Losing weight has become a matter of life or death and counting calories, Weight Watcher points and fat grams hasn’t lessened the numbers of people affected. In 2010, more than 25 percent of Americans had pre-diabetes and another 1.9 million got a diabetes diagnosis, according to the U.S. Department of Health and Human Services.

The single most effective way for people to avoid the disease? Losing weight.

“The current obesity epidemic proves that the typical low-fat diet recommendations and low-calorie diets have not worked,” says Don Ochs, inventor of Mobanu Integrated Weight Loss Solution www.Mobanu.com, a physician-recommended system that tailors diet and exercise to an individual’s fat-burning chemistry. “America is eating less fat per capita than we did 30 years ago, yet obesity, diabetes and heart disease are all up.”

To drop the weight and keep it off, people need to get rid of their stored fat by eating fewer processed carbohydrates and the correct amount of protein, and by doing both high and low- intensity exercises, Ochs says.

Here are some of his suggestions for getting started:

• Eat what your ancestors ate – if it wasn’t available 10,000 years ago, you don’t need it now. Our bodies haven’t had time to adapt to the huge increase in processed carbohydrates over the past 100 years. These refined carbs kick up our blood sugar levels, which triggers insulin production, which results in fat storage. Avoid the regular no-no’s such as candy and soft drinks, but also stay away from sneaky, sugary condiments like ketchup; dried fruits, which have more concentrated sugar than their hydrated counterparts, and anything with high fructose corn syrup.
• Eat the right kind of fat – it’s good for you! Bad fats include trans fats and partially hydrogenated oils. Look for these on labels. Trim excess fat from meats and stick with mono- and poly-unsaturated fats. Use olive oil for cooking, as salad dressing or on vegetables. Eat avocados, whole olives, nuts and seeds, and don’t be afraid to jazz up meals with a little butter or cheese.
• Eat the proper amount of lean protein to maintain muscle mass and increase your metabolism. Eggs, beef, chicken, pork, seafood and dairy in the right amounts are good protein sources. Remember, most of these contain fat, so it shouldn’t be necessary to add more. Use the minimum amount needed to satisfy your taste buds. Also, anyone trying to lose weight should limit non-animal proteins, such as legumes, because they contribute to higher blood sugar levels and increased fat storage.
• Vary your workouts to speed up fat loss. Both high-intensity and low-intensity exercises play a role in maximum fat loss. Low-intensity exercise, like walking, is effective for reducing insulin resistance so you store less fat. Alternate walking with high-intensity interval training to build lean muscle mass and increase your metabolism. Interval training can be cardio blasts such as running up stairs on some days and lifting weights on others. This type of exercise forces your body to burn up its glycogen – a readily accessible fuel for your muscles – faster than an equivalent amount of cardio exercise. When you’re done, your body will replenish that fuel by converting stored fat back into glycogen and you’ll lose weight.

“Healthy weight loss isn’t about picking a popular diet and trying to stick to it,” Ochs says. “It’s about discovering the right diet for your unique body. For each person, the optimal amount of carbohydrates, proteins and exercise to burn the most stored body fat will be different. And that’s why one-size-fits-all diets just don’t work.”

Lisa Byrne (left) and Lisa Ganem

Q:  We celebrated the holidays at my mother-in-law’s home. I was shocked to see how much her living environment had changed since we were last there. I am not sure that she should be at home alone anymore. How do we talk to her about our worries?

Many adult children find it difficult to talk about their concerns for the well being of their aging parents. It’s hard to face the fact that your once strong, independent parents are no longer as capable as they once were. There are several key elements to having a constructive conversation that will ensure positive results; solutions that will best meet everyone’s needs.

1. Prior to the conversation gather input from siblings and discuss the importance of this conversation.
2. Do some homework about ways in which your parents can be supported in their home. Explore community resources; gather information but avoid the tendency of diagnosing the problem and determining a solution in a quick manner.
3. Start the conversation by acknowledging your parents’ desire to stay at home.
4. Approach the issue as a conversation and not a lecture.
5. Above all else, keep in mind that you are talking with your parents.  Do not use patronizing language or tone. Convey your respect for them and try to put yourself in their shoes.
6. Discuss what you have observed and stay focused on the facts. This can be an emotionally charged discussion for everyone.  It’s extremely easy to get swept up in the emotions and lose track of the specific concerns.
7. Remember, you have had time to think about your concerns and what you wish to say to your parents. Allow them the same opportunity. This conversation may simply open the door for communication and require additional discussions.
8. Ask your parents what they think of these observations. If you are fortunate, they will acknowledge the situation. In this case, encourage them to discuss and explore solutions together. If your parents don’t recognize any issues, again use concrete examples to support your concerns.

