Medical Insider: Why Belly Pain Is a Headache for ER Docs

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Belly pain is the emergency room doctor’s booby prize. Invariably, care involves dealing with bodily fluids, internal exams and a dizzying array of diagnostic tests and therapies. Diagnosis is not easy. As Dr. Zachary F. Meisel writes: “Patients also expect a diagnosis from a doctor, but when it comes to belly pain, you don’t always get one.”
In this week’s Medical Insider column, Meisel explains why belly pain is not only so hard to manage in the ER, but also why it costs the health-care system so much:

First, it’s a bit of a black box. Conditions that cause it can be immediately life-threatening (such as a leaking aortic aneurysm or a ruptured ectopic pregnancy) or painful but not all that serious (intestinal cramps or ruptured ovarian cysts) or somewhere in between. The CDC estimates that about 17% of all ER visits for abdominal pain are due to what it classifies as “serious diagnoses.”

Second, the tools we use to look in that black box are far from perfect. Take the CT scan — the two-dimensional X-ray is one of the most commonly ordered ER tests for patients with belly pain. The pros: CT scans are readily available, able to look at every organ in the abdomen and pelvis, and very good for ruling out many of the immediately life-threatening causes of belly pain. CT scans can also reduce the need for exploratory surgery. The cons: Often, CTs can’t diagnose the actual cause of ER patients’ abdominal pain. Worse, CTs deliver significant doses of radiation to a patient’s abdomen and pelvis (equivalent to between 100 and 250 chest X-rays). Over a lifetime, patients who receive two or three abdominal CT scans are exposed to more radiation than many Hiroshima survivors.

Despite these imprecise diagnostic tools, the pressure is on for doctors to solve these medical mysteries: missed diagnoses after episodes of abdominal pain are among the most common circumstances for malpractice suits, Meisel writes.

Read the full Medical Insider column here.

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