If you do not love flame wars, then you should never write or read a blog.  The current flame war has taught me several things:

1. Emergency physicians are quite defensive about CT scans
2. Emergency physicians spend a lot of time reading and writing blogs
3. Hospitalists are happy to pour gas on a fire
4. Sometimes my writing is not that good, and I am misunderstood

So let us extract some comments:

My former friend GruntDoc (by the way I meant that sarcastically, GruntDoc is a great blogger) writes:

I would be more amenable to your suggestion were it not so patently smug.

So I read an article and editorial in the Annals of Emergency Medicine (I have corrected by egregious error from the original post), and comment on this.  I see patients admitted to the hospital who have CT scans that clearly are not indicated.  Some emergency physicians make these errors frequently; other rarely make these errors.  In my post I do not blame emergency physicians, and clearly recognize the difficulty of their job.

As the accompanying editorial states:

As an independent specialty within the house of medicine, emergency medicine must accept the challenge of ensuring the appropriate use of high-cost imaging in our EDs.

Another reader writes:

The goals of internal medicine aren’t the same as emergency medicine.  Not only is emergency medicine required to work up what is the most likely diagnosis, but it must also rule out emergencies.  It’s the business of stuff that could kill you soon, and a good history and physical can only take you so far.

I beg to differ.  All physicians have the same goal, do what is best for the patient.  When a patient has 10 head CTs in one year, or 10 abdominal CTs in one year we are doing harm.  We have all seen this.

To me the challenge for emergency medicine is to do what the editorialists recommend:

As efforts to measure and control the use of imaging increase, emergency physicians must lead the way by developing a sound scientific basis for imaging and then testing and implementing effective, responsible measures at the bedside.

So please understand, some emergency physicians order too many CTs (probably not the flamers on this site).  This occurs due to many factors.  We should care because of the financial and health costs of excess CT scanning.

We differ on the causes and solutions.  I do not mean to attack emergency physicians in general, but rather the apparent tendency of some to order tests rather than take an adequate history.  So I brace myself for more flaming.