The Lown Institute advocates rational use of medical resources. This is a noble goal and worthy of the attention of radiologists. It was recently RightCare Action Week: Here are five simple things any radiologist can do that week, and the following weeks. This will improve patient care by avoiding unnecessary tests.
1. Speak to the referring clinician, at least sometimes, if not often, perhaps twice a day. The conversation need not be adversarial. Ask before the imaging two simple questions. What will you do if the test is positive? What will you do if the test is negative? Inquire four weeks after the imaging is done if the study changed the clinical management. Inquire politely displaying academic curiosity not, judgmentalism. Appropriate use is a two-way street.
2. Don’t call pulmonary hypertension if the main pulmonary artery is > 3.1 cm on CT. Yes, I know this is the threshold, but thresholds are arbitrary. The chances that you will pick up pulmonary hypertension incidentally in someone with a 3.2 cm main pulmonary artery are dwarfed by the chances of an unnecessary right heart catheterization to confirm that the pulmonary hypertension was never there. It’s not fun having a right heart catheterization, even though cardiologists are really nice people.
3. Follow the ACR guidelines on the management of incidental thyroid nodules. Remember, if you pick up a papillary carcinoma of the thyroid, chances are that this will be overdiagnosed. Just ask the South Koreans. Be daring and bury the nodule in the “body” of the report, not the “impression.”
4. Don’t leave the decision to follow an incidental adrenal nodule, which is overwhelmingly likely to be benign, on CT in an eighty year old to the referring clinician by saying, “MRI may be obtained if clinically indicated.” Take ownership of the decision. Do we really believe that net societal suffering is reduced by doing chemical shift MRI on adrenal nodules on octogenarians? We are simply diverting their limited time on this planet from their grandchildren to the magnet.
5. God invented radiologists so that he could not be ruled out. The hedge is important, on occasion. The hedge cannot be a way of life. Please stop saying “subsegmental pulmonary embolism cannot be excluded.” Subsegmental pulmonary embolism is often an overdiagnosis. Let’s save our hedges for real monsters. On a similar note, just say “normal.”
Radiologists can reduce societal burden of too much medicine. We know the axis of futility, by heart.
5 ways radiologists can reduce unnecessary tests
16 Dec 2015