The ultimate goal of this conversation with your parents is to move toward solutions that will provide the maximum amount of independence for them. In looking for solutions, focus on their strengths and identify options for addressing challenges. Remember, this conversation is likely to be uncomfortable no matter when you have it. Sooner is always better than later. You want to avoid a crisis, and if you address issues as they arise, everyone will be better off.  Lastly, just because a senior is having more problems at home does not mean that it is time to look for an alternative living arrangement. There are many options that provide for high quality, cost efficient support in the comfort of their own home.

DALLAS, TX – Young patients with heart failure seeking treatment at Children’s Medical Center www.childrens.com) will not have to wait as long to receive a mechanical device designed to keep their hearts beating since the technology was officially approved by the U.S. Food and Drug Administration.

The mechanical cardiac assist device, commonly called a Berlin Heart, received FDA approval to be marketed under certain use restrictions. Up until now, the tool had been treated as an experimental device.

Known as Compassionate Care Use, artificial Berlin Hearts provide mechanical circulatory support, extending the life of heart patients for up to one year until an appropriate heart match is found. Since 2000, pediatric heart surgeons across the U.S. have had to appeal to the FDA for approval on a case-by-case basis under Emergency Use regulations because the Berlin Hearts were only approved for adult patients.

The FDA’s approval Friday will greatly benefit children with heart failure who need the tool to survive while they wait for heart transplants, one Children’s Medical Center physician said.

“For the ones who need it, it’s tremendous,” said Dr. William Scott, co-director of the Heart Center and director of the cardiology division at Children’s Medical Center. “Currently, the device is considered experimental. You can’t get it quickly and have to go through an (Institutional Review Board) protocol – so it’s been treated as if it was a research project.

“The fact that we don’t have to do that now – that we can turn around and get it as we would any other medical device – is tremendous,” said Scott, who is also a professor of pediatrics at the University of Texas Southwestern Medical Center and director of that institution’s cardiology division. “The ability to get it here will dramatically shorten the amount of time you wait.”

The Berlin Heart consists of one or two external air-driven blood pumps, multiple tubes to connect the pumps to the heart and a driving unit. There is no other device that will work on a young patient experiencing heart failure and needing a heart transplant, Scott said.

“I don’t think we will necessarily use it more,” Scott said of the device now that the FDA’s approval has been granted. “We’ve used it every time we needed to. It’s just that we will be able to get it more quickly now.”

Children’s Medical Center lauds the FDA for its approval of the devices. Children’s is one of the leading pediatric hospitals in the nation for heart transplants, and in the past year has had as many as five patients on the device at one time.

The device saved the life of Rylynn Riojas, a 2-year-old Children’s Medical Center patient who was in dire condition while waiting for a new heart. She received a Berlin Heart several months ago that will keep her alive while she waits for a heart transplant.

Manchester, NH – Dr. Howard Koh, MD, MPH, Assistant Secretary for Health of the United States Department of Health and Human Services, joined with the state health commissioners from Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont in Manchester, NH, to call on New England health and policy leaders to work together to accelerate progress on tobacco control and prevention.  The remarks were made just prior to Dr. Koh’s hosting of a New England Tobacco Town Hall which drew approximately 225 participants from the region.

Tobacco is the leading cause of preventable death in this country and in the region, killing 20,000 New Englanders each year.  While New England has been a leader in policies to prevent tobacco use, help smokers quit and reduce exposure to secondhand smoke, tobacco use continues to be all too prevalent among particular populations here and across the country, including low income adults (39.4% smoke nationally), the uninsured (35.5% smoke nationally) and military personnel (30.6% nationally) – all dramatically higher than the national smoking rate of 19.4% for adults. Annually, health care costs from tobacco amount to $1.63 billion in Connecticut, $602 million in Maine, $3.54 billion in Massachusetts, $564 million in New Hampshire, $506 million in Rhode Island and $233 million in Vermont.

While addressing the audience of tobacco control experts, health organizations, lawmakers, business leaders, and healthcare providers, Dr. Koh discussed both the urgency of ending the tobacco epidemic and the Obama Administration’s commitment helping tobacco users quit and preventing kids from starting.

