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RE: re:RE: Mammography Doses
Dear Mr. Weaver:
You misunderstand me. If asked by a patient for a radiation dose estimate, I
would not say "trust me, I'm a doctor", but rather I would provide the answer
or would look up the answer. I go out of my way to communicate with patients
as effectively as possible, primarily because it is good medicine, but also
because it is good malpractice-risk management, exactly as you noted. On the
other hand, it is simply not cost-effective for technologists or radiologists
to carry anything more than dose ranges of common procedures in their heads,
because there are far more important details they need to be concerned with
than examination dosimetry. A technologist should be far more concerned with
making the patient generally comfortable and with operating the machine
properly and obtaining high quality images to minimize the retake rate. A
radiologist who knew the dose, but always got the diagnosis wrong would be a
far greater hazard to the public health and safety than vice versa.
Reassurance provided to a patient by a health professional that a procedure
involves a relatively low radiation exposure is a satisfactory answer to >99%
of patients. It is not a deceptive answer. The remaining <1% (probably all of
whom are health physicists) are indeeed entitled to the information they are
requesting, but the cost and inconvenience of providing that information must
be ALARA. One must draw the line somewhere, and actual measurement of
individual patient doses because the patient insists on it is where I would
draw the line.
There are brochures available that nicely describe the radiation risk/benefit
trade-offs for diagnostic examinations. Many radiologists and nuclear
physicians provide these in their waiting rooms. Again, these are generic
documents and will usually not address specific doses, but as noted above, most
patients want general reassurance, not a regulatory impact analysis.
Barry Siegel, M.D.
_______________________________________________________________________________
From: radsafe@romulus.ehs.uiuc.edu on 8 Nov 1994 15:32
Subject: re:RE: Mammography Doses
To: Multiple recipients of list
Dear Dr. Seigel,
You know, I have considered what my reply to your letter should be. On one
hand, my gut reaction is to write a "flame"; however, it would probably
generate nothing but momentary satisfaction for me. It would certainly not
lead to my objective. So, here is something else:
When a patient asks about radiation dose or other hazard, they are entitled to
have something more than "trust me, I know more than you do." The reasons are
two-fold: it decreases outrage and it decreases lawsuits. As you probably
know, outrage is a real force in this world. It is made worse by industrial
(non-natural), unknowable, involuntary processes delivered by uncompassionate
persons to vulnerable populations. Although you perceive (and quite rightly
IMHO) that the hazard of the treatment or diagnostic procedure is low, the
outrage of irradiating the breasts or gonads and then refusing to gently and
briefly educate the person is *ENORMOUS*.
We hear that the high cost of medicine is due, in part, to the cost of
malpractice insurance. Perhaps, attitude of the care-giver can effect whether
or not that lawsuit is brought. I am not in medicine, you tell me.
As far as educating the public taking time and insurance companies not
helping, I would think a brocure with doses and risks might help. Maybe the
big insurance companies would be willing to put such a pamphlet out with our
help. Maybe not.
We in the nuclear industry have waited a long time to listen to our customers'
fears about what we do. We are suffering the result of that hesitation.
Medical radiation may well find itself soon in the same unhappy boat.
In service to Science,
J. Ellsworth Weaver
Rad. Pro Instructor Diablo Canyon Power Plant
119/2/247 PO Box 56
Avila Beach, California, USA 93424
Phone: (805) 545-3029 Fax (805) 545-3545
email: JEW1@PGE.COM or DrNucleus@AOL.COM
Public key available on request
<Mandatory disclaimer: This correspondence in no way reflects anything of
Pacific Gas & Electric>
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Subject: re:RE: Mammography Doses
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