Vignette: Patient with Headache Gets MRI, CT, and Other Tests—Is This Defensive Medicine or Good Medicine? Support, describe and explain your position.
The Scenario
- Gretchen Carlson, a former Miss America, has a very stressful job and small children to parent.
- Over the last several months, she has experienced random headaches.
- The headaches might be due to lack of sleep, eliminating caffeine from her diet, or job stress.
- Gretchen has tried increasing dosages of ibuprofen, as well as relaxation techniques she learned during the pageant.
- She never suffered from migraines and did not have a family history of debilitating headaches.
- Gretchen visited her primary care physician; she had a complete physical but the doctor could not find the cause of the headaches.
- The doctor referred Gretchen to a neurologist who also performed a battery of diagnostic tests.
- The neurologist had a colleague who was sued for malpractice after failing to order a CT scan for a patient with a headache; the patient died later that night of a ruptured aneurism.
- Another colleague was sued for malpractice by the parents of a child who hit his head while snowboarding.
- After the colleague sent the child home from the ER, the child later complained of dizziness and headaches and grew unresponsive. The child died later, and his parents sued the ER physician for malpractice.
- Despite “horror stories,” the neurologist did not want to waste money or expose Gretchen to unnecessary risk if there were other less costly methods of reaching a diagnosis for her headaches.
- The doctor carefully explored the literature and decided to “leave no stone unturned” in identifying the cause of the headaches and confirming it with the greatest possible certainty.
- He ordered a CT scan for Gretchen, which ultimately was negative for any abnormality.
- Not satisfied, he contemplated an MRI for further assessment.
- Then he remembered reading that a possible cause of headaches is food allergies.
- The doctor closely assessed Gretchen’s diet and required her to maintain a food intake journal.
- In consult with an allergist, a neurologist identified several foods that were possible causes.
- Once she stopped eating “flagged” food items, Gretchen’s headaches gradually disappeared.
