Is something that is convenient always good for you?

A reader named Ron put a comment on the last post, and it is so well-written, I thought it deserved full exposure.

Is something that is convenient always good for you?

Imaging studies are used to confirm a diagnosis and these studies should only be done after a full evaluation by a physician, never before. I find it inconceivable that any physician office could provide an in office imaging service immediately after the physician evaluation without wait. I’m willing to say that there will be either a considerable wait, or a reschedule to come back at a later time to the self referring physician’s office for the exam. If no wait for the exam, I'm sure there will be a wait for the results.

If this was all about convenience, then the same self referring doctors that offer in office imaging would also offer immediate no wait walk-in service 24/7. That would be most convenient for me. It would also be very convenient for me as Dr. Harold states above, to also have available child care and a full hot breakfast or a meal in general available for me when I arrive. In fact, it would be even more convenient for me if the doctor could meet me at my place of work at 5PM when I finish and provide my exam for me there. It would be convenient for him to also bring his mobile scanning equipment with him, just in case I may really need an imaging study. If I needed a specialist from Sloan Kettering, it would be convenient to bring them to his office also.

If this was all about convenience then why did all of the self referring physicians offering in office mammography stop offering the service? For what it matters, my question is why do the same self referring physicians that offer in office imaging not provide the one test that would be of most convenience to women, a mammogram, also in their offices?

Really, how inconvenient is it to make an appointment for a Radiology exam at your local hospital or Radiologist’s outpatient center? Most have after hours and weekend appointments and some could even see you the same day. If you go to your family practice doctor and they feel you need an orthopedic specialist, you make an appointment with the Orthopod and see him wherever his office is when you are scheduled. Why does the self referring family doctor not have an in house orthopedic doctor there for your convenience? What is the difference in convenience to the patient where in town they make an appointment to be seen by a Radiologist; the self referring doctor’s office (no Radiologist) or the local hospital?

Personally, I think it would be worth any inconvenience to be seen where the specialist Radiologist is present, overseeing the center and exams. Where does convenience play a factor when it comes to getting the best medical care by the best trained physicians? You wouldn’t go to the OBGYN to get your brain surgery? Why would you go to a cardiologist to get your Cat Scan of your liver? When you need an imaging study, anything from an Xray to an Ultrasound to an MRI, you want to be evaluated by the specialist, the Radiologist. You want a radiologist who is in town and known to your medical community, not some unknown name half way across the world somewhere reading scans on the cheap for the self referring doctor.

It seems that those with in office equipment have it only for their best paying patients. Those are the ones that seem to need to be less inconvenienced than the rest of us. If you have good insurance, then you are scanned by these self referrers. If you have Medicare, Medicaid, or Tricare (those in society that really cannot afford the inconvenience of the travel expenses etc.) it would be more convenient for you to be seen elsewhere. For the self referring doctor it appears it is convenient for these folks with “bad” insurance to go elsewhere. For patients without good insurance, their convenience is not at issue here.

A physician has a sworn duty to see that his patients get the best possible care irrespective of their insurance. A doctor who is not a trained radiologist who performs radiology exams is doing a disservice to patients in the name of enriching their own bank accounts. Better yet, patients have the right, and the responsibility to themselves to be seen by the best available physician for the job. In the case of imaging, it is the Radiologist. A patient should not feel obligated to help fill the coffers of a self referring doctor, by having their imaging done at his office or the center he gets a kickback from just because that is what he tells them to do.

Patients must always ask their doctor if he has a financial stake in services he offers or performs outside of his professional capacity. (Can you imagine the outcry that would come from surgeons giving money to their referring doctors for sending them patients to do unnecessary surgery on?) If a doctor has a financial stake in doing or sending you for any imaging study then you cannot trust that this study is necessary, that the study is the best study for you, or that it will be performed and interpreted under the direction of a board certified radiologist.

A self referring doctor is not interested in convenience, but rather lining his pockets at the expense of patients and the US health system. Self referring doctors are one of the main causes of increased health care costs. A self referring doctor’s patients will have more unnecessary exams, more poor quality exams, and more poor quality exam interpretations then the patients of other doctors who do not self refer. Patients being seen at the hospital or at a center where there are radiologists will always get better and more cost effective care than at a self referring doctor’s office. At worse, unnecessary exams provided by self referring doctors could lead to serious problems including increased unnecessary radiation exposure, increased unnecessary risk of contrast reactions that could lead to NFS, kidney failure and death. Self referral also has a way of leading towards additional unnecessary studies, unnecessary biopsies and unnecessary surgeries.

Self referring doctors typically have little oversight of their work. Typically their equipment is substandard and most times the people performing the exams are not certified technologists. There is no peer review or accountability for their findings from your exam. Most times, the actual images from the studies and reports are not shared with other physicians. If only the self referrer sees the study and the results and not a board certified radiologist, then who is to know what was missed and if the findings are correct. For patients, are you finding that you are getting additional imaging for the same problems because the self referring doctor got it wrong the first time or because he has a financial interest in you getting more exams?

There is nothing like the convenience of paying out a $5000 deductible and getting unnecessary exams just to make some self referring doctor rich.

Since September of 2006, Harold, the test of time has not proven you wrong. I bet hundreds more cars, boats and McMansions could be added to your list. Self referrers are still laughing all the way to the bank and the amounts of imaging tests and in office machinery is increasing exponentially.

Patients are lining up like rats behind the Pied Piper in supporting these self referring schemes. Insurance companies still seem willing to throw money at these guys. And the government....