“We have within our grasp the capacity to eliminate the harms from tobacco dependence in our society. We know how to end the tobacco epidemic and under President Obama’s leadership we are committed to advancing progress towards our shared goal of a society free of tobacco-related death and disease,” said Koh.

Dr. Jose Montero, New Hampshire’s Health Director thanked Dr. Koh and the attendees on behalf of his peers from the neighboring New England states.  As the senior public health official from the “host state” for this important convening, Dr. Montero said, “It was an honor to host the New England states for such an important event. The rates of tobacco use have been declining, but it is still a leading cause of death and disease in New England and we can and must do more to encourage people to quit and not start in the first place.”
In addition to those who attended the Town Hall in person, the event was webcast live to tobacco control and health experts throughout the country.

Attendees committed to working together to actualize a vision for dramatically reducing tobacco use in New England in order to save lives and decrease healthcare costs.

“The Mobilizing for Health research grants allow us to increase the evidence base for mobile health interventions,” said Carrie Varoquiers, President of the McKesson Foundation. “The use of mobile phones in healthcare seems very promising, especially in low-income populations with chronic diseases, but we need to better understand what works before these interventions can be scaled.”

The Center’s randomized, controlled clinical trial will integrate a text messaging program into an existing Diabetes Self-Management and Education (DSME) program at three of Massachusetts General Hospital’s community health centers representing medically underserved and low-income populations in the Boston area. The goal of this study is to assess the effect of personalized text messages on clinical outcomes and physical activity in patients with Type 2 Diabetes, many of whom are obese or have low levels of activity. Results will be measured by change in HbA1c (the clinical measure for blood sugar control), as well as patients’ engagement, usability and satisfaction with the program. This study will also use pedometers to measure physical activity, to better target messages to engage patients in behavior change to increase their activity levels.

Text messages will include coaching to improve activity levels, and reminder, educational and motivational messages to help patients meet their diabetes self-management goals. The text messages, offered in English or Spanish, will be personalized for each patient based on their initial stage of behavior change, or willingness to change behavior.

“While DSME programs have shown to reduce complications, improve diabetes self-management and quality of life, diabetic patients are likely to discontinue recommended behavior changes without ongoing support,” noted Kamal Jethwani, M.D., MPH, Lead Research Scientist, Center for Connected Health, and Principal Investigator for this study.

“By adding two key connected health cornerstones – objective data collection and targeted personalized feedback – we believe that patients will adopt new behaviors sooner and maintain healthy behavior for longer. And, because text messaging is a low-cost, widely available technology, we hope to improve the overall quality of diabetes management for a larger pool of patients.”

When preparing to leave a hospital’s Intensive Care Unit (ICU), decisions are needed regarding care.  Here’s what patients need to know to make informed choices, get home sooner, and maximize their recovery and quality of life.  For more information about how to choose the best rehab facility, visit www.chooseyourrehab.com.

Freedom of Choice

“Although they may not know it, patients have considerable say about where they go following discharge from ICUs,” says Deniz Ozel, M.D., medical director, New England Rehabilitation Hospital, a world class rehabilitative hospital located in Woburn, Massachusetts.  “Working with their case managers, they can become empowered and affect the decision-making process.”

Arthur Williams, M.D., medical director at Braintree Rehabilitation Hospital, another leading rehabilitative hospital in Braintree, Massachusetts, concurs.  “Case managers are uniquely qualified to understand a patient’s diagnosis, insurance coverage, and make recommendations for a discharge plan,” says Williams.  “It’s their job to find the right balance between medical care and rehabilitative therapy to help patients reach their goals and objectives.”

Typically, patients have three options:

• Skilled nursing facilities – offering less intensive rehabilitation therapy with management of non-complex medical issues;
• Long term acute hospitals – offering management of multiple system failure, with less focus on rehabilitation; and
• Inpatient rehabilitative facilities – offering intensive rehabilitation services, with management of complex medical issues.

Of these, inpatient rehabilitative facilities are dedicated to short-term rehabilitation, making them ideal for those who have suffered a significant medical event, yet are well enough to benefit from intensive therapy.

Patients with no prior rehab experience should network for recommendations.  The case manager also should be able to refer local providers.

