One of the paradoxes of working in hospital medicine is that my actions becomes less relevant to patients the more experience I gain. More than 25 years ago, even as a medical student, I could make a difference to the outcome of a patients illness. Now I just seem to investigate patients where, either the diagnosis is already known or, if not known, the knowledge would not benefit the patient in any way.
A typical example today in a baby. Now I admit to not knowing much about babies. I really can't remember anything about my paediatric attachment as a student except that the childrens' hospital staff restaurant was rather good. I also seemed to have missed the nappy years of my own children-lost in a mist of sleep deprivation and long days at work but I was surprised at the referral I received today.
I suppose the referrer was following the recently rediscovered ancient Hippocratic principles of one investigation good; two investigations better and no one has ever been sued for asking for too many investigations but when a child came down for an ultrasound scan of its nappy rash I did wonder whether it needed a Consultant Radiologist to make this diagnosis. Of course the parents expectations had been raised by the prospect of the scan revealing all and, rather than ending up with disgruntled parents, it was easier to pretend to do the scan and announce that I did not think it was anything serious. At least it has saved the baby from an MRI scan (well I hope it has but I might be surprised tomorrow).
From my point of view it is easier to agree to do a scan, however pointless, than argue with the referrer or patient. In most cases even the unnecessary radiation is hardly a consideration as the life expectancy of most of the patients we investigate is weeks rather than years.
Contrary to popular belief there is no shortage of radiologists or scanners but the number of ridiculous requests just keeps increasing at a faster rate than we can clear them. And the more we try to improve access the more silly requests we get.