Divide and conquer may be an old technique, but it still works

December 1, 2004

Tuesday morning, after Dr. David Levin and Dr. Alan Kaye’s course on self-referral in imaging, someone was handing out a press statement as attendees walked out the door. The title, “Patients belong in the imaging picture,” is profound. I agree, and groceries belong in the grocery store. I cannot think of a single imaging study I have ever done that would have been more useful had the patient not been in the study.

Tuesday morning, after Dr. David Levin and Dr. Alan Kaye's course on self-referral in imaging, someone was handing out a press statement as attendees walked out the door. The title, "Patients belong in the imaging picture," is profound. I agree, and groceries belong in the grocery store. I cannot think of a single imaging study I have ever done that would have been more useful had the patient not been in the study.

This statement was released by the Physicians for Patient-Centered Imaging (PPCI), an alliance of 18 altruistic medical societies, academies, and colleges that feel self-referral is God's gift to man. They are, of course, the same people who for the first 20 years of my medical career cried out in self-righteous indignation every time one of my reports mentioned getting another study. Self-referral is like sex - it's naughty when other people do it.

The last paragraph of the statement is a beautiful example of how to put the needs of your patients first, while keeping your own needs just in front of theirs:

"Healthcare for our nation's Medicare beneficiaries should not be about market control but about quality, patient convenience, and continuity of care. PPCI supports patient care plans that keep the welfare of the patient paramount and defends in-office imaging as consistent with patient-centered, value-added care, providing Medicare patients with access to essential and timely imaging by their physicians."

The gloves are coming off. Turf wars are escalating to star wars.

I suspect that in some expensive resorts and spas, in climes much warmer than Chicago, some very highly compensated health insurance executives, malpractice attorneys, and healthcare entrepreneurs are having a good laugh. They are siphoning off an astronomical percentage of the healthcare dollar, and physicians are fighting like street urchins over what they leave behind. And we think we're smart.

My favorite party at the RSNA meeting every year is the Philips event at the Art Institute. (This excludes last year's Bracco event at the House of Blues featuring Dan Ackroyd and Jim Belushi as the Blues Brothers, which will never be equaled.) This year, two special exhibits were open for the evening. One was an exhibit of early - very early - American art. On display were artifacts from Ohio dating before 1000 BC. Remains of sophisticated cultures have been excavated in several areas of the Mississippi River basin, dating hundreds to thousands of years BC. I was completely ignorant. It was an amazing exhibit.

The second exhibit featured 10 architects' vision of the future Chicago. It was either over my head, or it was stupid. But there was one fascinating room. When you walked in, you were surrounded by seemingly random upright pieces of metal, all painted the same monotone gray. Near the ceiling in one corner was a TV camera focused on the room, with four monitors hanging down. From the perspective of the camera, the random pieces of metal projected as four symmetric columns in an otherwise empty room, and you were walking both among and through the columns. The reality in the room around me contradicted the reality of the real-time TV image I saw on the four monitors. Perspective is everything.

An alliance of 18 medical societies, led by the American College of Cardiology, has apparently declared war on us. I guess we have to defend ourselves. While I hate to lose any more imaging to another specialty, I wonder if we're all really fighting the right battle. Medical imaging is doing amazing things, but our environment is becoming an M.C. Escher print.