a woman undergoing ct scan in front of a doctor

Peer Pressure Influences CT Scan Use for Dizziness/Vertigo Patients

It is usually believed that peer pressure ends when a person becomes an adult. But this is, unfortunately, not the case. Adults are just as much subject to peer pressure as children and youth. Peer pressure is when a person or group of people attempts to cause another person to conform to some type of uniform code. Peer pressure among adults can happen anywhere, even at workplace and in general work practices.

A new study published in the journal Medicine has shown that peer pressure among emergency physicians (EPs) plays an important role in the use of computed tomography (CT) imaging, also known as CT scan, for dizziness or vertigo patients. A team comprising researchers from Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Taiwan and Chang Gung University College of Medicine, Taoyuan City, Taiwan evaluated the effect of peer pressure on decision making in EPs to use CT scan for patients with dizziness/vertigo.

Dizziness is a common complaint in the emergency department (ED), accounting for 2.5% of all ED visits in the United States. While the most common causes of dizziness/vertigo are benign, a potentially serious underlying disease, such as cerebellar or brain stem stroke, may go unnoticed. Due to the uncertainty and cost of a misdiagnosis, EPs may reduce the testing threshold for brain imaging in handling these low-probability, high-morbidity situations. But unnecessary head CT examination may lead to prolonged ED stay, increased medical costs, and exposure to radiation (a potential carcinogen).

The use of CT imaging to examine patients presenting with dizziness has increased exceedingly, from 9.4% to 37.4% in the United States between 1995 and 2009. A previous study had showed that EPs vary in their respective decisions to either admit or discharge general ED patients. Senior EPs were found to have lower discharge rates compared with their junior colleagues.

The purpose of this study was, therefore, to evaluate the peer-pressure effect on the decisions of CT use for dizziness/vertigo patients by EPs with varying seniority. The EPs were categorized into 3 groups according to seniority. Group “>V12” consisted of 10 senior physicians with more than 12 years of work experience. Group “V7-V12” consisted of 9 physicians with 7 to 12 years of work experience (intermediate seniority). Group “<V7” consisted of 10 junior physicians with <7 years of work experience.

The study intervention used a behavior modifying measure by creating a “team norm” that imposed an unspoken peer pressure effect by announcing the CT-use rate of each EP by monthly e-mail reminders. Norms are the rules that the team agrees to follow and designate a standard for average performance by the whole team. Once developed, team norms are used to guide and shape team members’ behavior.

The authors explained, “To evaluate the effectiveness of peer pressure on changing EP decisions concerning CT use for dizziness/vertigo patients, we created a ‘team norm’ imposed peer-pressure effect by announcing the CT use rate of each EP through monthly e-mail reminders. We also conducted a before-and-after retrospective case review of patients who visited the ED.”

The study was conducted in a tertiary academic medical center in Southern Taiwan with over 2500 acute beds and an average of 72,000 adult ED visits per year. The medical records of nontraumatic patients who were older than 17 years of age and visited the ED with a principal diagnosis of dizziness and vertigo were extracted from the ED administrative database using the International Classifications of Diseases Tenth Revision coding system.

“Our study group consisted of 3165 patients; 1657 were enrolled in pre-intervention group while 1508 were enrolled in post-intervention group. Patients were assessed by the 29 EPs in the department,” the authors said.

The intervention strategy presented herein applied peer pressure through e-mail reminders. The findings of the study revealed a decrease in CT use for patients with isolated dizziness/vertigo, particularly among junior EPs and in younger patients. Although the study has a few limitations pertaining to the generalizability of its conclusions to other ED settings, the method used in this study offers a promising option that can effectively decrease CT use and unnecessary medical costs in ED.

Also read 10 Techniques to Help Your Child Resist Peer Pressure

teenagers smoking

10 Techniques to Help Your Child Resist Peer Pressure

As our kids grow, they experience an urge to fit in with their friends or peer. This desire to gel with the kids of their own age group, called peers is quite common among growing children. As they grow, they become more concerned about what others think of them, especially kids of their own age group. And in an attempt to seek approval from others, they engage in life-threatening activities like overspeeding or rash-driving or fall victims to risky behaviors like smoking, drug abuse, cheating, theft, etc. This feeling that one must do the same things as other kids of one’s age do, in order to be liked or be a part of their group is called peer pressure.

