The NY Times writes about the rise and fall of body-scanning clinics

This has pleasantly caught me by surprise as well. I’m happy that patients are doing the right thing and not getting these useless scans, despite the ceaseless amount of DTC advertising (via Faughnan’s Notes).

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Anonymous
You really ought to qualify what you mean by “useless” scans.
Is it that the scans are done in cut-rate facilities, with poor quality scans and/or poor quality “readers”?
Or that patients shouldn’t have access to self-pay imaging that might cost insurers money to follow up when something wonky is found?
(The cost of the scans, picked up by the consumer, isn’t the issue. The risk of a single “body scan” is exceedingly low, really negligible.)
The truth is, the scans aren’t useless for EVERYONE – they are just useless for a lot of people, probably a majority, who get them. Maybe some incidental finding like a hemangioma in the liver will lead to expensive follow up, for something that is a benign situation.
There’s a grey area here.
It’s one thing to say that “screening” scans in healthy people with no significant family history won’t get their money’s worth, and could cost the health system big bucks for follow ups, or the consumer needless risk from invasive follow-ups.
BUT here is another class of patient who wants to self-refer and self-pay for imaging, to dispense with insurance hoops…who could BENEFIT from access to self-pay imaging – people with family history of silent-onset cancers, or who have signs or symtoms of illness of undetermined cause prompting the investigation – where CT or MRI is being “rationed” out only when strict criteria are met. Yet in all truth, a better scan would be what everyone would do if cost were not a factor.
My physicians are under pressure to stall CT’s and MRI’s for as as long as possible, or even wait until something awful is found by means of an invasive and or less sensitive (read: a cheaper test, or one more personally lucrative to him) test.
An “executive screening” found my father’s renal cell cancer when doctors couldn’t piece together his vague symptoms. A friend of his, a non-practicing physician, suggested and arranged it. Of course, once you have symptoms of renal cell cancer, it’s kind of like the oil light on your car – too damn late to do any good. If he’d had that same scan a year or two earlier when symptom free, it might well have saved his life. Renal cell cancers have a high cure rate if they are found early. The rub – they aren’t found early unless they are found accidently.
My personal history, which I won’t get into deeply but includes some serious possibilities, has been requiring some investigation. I want to do the least invasive tests first, and get the maximum info possible from images. I’d expect to self pay for doing things “out of the system”, or out of order.
But I want to get out of PPO jail. I want to be able weigh risks and benefits as an educated patient, to ask for and get the best images from the least invasive tests with negligible risk, even if every blockade of my insurer isn’t overcome yet, or the need for the test lies in a grey area.

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