Top Criteria

With referrals in hand, here’s what to ask:

1. How will the facility help me reach my goals?  Does it have success in treating my type of injury?   Look for a comprehensive plan of care.  Ask about specialty programs for your condition.
2. How much therapy will I receive?  Intensive programs offer a minimum of three hours of therapy a day, five days a week, or more.
3. Who will provide my care?  How often will I see a doctor or specialist?  Ask who will comprise your team and if physician oversight provided 24 hours a day, seven days a week.
4. What technology is available that will benefit me?  New devices incorporating functional electrical stimulation and robotics offer a track record of success.
5. How does the facility compare against the competition?  Ask about accreditations like those from The Joint Commission, use of Functional Independence Measure (FIM) scores to measure patient outcomes and assess quality, and patient satisfaction surveys.
6. Is the facility convenient to my family and friends?  Would traveling a little further for care at a rehabilitation hospital make more sense in the long run?  Suburban facilities may offer proximity, without the headache of negotiating downtown traffic and parking, in addition to equal quality of care.  Since most rehab is often short term, lasting two to three weeks, consider the care provided by a rehabilitation hospital, which may result in a higher level of function and greater independence.
7. How long do patients typically stay and when can I expect to go home?  Although each case is unique, the average length of stay at the best rehab facilities is 15 days, with 65% of discharged patients returning home.
8. What kind of support can I expect in preparing to go home or back to work?  Ongoing education by the facility’s staff, comprehensive discharge planning, and home assessments are key to recovery.
9. Are outpatient services available after discharge?  Continuum of care is essential and should include access to outpatient services and support groups.
10. Are tours available?  If so, take one and look beyond the menu, dŽcor, and equipment to consider the staff’s level of commitment and compassion.

To find out more about choosing the best facility for rehabilitative therapy, visit www.chooseyourrehab.com.

Durham, NC — Women are the fastest growing group among the Veteran population.  “The Women Veterans Health Program addresses the health care needs of women Veterans and works to ensure timely, equitable, high-quality, comprehensive health care services are provided in a sensitive and safe environment at VA health facilities nationwide,” said Shenekia Williams-Johnson, Women’s Veterans Program Manager.

“The program is the result of two decades of fine tuning and process improvements focused on becoming a national leader in the provision of health care for women.  All women who served should contact us to learn about the health care benefits they have earned.”

In FY11, VA’s Mid-Atlantic Health Care Network, which serves North Carolina and Virginia, and a portion of West Virginia, spent $2.7 million on privacy, security and dignity projects for women Veterans.

“We have added clinics, remodeled inpatient and outpatient areas of our medical centers and hired health care providers specifically to address needs of Women Veterans,” said Williams-Johnson.  “We now have the capacity to provide comprehensive primary care and high-quality preventive and clinical care to many more women.”

Rural and homebound Veterans can benefit from emerging technology that will deliver care remotely through new telehealth efforts, and home-based care services.  Similarly, women Veterans with mental illnesses can benefit through integration of mental health services within primary care, so that necessary treatment is provided in a comprehensive and coordinated way.

Additionally, aging women Veterans can benefit from the latest advances in medical science and technology to identify and address cardiovascular disease as well as advances in treatments for diabetes, osteoporosis, and menopause.

For more information about VA health care for women, please contact Kenya Graham, Women Veterans Outreach Coordinator for North Carolina, at (910) 272-3220 ext.1002, or Ruth Miller, Women Veterans Outreach Coordinator for Virginia, at (919) 491-9888.

Information can also be found at the Women Health Care link on the VA Web site at  www.womenshealth.va.gov.

When I went into solo practice of internal medicine in 1981, it was very easy to get a doctor to see a Medicare patient. All I had to do was make a phone call. A courteous receptionist answered. If the doctor couldn’t come to the phone right away, I could count on a prompt callback.

Consultants saw patients quickly, and generally called me to discuss their findings and advice. And very often there would also be a letter in the mail: “Thank you for referring this delightful patient to me.”

How things have changed! Now a doctor gets the phone menu, just as the patients do, and it often ends in voice mail. It might be a few days before a staff member calls back-usually with the news that “we are not accepting any new Medicare patients.” At best, my patient might be offered an appointment in several months.

One very fine gentleman, who had recently moved to a rural area, found it easier to fly to Tucson to see me than to get in to see a local internist. That was in 2009. Recently, he has become unable to travel, so I needed to find him a local doctor.

I tried to expedite matters by ordering him an immediate diagnostic test: an abdominal CT scan. I don’t think anyone could argue that it wasn’t indicated under the circumstances. One little problem: I am not enrolled in Medicare and don’t have the proper government-issued number to enter into the computer. A license to practice medicine is not enough. This National Provider Identifier (NPI) is supposed to protect the system against being defrauded. Without that number, the imaging facility could not get paid by Medicare.

