When I was a medical student, I worked with a doctor who lied. One day, she lied by ordering a kidney stone CT scan on a patient whom she thought had appendicitis.
Let me explain. I was working in the emergency department with this physician
Here was the rub: the type of CT scan used for possible appendicitis cases — a CT scan with contrast — is a time consuming process. The patient has to drink a container of contrast, or dye, then keep it down without vomiting until the stuff makes its way through the intestines. This is a problem — it could take hours to complete a CT scan for appendicitis. But in Dr Fibber’s patient’s case, the surgeons and the operating rooms were available at that moment , and could have gotten pulled into a more urgent situation at any time. To top it off, our patient was feeling progressively worse; Dr. Fibber worried that he wouldn’t get the contrast down anyway or that his appendix would rupture. Assuming he did have an inflamed appendix, the patient would be better off if he received surgery sooner than later.
This is when Dr. Fibber lied by ordering a CT without contrast for our patient. A non-contrast CT scan is quick, doesn’t require intravenous or oral contrast and is pretty good, though not great, for looking at the appendix. By claiming that she wanted to look for a kidney stone — she was able to get our patient the no-contrast scan.
“Your patient does not have a kidney stone,” the radiologist who was looking at the CT scan images sanctimoniously told my teacher. “He has appendicitis — his appendix is severely inflamed. What made you think it was a kidney stone?”
“I didn’t,” said Dr. Fibber. “You confirmed my suspicion.”
As she hung up the phone, she turned to me and explained: “My pre-test suspicion for appendicitis was very high for this patient. Alone, the CT scan without contrast isn’t quite as good as one with contrast. But an imperfect test, combined with a very high likelihood of appendicitis was enough to confirm it.”
