Comments on: Too Many Unnecessary MRIs and CT Scans?
Add a Comment
- The article is a nice overview, unnecessary depends on the point of view.
Your ER doc is pressured by patients demanding immediate CT, ultrasound and MRI.
All your doctors are surrounded by lawyers and litigious patients waiting for any perceived opportunity to land a jackpot settlement, and if ordering a test helps protect them from losing their home and livelihood then perhaps they will. Notice the endless string of advertisements from lawyers recruiting patients?
Some doctors are trying to regain losses from repeated cuts in reimbursement and look to CT and MRI as a way to do so, they may own their own imaging equipment and self-refer patients to it. Many studies have been published documenting if there is profit involved, more tests will be ordered than if there is no profit (such as if patients are referred to a radiologist owned imaging center which cannot self-refer). The congressional budget office has recommended this 'in office exception loophole' in the anti-self referral laws be closed, and bill ammendments have been put forth to close the loopholes as recommended, but thus far the ammendments have always been denied.
What is to prevent this country from following the successes of other countries and utilizing expert health care review panels or dedicated health care courts? It works well in other countries with lower cost, fast decisions and a much larger percent of any settlement actually goes to the victim, rather than the one-third of the settlement which actually goes to the victim after years in an american court.
There are many, many ways to improve healthcare but it doesn't seem we're asking the right people. - Reply to this comment
- Self referral by non radiologists drives the cost of imaging skyward, say if your orthopedist owns an MRI, don't you think he will be a bit more liberal in having his back pain patients scanned? This is a major problem and it is one that the College of Radiology has been addressing, however, curbs on this practice have recently been voted down by those responsible for creating a new health care plan, giving in to pressure by large multispecialty groups, specifically physician owned hospitals. Why don't you run stories on this?
- Reply to this comment
- Anyone not aware of the tsunami of CAT scans and other imaging tests in the medical profession must be in a coma. It's part of a culture of excessive medical care that drives up costs and harms patients. Many stakeholders are fighting to preserve the status quo. Lots of blame to go around. See www.MDWhistleblower.blogspot.com
- Reply to this comment
- I have worked in emergency medicine for 15 years, and I agree that CT scans and MRI's are overused. I feel that the problem is two-fold. First, we are a "quick fix" society. Many people will present to the ED within minutes of the onset of symptoms (coughing, vomiting, diarrhea,etc.) instead of waiting it out at home or waiting to see their general practitioner. They will then research their symptoms and demand the tests/treatments that they feel are necessary and an immediate diagnosis and cure. Because of this, and because of the current medical malpractice climate in the US, providers are forced to practice defensive medicine.
I encourage patients to participate in and take responsibility for their own healthcare. I think patients should questions procedures, know the results and should understand how each medication they are on works. However, I would never dream of telling my mechanic how to fix my car or my electrician how to wire my house. Both of whom, by the way, make more per hour than I do. - Reply to this comment
- Good doctors and medical students know that getting the right diagnosis is getting an accurate history and physical. CT and MRI are only tools to help assist us in getting the right answer. The public wrongly believes that they are the truth, when they are not. After all, can you "see" a migraine on CT or MRI? No. Wouldn't the patient be better off if we treated it? Certainly if there are "red" flags that worrisome, then of course the test should be ordered.
The FDA has never approved either modality as screening tests because they are not proven to save lives. The point that 35% of scans are unnecessary seems reasonable. How many of us have seen a doctor with symptoms and then been told that the CT / MRI is normal? What does that mean? You still had symptoms and paid to get an expensive test. Do you feel any better?
With more individuals paying to get healthcare, we all need to be mindful of when these tests are truly helpful and when they are not.
Davis Liu, MD
Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System
Website: www.davisliumd.com
Blog: www.davisliumd.blogspot.com
Twitter: davisliumd - Reply to this comment
- #
*
o 12:07 am September 25, 2009
o I just diagnosed a huge brain tumor with a CYA head CT wrote:
I?m a primary care physician with 25 years of experience. A young woman came to me with a complaint of a severe headache and a nasopharyngeal mass. By the algorithm in the American Academy of Family Physicians journal, I should have tried some anti-migraine meds and so on. Instead, I got an immediate (well, almost immediate because she is uninsured and to scrape up the money) She has a huge brain-stem mass and we are now in the business of scrounging up money for, you guessed it, an MRI with and without contrast.
At the end of the day I and I hope every other physician will be guided by only one thing, our experience and the patient?s best interest. By the way, as I write this I am reading two ads at the bottom of the page for malpractice lawyers, one who promises to win you millions for your injury, but only if a specialist did it (lipkinhiggins.com). The other isn?t as choosy, Medicalmalpracticeclaims.net will evalate your claim online even if it was by a lowly GP.
James Boland, M.D. Denver, CO
#
*
o 12:12 am September 25, 2009
o Three more Lawyer's ads came up, from Dr. Jim wrote:
As I posted the above, three more ads from Med Mal lawyers came up. Any of you Docs want to hang your rear ends out in the breeze in this climate?
Dr. Jim - Reply to this comment
- For the last twenty years, I have experienced chronic back problems. Back in 2002, after my back went out for the sixth time, I went to medical and informed the Physicians Assistant that I may have a herniated disk. He didn't believe me, and told me I only had a bruised muscle. Wait and it will go away. After a month of barely able to walk and practically begging for an MRI, he finally gave in and put in the referral. When the test came back, guess what, I had a herniated disk.
Now for the rest of the story.
Those twenty years have been spent in the U.S. Navy. The moral of the story is it's not who you are but who's footing the bill. If your insurance company can pay for it, you?ll get test on demand. If you have public option (i.e. Tricare, VA) you aren?t getting squat. In my life, I have had two MRIs and ZERO CAT SCANS. A CAT SCAN is something I will never see.
For those whining about getting too many test, I DO NOT FEEL YOUR PAIN. - Reply to this comment
- In CBS's graphic for this segment, it says "A Users Guide." Sorry to go all English teacher on you, CBS, but "USERS" should have an apostrophe: " A User's Guide." Singular possessive. Apostrophe before the S. Thank you!
- Reply to this comment
- my doctor thought a scan was unnessary, also. That is until my eye almost popped out of my head, due to a 7cm anyurism. Oops.If it,s needed do it. Don't wait 3 years and then say "oh,look at your fat file" , no look at your fat wallet.
- Reply to this comment
- Our youngest son would not be with us today if he had not had a CT scan in the ER and a follow-up MRI ordered by the Neurologist within a few days. At the time, he was 23 at the time. They discovered a brain tumor. A week later when they removed it, using precise surgical techniques aided by another MRI, they discovered the tumor had doubled in size. If they had used traditional "observation" diagnostic methods we would have paid for a funeral instead of surgery. Thank God for medical technology. Thank healthcare reform and insurance companies for rolling back use of technology. I agree with KCIOWA. Medical care is way too expensive.
- Reply to this comment