“Why not use the radiologist’s number?” I asked. After all, he was the one who would get paid. Nope, a referral was required. How about a self-referral from the patient? Nope, we can’t allow patients to decide what tests they need. “The patient is willing to pay for his own test,” I said. Nope, if he’s on Medicare, they aren’t allowed to take his money.

They gave the patient 24 hours to find a properly enumerated doctor to countersign my order. Fortunately, he found a specialist willing to do so, and assume potential criminal liability for committing “waste, fraud, and abuse” by ordering a “medically unnecessary” study. (Fortunately for the patient, he turned out not to have cancer, but that could be bad news for the doctor.)

So this is the status of retired Americans. They can’t just walk into a facility and request a medical test, and pay for it with their very own money. A man may be qualified to pilot a 747 across the Pacific, but once he’s on Medicare, he is unfit to make an unsupervised decision about his own medical care.

I did find my patient a doctor. None of the internists within a 150-mile radius who “take Medicare” are willing to take on a new Medicare patient. But through the website of the Association of American Physicians and Surgeons (www.aapsonline.org), I found a link to the Medicare carrier’s list of opted out physicians. They don’t “take Medicare,” but many are pleased to see older patients, for a reasonable fee. There was one internist on the list, 150 miles from my patient. She has a courteous and helpful assistant who actually answers the phone, and told me the charge for a new patient visit: $300.

Things could be worse-and already are much worse in Canada. The “soul-destroying search for a family doctor” is described in the Globe and Mail on Aug 21. The Ontario government’s program called Health Care Connect manages to link only 60 percent of patients with a doctor-although you might find a concierge doctor for $3,000 a year.

That’s the cost of medicine when it’s “free”-if you can find it at all. If ObamaCare is implemented, all Americans will be in the same boat. And guess who will get thrown overboard first.

About the author/contributor:

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.

The Patient Safety Diamond devised by then ISAPS President, Dr. Foad Nahai (US), and presented at the ISAPS Congress in 2010 bases the concept of safe surgery on four factors:  the patient, the surgeon, the procedure and the facility.  The patient should be a good candidate for the requested surgery.  The surgeon must be properly trained and credentialed.  The procedure should be appropriate for the patient.  The surgical facility should be an accredited and a proven safe venue with properly trained staff and emergency preparedness.

When the World Health Organization (WHO) introduced the Safe Surgery Saves Lives initiative promoting their Surgical Safety Checklist www.who.int/patientsafety/safesurgery/en/ ISAPS was one of the initial endorsing organizations at the launch of this program in Washington, DC in June of 2008.  A recent study published in the New England Journal of Medicine showed that use of the 19-question checklist reduced surgical complications by more than one third and surgical deaths by almost half in the test hospitals as compared to control hospitals.  This simple form is used much as a pilot uses a check list before taking a plane onto a runway for takeoff.  Patients need to ask if their surgeon and hospital use this tool.

In 2006, current ISAPS President Dr. Joao C. Sampaio Goes (Brazil) developed “key guidelines” for those patients who do decide to travel for their surgery as posted on their website www.isaps.org  Several other organizations have since adapted these for their websites. Dr. Jan Poell (Switzerland), the current President of ISAPS, explains the need for this information as: “Consumers around the world have looked to ISAPS for over 40 years for the most accurate and reliable information about qualified plastic surgeons and advice about procedures. ISAPS provides a worldwide standard for consumers to reference when traveling for aesthetic plastic surgery.”

There is a misconception that anyone with an MD can safely perform any surgical procedure.  Legislation around the world is changing to reflect a growing concern that patients are being treated surgically by incompetent and untrained individuals – sometimes not even physicians.  As described in the current issue of ISAPS News, several countries including Italy, Russia, Mexico, Colombia and Canada are leading the way with new regulations controlling who can perform what specific procedure on which patients and in what facility.  This is also the case in Denmark, a front-runner in strict regulation of all private medical clinics and surgical facilities – indeed closing some that were sub-standard.  Similarly, Germany and France have had strict regulations for many years.  Under the auspices of the ComitŽ EuropŽen de Normalisation (CEN), a Europe-wide effort is currently underway to set standards that will protect plastic surgery patients.

