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How to make less more: empathy can fill the gap left by reducing unnecessary care

BMJ 2015; 351 doi: (Published 04 November 2015) Cite this as: BMJ 2015;351:h5831
  1. Edward R Melnick, assistant professor, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
  1. edward.melnick{at}

Sometimes no alternative, conservative option exists, writes Edward R Melnick

“But how can you be sure, doctor?” the patient asked. “Wouldn’t it help to get a CT scan? Just to be sure.”

My heart sank: another patient here for a scan—not for my expertise and recommendations. On the basis of my evaluation, she had sustained a concussion caused by a low risk minor head injury. Good evidence indicates that computed tomography (CT) would be negative for clinically important injury.1

“Could I have a concussion?” she asked.

“You can’t see a concussion on a CT scan,” I explained. We discussed what a concussion is and what to expect after leaving the emergency department. A conversation followed; I listened to her concerns and addressed them. She looked relieved. Would a normal CT scan have given her the same reassurance?

In regions of the United States where people receive more healthcare services, some measures of health are worse.2 Less …

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