More is not always better

Austin Frakt highlights a story in the Boston Globe on excess medical imaging:

In today’s Boston Globe, Marilynn Marchione writes,

Americans get the most medical radiation in the world, even more than folks in other rich countries, according to several studies reviewed by the Associated Press. The US accounts for half of the most advanced procedures that use radiation, and the average American’s dose has grown sixfold over the last couple of decades.

Too much radiation raises the risk of cancer. That risk is growing because people in everyday situations are getting imaging tests far too often. …

The best guess at how much radiation is risky is based on the 1986 Chernobyl nuclear power plant accident and studies of Japanese atomic bomb survivors who had excess cancer risk after exposures of 50 to 150 millisieverts of radiation.

A chest or abdominal CT scan involves 10 to 20 millisieverts (a measure of dose), versus 0.01 to 0.1 for an ordinary chest X-ray, less than 1 for a mammogram, and as little as 0.005 for a dental X-ray. Natural radiation from the sun and soil accounts for about 2 millisieverts a year. A study last year estimated that 4 million Americans get more than 20 millisieverts a year from medical imaging. Two percent of people in the study had high exposure — 20 to 50 millisieverts.

More is not better. In addition to causing harm to our health, we pay for it in dollars. How much of those harmful X-rays are from duplicative or unnecessary medical imaging? I don’t know, but some. This type of redundancy is something electronic medical records could eliminate if they’re interoperable and universally accessible across providers. There outta be a law.

I agree with much of what Austin says.  We focus on the physical harm, which is real but small, but ignore the financial harm.  As I’ve said before, there is not an unlimited amount of money in the world.  Every time we spend money on something wasted there is less to spend on something that might do some good.

I disagree (a little) with Autsin’s belief that information technology could eliminate this problem, however.  Kudos to him for clearly stating that interoperability is as important as access; many people miss this.  But I can’t tell you how many times I’ve seen patients arrive in the ED, carrying actual CT scans in their hands that have been performed that day, and still the hospital orders new ones.  We claim that we “don’t trust” the other hospital, or that we “do it better”, or that “we need to see for ourselves”.  I don’t know if it’s habit, or a need to make money, or a need to do something, but we order extra scans even when we have the information right in front of us.  It’s not enough to improve access to information.  We also need to retrain ourselves, and the American public, that we don’t need and shouldn’t get those tests.

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