A new insurance program developed in the UK, endorsed by ISAPS and underwritten by Lloyd’s of London, the first of its kind in the world, provides complications insurance for plastic surgeons globally to help protect their patients.  This insurance is only available if the surgeon is a member of ISAPS.  A directory of surgeons already participating in this program is now available at www.surgeryshield.com  A second insurance product for patients about to be launched in the UK will expand to other countries later.  Coverage will include travel insurance and will respond in cases of complications from aesthetic surgery either at home or abroad.  This new insurance program requires that patients are screened at home before traveling abroad for surgery to be sure they are appropriate candidates for the procedure they seek.  The intention is that a consultation with a surgeon at home will provide counseling against travel for complicated surgical procedures.  The insurance will only respond if surgical complications of surgery by one ISAPS member surgeon are treated either by that same surgeon or by another ISAPS member surgeon.  A patient requiring remedial or corrective treatment once back in their country of residence will be directed to an ISAPS surgeon approved to carry out the specific treatment indicated.

It is important to stress that complications are not malpractice.  Complications of plastic surgery can result in hematomas, post-surgical infection, slow wound drainage or healing problems, tissue necrosis, or suture dehiscence.   Some complications have very poor or no resolution and these results can never be corrected.

Ms. Foss reports that the number of patients contacting her office to check on surgeons’ credentials shows a growing sophistication among patients who want assurance that their surgeon is properly trained and competent. “The international medical community has a lot of work to do to educate patients that they have the right to ask if their surgeon is a member of their National Society, is board certified (or the equivalent) and is trained to perform the specific procedure the patient wants.”  The number of cases where patients suffer at the hands of incompetent doctors, or doctors attempting procedures they are not properly trained to perform, points to this growing need to educate the public about their own surgical safety.  No surgery should be taken lightly.  Traveling abroad for surgery just to save money can lead to poor outcomes, often with avoidable complications, little or no recourse to return for additional treatment, and sometimes resulting in tragic consequences.

The forty-one year old International Society of Aesthetic Plastic Surgery is the largest international society of individual plastic surgeons with 2,003 current members in 92 countries, and growing by more than 200 members each year.  Surgeons undergo a strict application process to determine their qualifications to join the society.

The ISAPS mission is twofold: the continuing education of plastic surgeons in latest techniques in the field of aesthetic (cosmetic) surgery and medicine – and the promotion of patient safety.

“Almost one-quarter of CT scans performed in the U.S. are performed in ERs, in part because primary care and other physicians refer their patients there for these studies and also because we are increasingly being asked to do all the initial tests for patients in the ER before a patient is admitted to the hospital,” said lead study author Keith Kocher, MD, MPH, of the University of Michigan in Ann Arbor.  “We saw a more dramatic rise in CT use among older patients.  But we also saw an associated decline in post-CT hospitalizations.”

Assessing emergency department visits from 1996 to 2007, researchers found an increase of CT use from 3.2 percent of patient visits to 13.9 percent.  Rates of growth were highest for abdominal pain, flank pain, chest pain and shortness of breath, all of which can be symptoms of life-threatening emergencies.

In 1996, the rate of hospitalization following CT scan was 26 percent.  By the end of the study period, 2007, that rate had dropped by more than half to 12.1 percent.  Researchers found a similar pattern of declining risk of admission or transfer to intensive care units during the period.

In an editorial accompanying the study, Dr. Robert Wears, MD, MS of the University of Florida Health Science Center offered “the desire for greater certainty” among emergency physicians as one reason for the increase, particularly in light of the high-risk environment of the emergency department and the potential for litigation by patients with bad outcomes.

“The occasional ‘near miss,’ where one manages a patient without imaging, only to discover later that they had CT-detectable pathology of some sort that could have been detected sooner reinforces the desire for greater certainty,” said Dr. Wears.

CT scans are powerful and provide a lot of information quickly that can be especially useful in the emergency department where patients are often very sick and time is critical.  CT scans allow doctors to arrive at a diagnosis quickly.

A 2010 study showed that patients with abdominal pain express more confidence in their medical treatment if it includes a CT scan.  Dr. Kocher suggests that patients and families ask if a CT scan is necessary, given some of the risks related to radiation exposure from these tests:

“Patients or their family members sometimes want – or even expect – these advanced tests to be done, so emergency physicians may be more likely to order them,” said Dr. Kocher.  “I encourage patients and their families to ask the provider if they think the scan is really necessary.  This allows open discussion about the necessity of the test and the patient’s or family’s expectations, and allows patients to be more involved in decision-making around their care.”