Radiology and Value-Based Health Care

While I agree with the author’s assertions that radiologists should engage in evidence-based guidelines for care and timely communication with referring physicians, I disagree with radiologists discussing results with patients. Without the full clinical picture and established patient-physician relationships, this would cause confusion and may increase anxiety in patients. Rather, explaining to the patient that the results will be communicated to their physician and encouraging follow up would be helpful. Being available to discuss optimal diagnostic tests/procedures with clinical colleagues is also helpful.

The commentary exhaustively describes a wide range of benefits that we derive clinically from radiology services, but the only adverse effect mentioned is the costs of the services. This presents an unduly rosy viewpoint. In practice radiology also produces many harms. Examples include the false positive test, in both screening and diagnostic settings, and the "incidentaloma" that leads to further intervention. Uncertain results lead to recommending repeat studies, or different modalities that may clarify the shadow, but also lead to greater anxiety as well as costs. Recommending frequent repeat monitoring tests to observe whether a cyst or other structure has malignant characteristics is too common. In screening, North American radiologists recommend much earlier and more frequent testing than in other parts of the world, with little evidence of better outcomes. It appears that some radiologists never take any risk and leave high rates of uncertainty in their reports. In doing so they pass risk back to referring physicians, and delay decision-making, not help.

That we cause harm is difficult for us as physicians to accept, but we must do so, and measure its effects. Until then, we are not providing a truly balanced perspective.