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Appendicitis & CT

trauma-list@trauma.org trauma-list@trauma.org
Sat, 26 Apr 2003 09:59:36 +0200 

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Dear Doc Rick Fry
Would you kindly send me the references which you have indicated in your =
reply. ( below "   The use of CT has done NOTHING to improve diagnosis, =
reduce hospital stay, reduce morbidity, --it CERTAINLY increases =
costs--from diseases presenting with acute abdominal pain, over a large =
population.  IF you assert otherwise, please refer us all to the =
citation demonstrating such?  I will be happy to refer you to the data =
(for about the fourth time in the last 2 weeks) showing it has made no =
difference in a statewide population
ERF ")
Thank you.
Mike H MD
hey@dadlnet.dk


  ----- Original Message -----=20
  From: DocRickFry@aol.com=20
  To: trauma-list@trauma.org=20
  Sent: Friday, April 25, 2003 2:02 AM
  Subject: Re: Appendicitis & CT


  In a message dated 4/23/2003 11:49:16 PM Eastern Daylight Time, =
pandanas@OregonFAST.net writes:


    Now, my question is, as a non surgeon, in a acute abdomen of non =
clear
    etiology, what do you do? to CT or not CT?



  You examine the patient (pretty novel, huh?), order a minimum of =
simple tests (maybe WBC, lipase, CXR, KUB), and then--use some clinical =
acumen.  And guess what?  In the great majority of these cases, nothing =
more is necessary!  Surprised?  If so, you need a lot more experience =
with the acute abdomen and surgical diseases--and ordering more =
expensive and exotic tests does not substitute for some thinking, =
reading, studying and clinical experience.  It is done because the =
former is much easier, and usually only by those who have no =
responsibility for the ultimate care and welfare of the patient.  You =
must remember--before about 20 years ago there was no CT---and guess =
what?  The diagnosis of the acute abdomen was no different!  The use of =
CT has done NOTHING to improve diagnosis, reduce hospital stay, reduce =
morbidity, --it CERTAINLY increases costs--from diseases presenting with =
acute abdominal pain, over a large population.  IF you assert otherwise, =
please refer us all to the citation demonstrating such?  I will be happy =
to refer you to the data (for about the fourth time in the last 2 weeks) =
showing it has made no difference in a statewide population
  ERF 
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<BODY bgColor=3D#ffffff>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><STRONG>Dear Doc Rick=20
Fry</STRONG></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff><STRONG><FONT size=3D2>Would you =
kindly send=20
me the references which you have indicated in your reply.</FONT> <FONT=20
size=3D2>(&nbsp;below " </FONT></STRONG><FONT color=3D#000000><FONT =
size=3D2>&nbsp;=20
The use of CT has done NOTHING to improve diagnosis, reduce hospital =
stay,=20
reduce morbidity, --it CERTAINLY increases costs--from diseases =
presenting with=20
acute abdominal pain, over a large population.&nbsp; IF you assert =
otherwise,=20
please refer us all to the citation demonstrating such?&nbsp; I will be =
happy to=20
refer you to the data (for about the fourth time in the last 2 weeks) =
showing it=20
has made no difference in a statewide population<BR>ERF</FONT>=20
</FONT><STRONG><FONT color=3D#0000ff =
size=3D2>")</FONT></STRONG></FONT></DIV>
<DIV><STRONG><FONT face=3DArial color=3D#0000ff size=3D2>Thank=20
you.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DArial color=3D#0000ff size=3D2>Mike H=20
MD</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DArial color=3D#0000ff=20
size=3D2>hey@dadlnet.dk</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DArial color=3D#0000ff =
size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><FONT face=3DArial color=3D#0000ff></FONT>&nbsp;</DIV>
<BLOCKQUOTE=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3DDocRickFry@aol.com=20
  href=3D"mailto:DocRickFry@aol.com">DocRickFry@aol.com</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Friday, April 25, 2003 =
2:02=20
AM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: Appendicitis &amp; =
CT</DIV>
  <DIV><FONT face=3DArial></FONT><FONT =
face=3DArial></FONT><BR></DIV><FONT=20
  face=3Darial,helvetica><FONT lang=3D0 face=3DArial size=3D2 =
FAMILY=3D"SANSSERIF">In a=20
  message dated 4/23/2003 11:49:16 PM Eastern Daylight Time, <A=20
  href=3D"mailto:pandanas@OregonFAST.net">pandanas@OregonFAST.net</A>=20
  writes:<BR><BR>
  <BLOCKQUOTE=20
  style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #0000ff 2px =
solid; MARGIN-RIGHT: 0px"=20
  TYPE=3D"CITE">Now, my question is, as a non surgeon, in a acute =
abdomen of non=20
    clear<BR>etiology, what do you do? to CT or not=20
  CT?<BR></BLOCKQUOTE><BR><BR>You examine the patient (pretty novel, =
huh?),=20
  order a minimum of simple tests (maybe WBC, lipase, CXR, KUB), and =
then--use=20
  some clinical acumen.&nbsp; And guess what?&nbsp; In the great =
majority of=20
  these cases, nothing more is necessary!&nbsp; Surprised?&nbsp; If so, =
you need=20
  a lot more experience with the acute abdomen and surgical =
diseases--and=20
  ordering more expensive and exotic tests does not substitute for some=20
  thinking, reading, studying and clinical experience.&nbsp; It is done =
because=20
  the former is much easier, and usually only by those who have no=20
  responsibility for the ultimate care and welfare of the patient.&nbsp; =
You=20
  must remember--before about 20 years ago there was no CT---and guess=20
  what?&nbsp; The diagnosis of the acute abdomen was no different!&nbsp; =
The use=20
  of CT has done NOTHING to improve diagnosis, reduce hospital stay, =
reduce=20
  morbidity, --it CERTAINLY increases costs--from diseases presenting =
with acute=20
  abdominal pain, over a large population.&nbsp; IF you assert =
otherwise, please=20
  refer us all to the citation demonstrating such?&nbsp; I will be happy =
to=20
  refer you to the data (for about the fourth time in the last 2 weeks) =
showing=20
  it has made no difference in a statewide population<BR>ERF</FONT>=20
</FONT></BLOCKQUOTE></BODY></HTML>

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