The inspiration for this article came from a recent discussion on the ASRT forum in CT. If you aren’t a member yet, I strongly consider you joining as there are lively discussions all the time and if you have any work related questions, the members are pretty good at responding with great solutions. Also, I am on the ASRT forum all the time, so what more could you ask for. LOL .
Anyway, I wanted to take a walk down memory lane and share with you my story from residency to now, about some of the changes that have taken place, not so much in medicine in general, but more so in radiology. Obviously, I can’t cover everything, otherwise this would be more of a book instead of a blog article, but here is a little historical for you.
I am old enough to remember the transition that happened during my residency. Back in the day, it may have been a Tuesday but who knows, all the medical teams used to come to radiology to get approval for every CT and MRI. Every single one. They would give us the patient history and physical exam findings and discuss the differential and then we would discuss whether a cross sectional imaging study was indicated and its probability of helping the patient. This was literally the way it was done for years. Providers just being able to order whatever they want, whenever they want, was unheard of. Pretty quickly, and with pressure from ER docs and other services, the approval process started to erode. Head CT’s and stone studies were removed from the discretion of the radiologist. This unfortunately started the slippery slope. Shortly after, my hospital went with an electric medical record and order entry system. Now any doc in the hospital could order whatever study they wanted, for whatever reason. Radiology was quickly taken completely out of the approval discussion. And guess what, the volume exploded, I mean really exploded. We had trouble keeping up and the department had to hire more people. Now I don’t really blame the ER docs or other providers for this, I have others in mind, and to defend the ER guys a little, they are under tremendous pressure to disposition patients as fast as safely possible. Hospitals actually measure how long the ED stay is based on the presumptive diagnosis. And the bean counters in admin actually think they are doing a good thing by making this number as small as humanly possible. In addition, the bean counters loved how much money they were making off all the imaging studies. See the problem here? All the incentives quickly aligned against radiology approval as soon as it became a thing for medical centers to make a ton of bucks off the scans and for referring docs to easily just order whatever they want. Now, I don’t wanna look like a hypocrite here. I have significantly benefitted from this volume explosion. Job security is through the roof. Being a radiologist is not so bad; but the current system is far from what I wold call ideal. Anyway, so that’s kinda how we got to where we are today. Depending on the doc in the ER or the hospitalist on for the day, a scan may be ordered on a “reasonable” number of patients or ordered on just about everyone, and there is an incentive to order, because the patient can be discharged or admitted faster.
Of course, there are other variables at stake here and many patients should get a scan, but consider this; the vast majority of all PE exams, head CT’s and dissection studies I read, are NEGATIVE. Probably 95% or more. It’s crazy. Of course, I have free market ideas on how to fix things, but we are so far away from that sort of scenario right now, it’s just not doable on scale.
Anyway, I didn’t expect this story to help make anyone feel better who is currently frustrated with the current system. But I wanted some of the newbie Techs to see a little of how we got to where we are today. The Techs who were practicing back when I was a resident or longer totally understand this, as they saw it happening before their very eyes. So to them, I would say that I understand how you feel and wish things could regress a little to where the radiologists were the “gate keepers” for the expensive cross sectional studies.
I still think radiologists have plenty to offer in the decision making process. Most of the time, we are in the go-along camp nowadays. I remember when the transition was occurring years ago, some of us would try to put up a fight, but then we were labeled as obstructionists and both the other medical services as well as our own admin bigwigs sided against us. We lost the battle and now most of us don’t even try anymore. Sometimes I block a study when it just seems stupid, but mostly I try to advise when possible, which study will be best for the patient. I know it’s not what all you hardworking Techs wanted to hear, but this is where we are and how I believe we got here for the most part.
So what to do? Probably not much. I try to keep positive and do the best I can for patients everyday and continue to operate in the medical field as it exists. I try to be as helpful as possible to the referring providers because I think this will get them to call me more to discuss things. But I’m unsure how else to affect meaningful changes at this time. I’m not sad or anything, just a realist at this point and look forward to doing what I can, when I can. I recently started to get into Tech education/training (check www.TechnologistTraining.com), and will also continue to push that pretty hard, as in many ways, the Techs are really the “face” of the radiology department and can have a huge impact on the lives of patients. This stroll down memory lane brought up a lot of memories for me and was fun. What memories does it bring to the forefront of your mind?