However, peer pressure is not always negative, it can be positive as well. A positive peer pressure is when the child is influenced to perform better at studies, or take part in activities like sports, or join drama club at school because all his or her friends are  doing so. When peer pressure is positive parents don’t have to worry. However if you suspect that your child is falling prey to negative peer pressure, you must not take it lightly and rather address it properly. As a parent your job is to help your child learn techniques to deal with peer pressure. Here are some of the techniques that you can use to help your child resist peer pressure:

1. Make your child understand what negative peer pressure is: Often children are unaware of the concept of peer pressure and how detrimental it can be to their overall wellbeing. Knowing how peer pressure works can help your child identify and defy it. Sometimes your child’s friends might be using the method of emotional blackmail to make him or her conform. Knowledge about peer pressure will help your child identify such situations and act rightly. For instance, when your child’s friends force him or her to go to a night party if he/she wants to remain part of the group, he/she will be better equipped to make the decision.

2. Lead by example: Like kids, adults too sometimes fall prey to peer pressure. When adults feel obliged to go on a vacation or buy some fancy dress just to maintain their status, that’s peer pressure. Kids observe their parents and follow what they see them doing. You are your child’s first teacher, and also his or her role model. Your child learns a lot from watching how you act. If the child sees you dealing with the peer pressure in a healthy and rational way, he/she would learn doing so. Set a good example for your children and let them learn from you how to resist peer pressure.

3. Know your child’s friends: It is important to know about your child’s friends to find out whether they are a bad influence or a good influence. Invite them over, interact with them, and try to understand their value system. Help your child understand about the qualities of good friends. Help your child understand that a friend who puts conditions cannot be a good friend.

4. Spend quality time with your child: As children grow, especially during adolescence, they start spending more time with their friends and less with their family. We as a parent, also sometimes become so busy with our daily responsibilities that we don’t find time to interact with our children; also sometimes we think that they don’t need that much care and attention, which is a misconception. As children enter adolescence, life challenges become more serious and the children often feel confused about how to deal with such challenges. Most children start smoking or try drugs or alcohol during adolescence in an attempt to become popular or look cool in front of their peers. Therefore, it becomes even more critical that you, as a parent, are there for your child. Make a schedule to spend some time with your child on a daily basis—may be a dinner together or going for a walk with your child, etc.

5. Communication: Keep communication channels open with your child. Let them know that they can come to you whenever they feel like and talk about anything with you. Have regular conversations with your child as you both spend some quality time together. Find teachable moments in your day-to-day conversations. Be a good listener, and hold yourself from overreacting if they share something alarming. Your reaction will determine the probability of whether they will share their secrets or problems with you in future.

6. Teach decision-making skills: Decision making is a skill that can be easily learned. Help your child learn this skill by giving situations where he or she needs to choose one option out of two or more. Teach your child the concept of pros and cons and how to weigh each option on pros and cons. You can give imaginary situations which involve decision-making and encourage your child to think through each option with possible future consequences. You can even use role-play to help your child better understand the situation and decision making involved.

7. Prepare response: It is often better to prepare some responses for a possible situation where the child might face peer pressure in advance so that these responses come handy. This is important in cases where the child is young and has not yet mastered the skill of resisting peer pressure. Sentences like, “Maybe some other time,” “Sorry, I have some work at home,” “Sorry, but I am not feeling well today, next time” can help your child instantly resist peer pressure. Make your child practice these sentences in role-play, like when someone asks him to drive, go for a night out, or to try smoking. Also teach assertiveness techniques to your child and how to say NO in such situations. Assertiveness requires practice; therefore, create role-plays to help your child master assertiveness.

8. Boost your child’s self-esteem: Children who are confident and have high and positive self-esteem are less likely to succumb to peer pressure because they don’t rely on others for acceptance. Build your child’s self-esteem by pointing out their strengths and by praising your child’s positive behaviors. Give them opportunity to voice their opinions and also value their opinions even if they sound incorrect or unrealistic. By respecting their views and opinion you will help them become more confident.

9. Hobbies: Encourage your child to take part in hobbies or activities other than studies. This will not only help your child gain positive self-esteem, but will also bring your child in contact with like-minded friends or better role models among peers.

Set healthy rules: Rules are very important provided they are healthy and not unreasonable. Rules not only help your child feel safe, they also give you, as a parent, a ready model of resisting pressure. When your child sees you refusing to give in to his or her unreasonable demands they also learn how to assert oneself under peer pressure and say no. Rules also provide order to the situations that are challenging. Setting limits for screen time, staying out at night, or going out for a party with friends are good examples of healthy rules.