Reply to the Letter to the Editor: “Did medical doctors who order abdominal CT scans during on-call hours truly become worse at clinical reasoning? Yes, they did”

by Did medical doctors who order abdominal CT scans during on-call hours truly become worse at clinical reasoning? Yes, they did (thomaskwee@gmail.com)

Did medical doctors who order abdominal CT scans during on-call hours truly become worse at clinical reasoning? Yes, they did

Dear Editor,

We thank Sikkens and Thijs for their thoughtful comments. In a multiple regression analysis, the year in which the CT scan was performed was significantly negatively associated (β coefficient of -2.039, p = 0.017) and the number of CT scans performed per year based on the randomly drawn sample was significantly positively associated (β coefficient of 0.625, p = 0.035) with the clinical reasoning quality (the latter expressed as the concordance between the differential diagnoses on the CT request form and the CT result).

When ordering abdominal CT in our hospital during on-call hours, the referring physician both calls the attending radiology resident or radiologist to explain the case and the differential diagnosis, and submits a digital request form. We know from our own direct clinical experience that the differential diagnosis on the CT request form almost always matches the verbally provided differential diagnosis in this specific setting (i.e. requests for abdominal CT scanning at our tertiary care center during on-call hours). Based on our results, we think that it is important to reflect on both the too liberal use of CT scans (don’t scan because we can) and the clinical reasoning quality. Further research is required to confirm our results and, most importantly, to critically evaluate the use of imaging in the current era.