Theodore E. Keats, MD
"To what purpose is this waste? Matthew 25:40
A
lthough we are currently experiencing a relative financial blight
in medicine, I do not sense that we as physicians are practicing
appropriate diagnostic restraint. It appears that we still practice
in much the same fashion as we did in the palmy days when there was
little concern for the financial implications of what we did.
Patients from the emergency departments still arrive for multiple
examinations, often without prior physical examination. We lavish
CTs, MRIs, as well as invasive and interventional procedures,
without careful consideration of the potential diagnostic or
therapeutic rewards. At times, the motivation seems to be what I
think of as the Mt. Everest motto-we do it because it's there
(available).
It would be comforting if we could blame all of this on
referring physicians, but unfortunately this is not the case. We
radiologists recommend, encourage, and foster many of these more
elaborate procedures without careful consideration of whether the
result is likely to significantly influence patients' treatment or
outcome. Do financial rewards sometimes cloud proper judgement?
Our specialty includes many of the most costly diagnostic
interventions. I believe we have an obligation to help control
needless over-utilization of these resources. We can do this by
educating our colleagues about the true benefits that are likely to
ensue from our studies or procedures and by practicing restraint in
our own activities. As a specialty, we can make a contribution to
limit the burgeoning cost of medical care.