There’s a provocative editorial in a recent New England Journal of Medicine about the explosive rise in high-tech medical imaging. Everyone knows doctors order a lot of CT scans, MRI scans, and ultrasound studies, and that the number of these has been steadily increasing. And the cost is enormous. From the article: ” . . . these costs were the fastest-growing physician-directed expenditures in the Medicare program, far outstripping general medical inflation.”
To be fair, rising use of new medical technology is expected because, well, it’s new. What is unclear is that how much of this increased use has led to improved health to justify the cost. Clearly much of it doesn’t, and unnecessary scans, particularly CT scans, lead to risk with no benefit.
The practice of “defensive medicine,” of doctors ordering tests out of a fear of being sued for missing rare conditions, is often given as a cause for overuse of scans. There is some truth to that: the article cites a Massachusetts study showing that 28% of scans are done for that reason. Lawsuits over failing to diagnose things are common; lawsuits about overuse of tests are vanishingly rare.
Physician conflict-of-interest also plays a part. Through a loophole in Medicare regulations, physicians are allowed to refer patients for scans from which the physician benefits financially. That is wrong and needs to be fixed.
But there are deeper reasons. The root cause may well be “the style and content of clinical education and their impact on medical practice.” In other words, how doctors are trained. We use scans unthinkingly, and, unthinkingly, can cause harm. Again from the editorial: “The greatest risk that patients face with unnecessary imaging is the needless exposure to downstream testing and inappropriate treatment related to misdiagnosis and the overdiagnosis of common but unimportant findings.” I’ve seen that happen more than a few times.
12/01/2007 • I've written before about the radiation risk of x-ray studies. Most of this risk is in the form of increased lifetime cancer risk. This is a particular concern for children because lifetime risk is cumulative, ...more
04/03/2010 • I've written before about how to think about the risk of x-rays that we doctors do -- here, here, and here. These posts, particularly the first one, are the most read and commented upon ones ...more
Leave a Reply
08/19/2013 • Many, myself included, have written about the overuse of head computed tomography (CT) scanning in children. This concern has become more focused now that we have some data on the radiation risk of those scans. ...more
06/08/2013 • I've written before about the increased risk for future cancer, if any, of diagnostic radiation (here , here, and here). These posts have generated a large number of comments and questions from parents. Most take ...more
10/05/2012 • The sinuses are air-filled cavities in our skulls. They are important for a couple of reasons. For one thing, they help warm and humidify the air we breathe in through our nose. For another thing, ...more
08/22/2011 • Nearly everyone has heard about the medical malpractice controversy. Most doctors call it a crisis, saying, among other things, that physicians are retiring early because of it or altering their practice -- not taking on ...more