It’s clear, despite what trial lawyers and their defenders may say, that significant cost control in health care will not be achieved without tort reform, because much overuse of medical imaging (over 25% in one recent survey), a significant source of cost, is due to the practice of defensive medicine – But despite what tort reform proponents insist, there is not a single easy solution to overuse of high-tech medical imaging, which has become a clear problem for many reasons.
The exquisite depictions of anatomy and function generated by modern imaging technologies have blinded many physicians to the limitations and potential harms of radiologic diagnosis. The greatest risk that patients face with unnecessary imaging is needless exposure to nonbeneficial downstream testing and inappropriate treatment related to misdiagnosis and the overdiagnosis of common but unimportant findings.
While the idea that imaging is becoming a crutch to overworked and less-engaged doctors is disturbing, there is another enormous downside to the overuse of medical imaging that is mostly unrecognized (by anyone aside from interested parties, such as companies involved in medical technology) and gone undiscussed at a political level. That is, there are or will be potentially greater restrictions and hurdles involved in the development and clinical approval of new potentially life-saving tools. While biotech companies have an economic interest in fighting provisions in the ACA that delay clinical use of new technology in the U.S., it would make the most sense for policy makers to focus efforts on altering the cause of the problem – current technology overuse – rather than its effect.
As is often the case, change will be difficult and not adequately effected by legislation because ultimately what is needed is a cultural shift. Certainly it is clear that radiologists, who benefit directly from overuse of imaging, will be less than willing to change their own culture, as evidenced by the completely self-serving and hostile reaction against the new mammography recommendations by the U.S. Preventative Services Task Force. The NEJM article’s suggestion that radiologists should actually be “more assertive as consultants” seems more likely to reinforce, rather than change this attitude.
In the meantime, this is another area in which patients should begin to take more charge of their own healthcare decisions. Everyone, everyone should read the book Should I Be Tested for Cancer?: Maybe Not and Here’s Why. This way you can make an informed decision, given both the advantages and disadvantages to routine cancer screening, one area in which imaging is overused. Although there are obvious downsides for public health and economics, there are also less commonly understood problems for individuals being overscreened.