Friday, June 11, 2004

Dr. Smith has a post today on what radiologists have told me is the "most dangerous thing they do", read mammograms. Quoting from this CNN.com report the number of mammography sites has decreased 8.9 percent since 2000. Other items of interest:

The decline is thought to be due to low insurance reimbursement for mammograms, rising malpractice litigation and fewer radiologists choosing breast imaging instead of other specialties, the scientific committee said.

At the current Medicare reimbursement of about $60 per study, the risk is becoming not worth the reward.

At the same time, the number of false-positive mammogram readings -- when something suspicious turns out to be noncancerous -- has nearly doubled, the report found. That may be due partly to radiologists practicing "defensive medicine" in hopes of avoiding lawsuits.

This is more widespread than you may think. I have had several BIRADS 4 lesions that "disappear" when sent for localization just a few weeks after the initial mammograms are taken. I am also seeing many long-standing lesions that were called BIRADS 2 in previous years now called BIRADS 3. These patients are not usually biopsied right away but may have short-term (6 month) mammograms. This can be stressful in and of itself.

Some solutions offered:

Mammography facilities specially train nonphysician workers to prescreen mammograms. These employees would not replace radiologists but would do some of the less critical work so sites can perform more scans.

So on the one hand the article laments the lack of breast-fellowship trained radiologists and cites the high risk of litigation involved with mammography, while on the other hand want non-physicians to "prescreen" them. Given the malpractice climate now I think this is a non-starter.

The easy-to-perform X-ray be offered at more locations but that mammograms be read at a few centralized sites, to maximize the number of radiologists.

This could work for screening mammograms, but not for diagnostic studies which usually have a radiologist on site for a on-the-spot read.

The CodeBlueBlog, written by a radiologist, has some thoughts here.
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