As long as it's covered by their insurance, why the hell not?
So every few years I order a repeat study, though at this point it's starting to get silly. I mean, even if it were growing, surgery at this point would pose a bigger danger to her than the aneurysm. But she wants the test, her daughters want the test, and my personal feelings take a back seat to covering myself.
The repeat study this year was, of course, unchanged. Fine. I sent her a letter saying we'd repeat it in 3 years.
I got a call a few days later... from the hospital, asking me to come see her.
Leaving the MRI place she'd fallen while getting in her car, breaking her hip. Which needed surgery. So now she's in the hospital, post-op, and completely whacked out from unfamiliar surroundings and pain meds. So they needed a neurologist to come see her.
Am I medically or legally, at fault for this? Not really. But I still feel guilty about it. I mean, she could also have fallen at the grocery store or walking to her bathroom, with the same outcome. But, instead, she fell while having a test that I wasn't even sure was needed, but was somewhat obligated to order. Yes, she and her daughters insisted on having the scan, so it's their decision, too.
But I still feel bad. Because of guidelines and defensive medicine a nice older lady had a scan she didn't necessarily need, and in an odd way suffered a complication of it.
Will this change how I practice? Probably not. The culture of defensive medicine is so ingrained into American physicians that it's hard to do otherwise. But stories like this make me wonder what the real cost of it can be.