Radiology Tech: "So, you want regular c-spine films or a CAT scan?"
Me: "Well..the scan would give a little more detail, but it costs a lot more.."
Radiology Tech: "You're the only one who cares."
He wasn't really kidding either. The patient did not care, it was the too common scenario of alcohol and a very vague history. The hospital sort of cares, they keep reminding me about the costs, but actually once the capital expense of buying the scanner is made, it really does not expend more of their resources to do one or the other.
So I do care, but find several facets of myself in debate.
Professional Self: "Sure the odds of the scan showing something more significant are 1/1000, but we often pursue long shots. And we do have to prevent harm where we can."
Academic Professional Self: "Well, OK this time, but easy on the scans for kids, remember that lifetime radiation exposure."
Frugal Self: "It does cost four times as much. On paper anyway."
Responsible Citizen Self: "So, do you want to take a 1/1000 chance of missing something bad, losing a big malpractice case and converting a large chunk of societal resources into their life time bar tab?"
It is a hard world for purists.