People need help. Honestly.

You hit the nail on the head. CMS is aware of this and the radiologist and ‘apollonius’ is on their hit list…

The ER guy couldn’t find the fracture on the film but from the sail sign and clinical findings, concluded there was one and spinted it and referred me to ortho.

My friend from ortho guy saw me the next morning and took 1 second to spot the fracture and point it out. He provided management and then,

Two days later the radiologist report comes up describing the fracture.

I paid more for the radiologist than both the other guys put together–and it didn’t add a damned thing. It is a racket.

Your screen-name ‘apollonius’ is just as anonymous since you do not allow access to your profile online. What are you trying to hide? You ooze pure bias.

“Do you self refer?”

I am a specialist surgeon in the military and order large volumes of CTs, MRIs, etc, etc. No self-referral here. Not that there is something wrong with that though. By the way, the 2 MRI scanners here run 24/7 and they are still deferring patients out to civilian MRI centers. There must be some sort of self-referral going on here!! The mere fact that you are not divulging your funding source leads me to believe that you have a bias and likely receive funding from the ABR or the ACR.

“Do you have a vested interest in reading your own films?”

This is an easy one. Yes, I do have a vested interest in the outcome of the patient. Before taking a patient to the operating room, I look at the CT scan. It is called malpractice to rely only upon the radiologist’s dictation, who has no vested interest in the outcome of the patient, to tell me where and what to operate on. Although small, I can remember several cases where the dictation from the radiologist gave the wrong side as to the abnormality. Guess who will be explaining to the jury why the wrong kidney came out? Certainly not the radiologist. Once again, it is malpractice to purely rely upon a radiologist’s dictation prior to surgery. The surgeon should put eyes on the CT scan himself before cutting. I guess you need to credential me to read a CT scan…

It is a pure turf war nothing else.

“Hoping that I’m funded by a party you dislike or a malcontent doesn’t change the validity of the studies.”

That is assuming the studies are valid. Bad data in, bad data out. The article you cited in the American Journal of Roentgenology is automatically biased since it came out of a radiology department and one of the lead authors received funding from the American College of Radiology (“H. R. Alpert was supported by the American College of Radiology”). I can smell a rat!

With the spread of Nighthawk services, you and your radiologist buddies may be looking for a new job soon as more and more Indian and Chinese radiologists read CT scans for pennies on the dollar. I don’t blame you for “sounding so hostile”. The radiologists sealed their fate when they relegated themselves to the status of a highly paid technician with no vested interest in the outcome of the patient.

Hopper KD, Rosetti GF, Edmiston RB, et al. Diagnostic radiology peer review, Radiology 1991

BE Kouri, RG Parsons, HR Alpert. Physician self-referral for diagnostic imaging: review of empiric literature (most interesting paper I’ve read on the subject)

N Engl J Med 354:26 June 29, 2006

Who do you represent? Is your research funded?

This from an anon? Who are you? Do you self refer? Do you have a vested interest in reading your own films? Sounds hostile doesn’t it?
Either the statement is true or it isn’t. Hoping that I’m funded by a party you dislike or a malcontent doesn’t change the validity of the studies.

I could be a malpractice lawyer but it doesn’t change anything. Just because someone you dislike says something doesn’t make it less true. I’m writing a paper.

I wouldn’t have bothered to respond to Kevin’s post but for the fact he left out one of the largest reasons imaging costs continue to go up. Doctors with x-ray machines, ct scanners, MRs tend to utilizes them at far higher levels than doctors who refer that end of medicine to radiologists (this is paraphrased from the NEJM article mentioned above). To me this means 1 of 2 things, either the doctors that don’t have this equipment are not practicing good medicine and are missing opportunities to diagnose their patients or the doctors with this equipment are overusing them.

Do you have a link to your quoted study?

Who do you represent? Is your research funded?