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Who Needs Radiologists Anyway!

Posted Sep 03 2009 9:26am

Just when I thought I really didn’t want to hear anything else about health care reform, something came along that really caught my attention and got me excited all over again. And it came in a venue and from a source that I least expected it!

The past few months have been distressingly, depressingly bleak when it came to hearing thoughtful, considered discussion of the need for health care change in the U.S. All we seemed to hear were voices raised in anger and ignorance, spewing out fear and loathing. Lies about “death panels” gained ground while the truth about other options were ignored or shouted down.

So for a while I started to tune it out thinking that I would wait to see the final health care reform proposals before paying attention again.  That was before I went to a conference on health care reform, staged by the San Francisco Chamber of Commerce – and in the interests of full disclosure I have to admit that the event was sponsored by the hospital I work for.

The guest of honor was House Speaker Rep. Nancy Pelosi and there were other heavy hitters in attendance, but the most riveting part of the program came from three characters who are responsible for taking care of a huge chunk of the population of San Francisco.

Dr. Warren Browner, CEO of California Pacific Medical Center (and my boss) asked Dr. Mitch Katz, Director of the Department of Public Health for SF, and Mark Laret, CEO of the University of California San Francisco Medical Center a simple question; name areas of waste in the current health care system that could easily be cut.

The answers were blunt, direct and fascinating.

Dr. Katz began by saying he didn’t think we needed people to be paid $350,000 a year just to read mammograms. He says it isn’t necessary for someone to go through four years of medical school just to be able to read mammograms, that we could train people to do it for a fraction of that cost and pay them a lot less than radiologists currently get, without impacting the overall effectiveness or accuracy of the mammogram reading.

Now that is not the kind of answer that is going to get a round of applause at a radiologists conference, but it is an intriguing idea, a fresh way of looking at health care and instead of thinking about how to tinker with the current system basically says ‘to hell with the current system, let’s take a serious look at everything we do and question if we need to do it.”

Then Mark Laret said that at UCSF, one of the most highly regarded medical centers in the U.S.,  anytime a patient comes to them from another center with a diagnosis of, say for example, a brain tumor, they’ll almost always ignore the fact that the patient has already had a brain scan and order a series of new tests.

Those new tests, done on the very latest equipment are very accurate. They are also very expensive. So Laret posed the question, do we really need to do another series of scans when the tests that were done in previous hospitals are just fine?

Now, if it’s your life that is on the line you might think ‘abso-bloody-lutely we should do more tests’, but is there really any evidence that it improves outcomes, that it does anything other than generate a nice income for doctors and hospitals.

Maybe the doctors are doing the scans not because they don’t trust the other hospital’s work but simply because they want to reduce the likelihood of being sued if something goes wrong. By ordering fresh tests they can show they were being diligent, thoughtful and thorough. But along the way we also incur a huge medical bill.

Two very different ideas from two very different parts of the health care debate, the public health sector and a leading academic medical center. But two fresh approaches, blunt, direct, and intriguing.

Maybe we should get other hospital leaders to think about how they would answer that same question. You never know, it could lead to some equally fascinating and provocative answers. It certainly makes a refreshing change from most of the other conversations about reform that are currently taking place.

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