Frequently, simplistic answers are given for why expenses keep rising in healthcare. One area of medicine that often is the focus of this over-simplification is related to imaging studies. Radiologic practice has been under consistent and prolonged pressure to lower costs in cross-sectional imaging studies; more commonly called, magnetic resonance imaging (MRI) and computerized tomographic (CT) scans. These have variable and yet relatively high costs, ranging upwards into the many thousands of dollars per exam, especially if generated in hospital-based facility.
Dr. Rebecca Smith-Bindman, a UCSF professor of radiology, epidemiology and biostatistics and obstetrics and reproductive medicine and her colleagues recently undertook an analysis to determine usage rates across many age groups for MRI and CT scans from 2000 to 2016 in seven U.S. health systems, as well as the publicly funded system of Ontario, Canada.
In spite of a slight dip in use of cross-sectional scans in the mid-years of the analysis, the rate of imaging use is now accelerating again. The authors suggest that even though most physicians know these imaging studies are overused, there is not enough evidence on balancing the information obtained with the risks and harms from their over testing. They further suggest that in spite of financial incentives and public information campaigns to decrease imaging studies neither have been “entirely effective.” That can be classified as true understatement!
It seems to me from caring for patients during many of the years detailed in this study, there is an increasing anxiety in patients over their diagnostic uncertainty that is pushing physicians to offer rapid cross-sectional imaging as a central aspect of the treating the uncertainty. My hypothesis is that our digital device culture – phones, handhelds, and laptops – makes imaging attractive to damp down the patients’ anxiety. Seeing “inside” seems to provide solace.
Could it be that when our bodies are not working – and our health is uncertain – we look to a negative cross-sectional imaging study in one sense as a reboot, or restart of our body, similar to our ubiquitous handheld device? Couple this patient generated push for immediacy of answer about “what is wrong,” with the clinical production pressure experienced by our physicians and their teammates, and the relatively high fees for producing these images, is it any wonder that immediacy of imaging seems to be continuing despite concerns over overuse?