What if We Photoshopped Medical Images?

I had a great idea this morning: Why not use Photoshop to modify medical images, like X-rays, and fix the problems. Now that most images are captured digitally, it would be fairly easy.

See, when I was in high school I played soccer and two weeks before tryouts I was playing in the park with some friends and a nasty two-legged tackle hurt my leg. I went to the hospital for an X-ray. As a result they put a cast on my leg for two months. I missed tryouts, but the coach still selected me to play on the JV team. I ended the season as the top scorer so that was good, but my point is if my X-ray images were digital and someone had used Photoshop to modify the image, I wouldn't have needed the cast. I would have been selected for the Varsity team and well, most likely would have had an amazing professional career in Europe.

As I think about it more, I realize all the great things that we could do in medicine if we could just modify the results with Photoshop. Think of the costs we would save and of course the impact on our lives. We could stamp out cancer very quickly. Think of what an amazing world we would live in, if we could just Photoshop medical images.

This is, of course, a preposterous proposal. The image is not the cause of the broken bone or the cancer. Of course the treatment I received for my broken bone, while an inconvenience, was better than the alternatives. (Although it did cost me a win in the World Cup for the USA in 2006.)

Do we sometimes in our private and professional lives ignore the evidence because we don't like the answer or the solution? Of course. When my wife hears an odd sound in her car, she doesn't try to investigate it, she just turns up the music so she doesn't hear it. In October 2008, when the stock market took a huge drop, I refused to look at my 401(k). I didn't want to know the damage and I didn't want to have to think about my portfolio allocations and changes I should have made to recover better.

I have also seen the issues professionally. I worked at a place where one of the employees would regularly fall asleep at work. By regularly I mean everyday at his desk between 1 p.m. and 3 p.m. It was common knowledge but nobody did anything to help. I don't think he should have been fired, but everyone acted like it didn't happen. That sent a huge message throughout the company.

In the work I do now I see people effectively Photoshopping medical images. I help radiologists discover missed revenue opportunities. Usually people have two thoughts going through their mind: First, "I don't think that you will find anything." Second, "I hope you find a lot."

I recently had a conversation with a director of radiology in a hospital and his response surprised me. He didn't want my company to do the analysis because he didn't want to do the work when we returned with a list of billing opportunities that the hospital could submit. I had no answer to that.

At RSNA I was talking with a billing company that specializes in radiology. I explained what I do. Their response? "We guarantee that we capture 100 percent of charges." I was surprised that they could guarantee that. "Well, virtually guarantee almost 100 percent." Well sure. If you ignore what you miss, then I guess you capture everything that you captured.

We live in a chaotic, unpredictable and random world. In medicine, business and life we will find things that we wish hadn't happened and things we didn't want to know. We do things we wish we hadn't and we make mistakes. It is part of being human, I guess. But, just because we can Photoshop the image doesn't mean we should.

David Fuhriman is CEO at Bern Medical, where he analyzes radiology data to discover under-billings.