Cooperation, communication vital to curbing unnecessary imaging

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Despite efforts to reduce unnecessary imaging tests, the imaging community still has work to do. A study recently published online in the Archives of Internal Medicine by Gilbert Welch of the Dartmouth Institute for Health Policy found that Medicare patients undergo an excessive number of repeated examinations, with as many as half of all tests repeated within a three-year period.

"Although we expected a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction," Welch and his colleagues wrote. They added that the finding raises the question as to whether physicians are repeating diagnostic tests routinely.

In an accompanying commentary, Jerome Kassirer, a professor of medicine at Tufts University School of Medicine, and Arnold Milstein, a professor of medicine and director of Stanford University's Clinical Excellence Research Center, called the study a "discouraging" sign that the medical community is failing to curb the waste of healthcare resources. They said that extra tests ordered out of curiosity or to satisfy a patient's demands clearly do not represent good practice, and suggested that financial incentives likely are the most powerful cause behind unjustified testing.

I agree, and tend to believe, like Yul Ejnes, immediate past chair of the Board of Regents for the American College of Physicians, that radiologists can play a large role in finding potential solutions to the problem.

Ejnes recently wrote that despite barriers to implementing recommendations on high-value care, such as concerns about liability or patient demand, "[physicians] can improve the quality of care and lower costs by reducing the use of tests and treatments that provide little or no value to the patient and might even be harmful." However, radiologists, he said, need to let physicians know if they've ordered the wrong test for the clinical question prior to the test being conducted.

"If you find something that may require further testing depending on circumstances, call us so we can discuss it rather than commit us to the test by recommending it in your report," he wrote.

What it comes down to is cooperation and communication. I don't think that sounds too difficult. - Mike