All of this 1000%. Its almost like Im talking to my buddy wh is an ER doc.
I didnt say that, but they are costly overkill. The ER always orders at least one, even though ultrasound can make the diagnosis without radiation exposure. But truth be told, you can usually diagnose stones based on a good history, exam and urinalysis - it wouldnt surprise me if the CT was ordered before his urine was even collected.
Cloacas case is a perfect example of the problems with our healthcare system. He got an ultrasound to exclude testicular torsion (an uncommon diagnosis in middle aged men), then a CT to diagnose stones, and his urologist has suggested a second, more high tech CT to tell what type of stone. Or he doesnt even care, because more kidney stones = more urologic procedures = more $$$. And he got two prescriptions, one for an addictive pain medication which may slow stone passage, and a second which has been shown NOT to alter the natural history of the disease. https://first10em.com/meltzer-2018/
But Cloaca cant be expected to know any better, and probably thinks he received excellent care. His insurance will pay the lions share of the egregiously overpriced, largely unnecessary work up, he doesnt feel any immediate effects from the unnecessary radiation, and hell continue to take medications which arent helping the situation, all leading up to a urologic procedure(s).
Meanwhile, TBB is probably getting more appropriate care in a developing world country, and we wonder why we spend ~18% of our GDP on healthcare.
I refused a CT my last trip to the ER. And they absolutely wanted it before urinalysis. No blood in urine,no signs of infection in urine. The torodol had done its job and the stone was out of the ureter. I followed up with my doc and he gave me torodol to keep at home for the next one.
Also, the one time I took Flomax, it actually took the longest to pass the stone. Also, it gave me retrograde ejac. No good.