Recent Attention on Radiation Risks a Reason to Question Your Doctor

We give doctors entirely too much of our trust.

The other day Anna Reisman wrote a troubling piece for Slate entitled "What Your Doctors Don't Know Can Hurt You." In it Reisman—a doctor—breaks down the troubling rise in ordering CT scans among doctors and how it is likely increasing each patient's risk of developing cancer.

Her most illuminating passage arrives near the beginning (emphasis mine):

"Even though I knew in the back of my mind (as every doctor does) that CT scans wallop us with a generous dose of radiation, my working assumption was that someone would have said something if there was something to say."

Who among us hasn't followed this line of thinking in the doctor's office?

But the germaine part of her piece comes when she speculates on why so many scans are being ordered. Of the many reasons offered, it's the last one that is so troubling: doctors who own their own imaging machines could be padding their own income at the expense of the patient's health.

It's a sickening thought, but it's human nature. If doctors have that kind of imaging technology in their practice, expect them to use it, and often.

While both the brand name and the type of the scanner matter, buying such equipment could set a practice back as much as $450,000.

Now that is an investment—one you know they'll want to make back.

Terminal Scans

Reisman's article arrived on the heels of a major study published in the Journal of the National Cancer Institute about how doctors nationwide are ordering an average of ten CT scans per terminal cancer patient on Medicare. Why? There is no justification for this many scans on a post-diagnosis patient in such a short amount of time unless you are trying to generate as much income as possible.

NYT

Then Jane Brody of the New York Times wrote about how the risks of medical radiation tend to go overlooked and how doctors typically do not discuss the dangers of radiation with their patients.

Texas Urologists

Finally, HealthDay News reported on a study of many Texas urologists whose frequent practice of self-referring patients for radiation oncology services to clinics they have links to or associations with was forcing patients to drive an average of about 20 miles out of their way to be treated, adding to the difficulty of cancer treatment, which doesn't need another level of difficulty added to it.

This is not the first time we've seen urologists acting in their own interests. Just a couple years ago a pair of studies were published in the New England Journal of Medicine about how the treatments recommended by many urologists for prostate cancer patients were dependent on whether or not the doctor would receive Medicare or Medicaid reimbursement. When certain reimbursements were cut off, these doctors recommended different treatment options.

Service Providers, One and All

Recently, I wrote a piece for a women's lifestyle website regarding reasons to fire your doctor and the reason I gave first then I offer up now: Doctors too routinely face conflicts of interest that you almost never learn about. I learned about my doctor's conflict of interest when during my first visit she recommended I begin taking a supplement, and on stopping at reception to schedule my next check-up I learned that the doctor sold that exact supplement,and I could buy it right then. Who exactly was that supplement going to do the most for—me or her? So I never went back.

To that end, without an in-depth investigation it is unlikely you will uncover all the conflicts of interest—from supplements to pharmaceutical companies to imaging centers—that your doctor either is tempted by each day or is actually involved in, but your job as a patient is to see that you get the best and most appropriate treatment according to evidence-based guidelines, so it's certainly not outside of your business to ask your doctor why they're referring you to a particular imaging center or why they're suggesting a specific treatment and whether or not they have any links or associations behind that recommendation.

At the end of the day, doctors are service providers like any other small business. If you have any reason to distrust them, you should find a new one.