Re: A question of ethics

[Kevin Donohoe <kjd@nucmed.bih.harvard.edu>]

Al Tschaeche wrote:

> Let's have the federal government require all risks of medical radiation
> exposure to be fully explained to every nuclear medicine and radiology
> patient.  

1) How can physicians "fully explain" the risks of diagnostic radiation 
procedures when the HPs, who deal with radiobiology all the time, can't 
even agree about what the risks are, if any? 

2) A large majority of patients do not question the need for 
their diagnostic exposure to radiation.  Going through a long 
explanation of LNT, hormesis, BEIR V, etc. with most of these patients 
will do more harm than good.

3) The few patients that do question their radiation exposure certainly 
deserve an answer.  But as #1 suggests, many times the answer is inexact 
and that is particularly frustrating to those who want a "yes" or "no" 
answer.  Dose is relatively easy to come up with.  What the numbers mean 
is another matter.

4) Comparing risk from an unfamiliar hazard (e.g., radiation) to that of 
a familiar hazard (driving an automobile, etc.) is often unacceptible to 
many patients.  They think they have control over the car they are 
driving and they feel they do not have control over the radiation.  
Offering a simple explanation, and especially putting it in perspective 
of the risk of alternative procedures, or of NOT having the test done 
provides the patient with some feeling of control.  In most cases, they 
will elect to proceed with the test. If they do not, that is certainly 
their perogative, but in that case it is frustrating to see them put 
themselves at greater risk because of a radiation phobia that has been 
perpetuated through the sensationalistic media.

Kevin Donohoe, M.D.
Div of Nuclear Medicine
Beth Israel Hospital, Boston
kjd@nucmed.bih.harvard.edu