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Are Doctors Trained To Overimage?

February 28, 2011
Written by: , Filed in: Diagnostic Imaging, Emergency Radiology, Practice Management
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Why do doctors order too much advanced imaging? Because that’s what they’re taught.

That’s one of the arguments in a story that appeared Friday on the Time magazine Web site. The authors are two emergency physicians, Jesse M. Pines, MD, and Zachary F. Meisel, MD. They contend:

Lately, radiology tests have become a crutch: doctors in training are no longer taught how to distinguish patients who need testing from those who don’t.

Drs. Pines and Meisel continue: “A decade ago, a surgeon would spend time interviewing and carefully examining a patient to help decide if he or she needed a CT. Now, many surgeons, especially the younger ones, won’t see a patient until the CT is complete. Testing has become more of a reflex than a higher-level decision.”

The doctors mention the recent finding, which we noted two weeks ago, that younger orthopedic surgeons were less likely to order tests for reasons of defensive medicine than older, more experienced doctors. “Could it be,” Drs. Pines and Meisel ask, “that younger doctors are simply less likely to view imaging tests as defensive, considering them instead as the standard way to make a diagnosis?”

Dr. Pines is director of the Center for Health Care Quality and an associate professor of emergency medicine and health policy, both at The George Washington University Medical Center. Dr. Meisel is a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania.

Their insight about the changing nature of physician training is one of the most interesting points in their even-handed discussion of, as the headline says, “Why Doctors Order Too Many Tests (It’s Not Just to Avoid Lawsuits).”

Radiologists will not find many surprises, though the nonmedical public will. For example: “Let’s talk about some of the other motivators for overtesting, like having to stand up in a forum called a ‘morbidity and mortality’ (M&M) conference and talk about mistakes. … Once a doctor has presented an M&M, she will probably never make that same mistake again—but she may start ordering more tests on her patients for minor symptoms.”

Drs. Pines and Meisel conclude: “Real reform is unlikely to happen unless doctors’ groups, supported by patients’ groups interested in better medical care, band together with a common voice. Until then, the next time your doctor wants to order a test, ask why. The odds are that it will be the right decision, but just by asking you may be able to steer clear of a test or two and the potential downsides of overtesting.”

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

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One Response to “Are Doctors Trained To Overimage?”

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