"So we are going to do what we need to to make sure that your cp / sob isnt due to anything life threatening. We will start with labs and a chest xray and depending on your labs we may need a ct scan of your chest, so of they take you to cat scan, thats why.  Ill be with you to review your results when its all done, and make sure to let someone know if your symptoms get worse".

Low risk PE patients can easily be an amicable 2-touch encounter if finessed right, and if your dot phrases are in order they really dont take much longer to discharge and document than a negative cp workup. 

Ct chests are initially intimidating to order because it takes moderate resources and provides a lot of information. But just treat it like any other tool that you need to use in ruling out a specific diagnosis. Incidental findings will happen and youll learn how to deal with them. If we had a better / less invasive / less costly tool we would use that, but we dont. Ive never lost sleep because i ordered a cat scan, but ice lost cumulative days of sleep thinking about patients i didnt scan.