Are Radiologists Trustworthy?

September 2, 2011

As a radiologist (or, indeed, any kind of physician), you are a professional. You have completed at least two decades of education, including an advanced degree. You have not just passed but scored very competitively on numerous exams, held up under scrutiny from dozens of educators and interviewers, and committed yourself to maintaining your clinical edge by keeping current with academic literature and educational conferences.

As a radiologist (or, indeed, any kind of physician), you are a professional. You have completed at least two decades of education, including an advanced degree. You have not just passed but scored very competitively on numerous exams, held up under scrutiny from dozens of educators and interviewers, and committed yourself to maintaining your clinical edge by keeping current with academic literature and educational conferences.

 

This is due to your desire to do the best work you possibly can, or (at the barest minimum) to avoid the negative repercussions of doing a bad job.

 

But can you be trusted?

 

An outsider, seeing our healthcare system for the first time, could easily conclude that the answer is no. Multiple layers of oversight, involving few or no physicians in their routine operations, are in place for virtually all aspects of our work. We are told how much CME we must earn to remain in good standing, what business enterprises or investments we are allowed to own, and how much we are permitted to charge for our services.

 

We are regularly visited, sometimes without warning, by inspectors with far less training than ourselves who nevertheless have the power, with a few pen-strokes, to declare us or our facilities unfit for service - possibly to face fines or even criminal charges, if we are particularly unlucky.

 

The hypothetical outsider could be even more convinced of our lack of trustworthiness when comparing us with other citizens in their respective fields. Where else can one find such intricate scrutiny? Certainly not for a carpenter or plumber; evidently they can be trusted to police themselves. Speaking of the police, how about them? True, they have departments of internal affairs, but those get involved only when needed, on a case-by-case basis.

 

One might theorize that healthcare is more stringently controlled because more money is involved. If that’s the case, however, shouldn’t the financial sector be even more heavily regulated? The past few years have shown us that, however many issues face investment bankers and the golden-parachute corporate set, excessive regulation is not one.

 

Perhaps we are not to be trusted because healthcare is so much more important than other sectors of our society. The stakes are too high and the potential for abuse is so great that we simply should not be left alone with temptation.

 

If that’s true, I can think of at least one group that merits far more hawk-like watching than ourselves: our government (elected and appointed). It controls resources an order of magnitude greater than healthcare. It deals with fundamental issues of fiscal policy, whether or not we go to war, and what rights we may or may not have. Ask citizens whether they trust their government, and then ask them whether they trust their doctors. I bet it wouldn’t take too long for us docs to amass a landslide victory in such a straw-poll.

 

So how is it that politicos are trusted to have multimillion-dollar fundraiser parties, while we raise eyebrows if we get a free pen from a vendor? Or, heaven forbid, a sponsored lunch to accompany a guest-lecturer?

 

It seems that, the more a subset of the population misbehaves, the more it’s tolerated by everyone else. One hardly pays attention when there’s a scandal about a senator having an affair behind his terminally-ill wife’s back. Or when a DA is caught cheating on his taxes. “They’re all crooks,” folks will say with a shrug, just before they vote to reelect their favorite perps.

 

But physicians, who routinely bend over backwards to comply with all sorts of nonsense to prove they’re on the up-and-up, get rewarded with more regulation and less control of their own affairs.

 

Perhaps it’s time to emulate the political set. Can anybody recommend a crooked accountant to set me up with an account in the Cayman Islands?