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.