In short, there’s no national standard for training or performance of such technicians, 12 states don’t have any requirements at all, and standards in the other 38 vary wildly. As the medical imaging industry continues to flourish, and Americans’ exposure to radiation increases, regulations have failed to keep pace. Likewise, imaging equipment has proliferated, but inspection rules have not. Only mammography machines are subject to federally mandated annual inspections, though the Joint Commission and other organizations will begin accrediting imaging centers in 2012.
Haig writes about how, despite the fact that their condition could be easily and accurately diagnosed with no technology at all, two of his patients demanded MRIs for their ruptured Achilles tendons. Their insurance would cover the procedure, and one of them had even seen an advertisement trumpeting the hospital’s fancy new MRI machine. Convincing a pushy patient that the fanciest, most expensive treatment or diagnostic technique isn’t the best one is an often insurmountable challenge, Haig writes, a challenge that becomes ever more significant as pressure to cut health care costs mounts.
Blocking a patient who wants something they saw in an advertisement is time-consuming. Teaching the complex truth one on one is a lot harder than convincing large numbers through eye-catching, sound-biting market psychology. It’s a money loser too. Most of the time, a patient who has been sold on something you don’t want to use will just leave and go to another doctor.
We face this issue every day: the pill they saw on TV or in the magazine, the new scan, the diet supplement, even the specific brand of hip or knee prosthesis are difficult, occasionally impossible, to deny to the folks who ask for them. In the American doctors’ precarious medico-legal (and fiscal-social) position, career success is increasingly built on cooperation with the corporate and government powers that touch us. Playing along with that sketchy (but expensive) new treatment or being a champion of the wacky new state initiative is more likely to help your career than giving an educated but honest appraisal of actual patients’ well being.