ObjectivesTo establish if emergency medicine and neuroscience specialist consultants have different risk tolerances for investigation of suspected spontaneous subarachnoid haemorrhage (SAH), and to establish if their risk–benefit appraisals concur with current guidelines.Setting4 major neuroscience centres in London.Participants58 consultants in emergency medicine and neuroscience specialities (neurology, neurosurgery and neuroradiology) participated in an anonymous survey.Primary and secondary outcome measuresThe primary outcome measure was the highest stated acceptable risk of missing SAH in the neurologically intact patient presenting with sudden onset headache. Secondary outcome measures included agreement with guideline recommendations, risk/benefit appraisal and required performance of diagnostic tests, including lumbar puncture.ResultsEmergency department clinicians accepted almost 3 times the risk of a missed SAH diagnosis compared with the neuroscience specialists (2.8% vs 1.1%; p=0.02), were more likely to accept a higher risk of missed diagnosis for the benefit of a non-invasive test (p=0.04) and were more likely to disagree with current published guidelines stipulating the need for LP in all CT-negative cases (p=0.001).ConclusionsDivergence from recognised procedures for SAH investigation is often criticised and attributed to a lack of knowledge of guidelines. This study indicates that divergence from guidelines may be explained by alternative risk–benefit appraisals made by doctors with their patients. Guideline recommendations may gain wider acceptance if they accommodate the requirements of the doctors and patients using them. Further study of clinical risk tolerance may help explain patterns of diagnostic test use and other variations in healthcare delivery.

Background: Healthcare expenditure is becoming a point of discussion in the recent past. Cardiac problems are the major non-communicable disease burden in the society. Health insurance play a major role to share individual health risks and there by provide better access to health care. In this study an attempt was made to find out the level of awareness of health insurance policies among cardiac patients in a tertiary care hospital.Methods: One hundred and twenty patients were surveyed using a pretested questionnaire comprising of thirty different questions related to health insurance. Simple statistical test and Chi square test was used to assess the association between the variables.Results: Only 41% were aware of health insurance among non-insured patients (n=100). It was found that only 16.7% (N=20) had chosen insurance policy and reason for having taken insurance was to cater to the huge medical expenses (14.2%). 45% patients were opted Insurance due to low premium and good reputation. Majority (42.5%) meet their medical expenses from salary. It was found that majority (55%) were satisfied with the insurance.Conclusions: It is found that less than one fifth of the patients opted for health insurance policy, which is very low. The level of awareness about insurance among the non-insured is also very poor. Study concluded that the awareness of health insurance is very poor especially in rural and semi-rural areas. Continuous awareness creation is needed to enhance the health insurance benefits and various features.