Imaging Idolatry. That's what Dr. Rick Deyo describes in the Archives of Internal Medicine with a subhead of "The Uneasy Intersection of Patient Satisfaction, Quality of Care, and Overuse."
Background: "A 2008 report by the Government Accountability Office (GAO) noted that in just 7 years, from 2000 through 2006, Medicare spending for imaging more than doubled to approximately $14 billion. Most of the growth was in advanced imaging such as computed tomography (CT) and magnetic resonance (MR) imaging. In the particular case of lumbar spine imaging, MR images covered by Medicare increased 307% between 1994 and 2005. The GAO linked spending growth, in part, to a shift of more advanced imaging from hospitals into physician offices. It also noted wide geographic variability in the use of imaging, "suggesting that not all utilization was necessary or appropriate."
And outcomes aren't necessarily improved by more imaging.
Key points from Deyo's summary:
• Just because patients want imaging doesn't mean it's good medicine. Deyo writes: "First, it seems unwise to equate patient satisfaction with better health outcomes, and satisfaction-based incentives may foster overuse. Second, it may be necessary to redouble our efforts at patient education. There is at least a shred of evidence that brief patient education can help to maintain patient satisfaction when imaging is not recommended. Avoiding imaging may itself be part of this education: when radiography was performed for low-risk patients with back pain, expectations for imaging increased. In essence, performing imaging may teach patients that it should be expected. Finally, if quality of care is defined in part by avoiding overuse, we have a challenging task that may require more innovative strategies. That task is to convince our patients that more is not always better."