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I have docs in NJ playing a form of defense called Annual Wellness. It's one of many Medicare Personalized Preventive Services and a great place to start. Defend against development of chronic illness or catastrophic events by performing AWVs with your patient population and watch your winning percentage rise.
The radiology industry has been struggling to create best practices around radiation dosing rates, but research shows that CT radiation doses are often 30 to 50 percent higher than need be, and as much as 30 percent of advanced imaging studies may be unnecessary. Do you feel it's time to get really concerned about "over-imaging," or are radiation exposure concerns overblown?
There are big movements afoot to restructure incentives so physicians will be rewarded for quality as well as reducing the number of tests and procedures deemed unnecessary by new protocols and best practices. But can physicians at this juncture afford, financially and legally, to stop practicing defensive medicine? Following are excerpts from a blog posting by Dr. Grumpy, who maintains his own site at http://drgrumpyinthehouse.blogspot.com/. Agree or disagree?
"Diagnosing people without an MRI is fairly easy. I (and many other hard-working neurologists) do it every day. Bear in mind that many neurological conditions (migraines, Parkinson's disease, epilepsy, Bell's palsy, and Alzheimer's disease, to name a few) are clinical diagnoses. This means they're based on what the doctor thinks after taking a history and doing an exam. The purpose of MRI's (which, I admit, are often overused) is usually to exclude other causes, rather than confirm the diagnosis.
"MRI's, like all forms of technology, are like genies. You can't put them back in the bottle. If you don't like it, perhaps you should consider going back to the days when an internist could actually make a diagnosis without a CBC. Or CMP. Or stethoscope (after all, in 1840 the flexible binaural stethoscope was cutting edge). MRI's may be overused, but I find them to be more effective at excluding/confirming serious neurological disorders than sacrificing chickens over the patient and dancing naked under the moon.
"I'm going to guess that you've never been sued (I have). Nowadays you can get legally reamed out for NOT ordering tests, regardless of any guidelines that say it's fine not to do them. You can tell me that I'm practicing defensive medicine, and guess what? I don't care. If doing everything I can to protect my family and my livelihood is being lazy, than so be it.
"Ordering a test often has more to do with CYA [cover your ass] than diagnostics in ANY branch of medicine. If you have some magic power that exempts you from legal action and allows you to make 100% accurate diagnoses without using that newfangled stuff, than you have my respect for being a better physician than little old me."