A Tale of Two Studies: Are Doctors Fulfilling too Many Imaging Requests?

A recent qualitative study aimed to investigate the factors influencing general practitioners’ (GPs) decisions to fulfill patient requests for imaging studies during clinical consultations. Ten GPs from private medical centers in Northwest Sydney were interviewed, and their perspectives were analyzed through content analysis. On the other side of the spectrum, we explore an American study that reveals the importance of encouraging more people to undergo screenings.

Patient Imaging Requests

The study revealed six key themes that emerged from the interviews regarding GPs fulfilling patient imaging requests:

Patient Expectations: Patients’ desires and expectations played a significant role in GPs’ decisions to fulfill imaging requests. Some patients expected certain tests due to their health concerns or beliefs.

‘Therapeutic Scans’: GPs recognized that some patients viewed imaging scans as a form of reassurance or therapeutic action. This influenced GPs to fulfill requests to alleviate patient anxiety.

“I find X-rays have become a therapeutic requirement, [and] that their [patients’] problem often dissipates once the request is given. (Female, 40)”

‘Impressive Labels’: The use of serious-sounding terms in imaging reports contributed to patients’ perception of the severity of their condition. This, in turn, led to increased requests for such scans.

Entitlement: Some patients exhibited an attitude of entitlement, expecting imaging scans without sufficient medical justification. GPs were more likely to decline such requests, especially during initial visits.

Defensive Medicine: GPs expressed concerns about potential legal repercussions if they refused imaging requests. Fear of litigation influenced GPs to fulfill requests to avoid legal issues.

‘New Patients’: GPs were cautious about fulfilling imaging requests from new patients, as they needed time to establish trust and assess the necessity of the requested scans.

The study concluded that GPs faced challenges in balancing their role as gatekeepers of imaging with patient expectations. Clear guidelines, patient education, and GP training were suggested as potential strategies to manage patient expectations and provide appropriate care. The study sheds light on the complexities of patient-GP interactions regarding imaging requests and highlights the need for evidence-based strategies to navigate these challenges. The study was conducted within the Australian Medicare system, where medical imaging is relatively accessible and affordable, and the findings contribute to understanding the dynamics of patient-GP interactions in this context.

Cancer Screenings Saves Millions of Years of Life

Meanwhile an American study conducted by teams from the University of Chicago, University of Michigan, and study sponsor Grail LLC estimates that Americans have gained an additional 12 million years of life due to preventive cancer screenings over the past 25 years, leading to an economic impact of around $6.5 trillion. These screenings, targeting early signs of breast, colon, cervical, and lung cancers among high-risk adults, emphasize the importance of encouraging more individuals to undergo recommended cancer checks and exploring novel screening methods. The study suggests that if all eligible individuals received current screening for these cancers, it could save an extra 3.3 million life-years and add $1.7 trillion in economic impact.

mammograms

 

The research utilized a mathematical model to assess the impact of cancer screenings endorsed by the U.S. Preventive Services Task Force (USPSTF). This federally authorized panel evaluates evidence for preventive medical services and provides recommendations using letter grades. Since 2010, screenings with “A” or “B” grades have been covered by most insurances without patient costs under the Affordable Care Act.

Although screenings for breast, colorectal, cervical, and lung cancers have saved millions of life-years, their full potential remains untapped. The majority of life-years saved and economic impact come from cervical cancer screening due to its early and consistent screening intervals for individuals aged 18-65. However, the study acknowledges that the availability of the HPV vaccine since 2006 could affect the future value of cervical cancer screening.

While there are validated screening tests lacking for many cancer types, decreased death rates from cancers with available screenings have contributed to the overall reduction in U.S. cancer deaths. To establish more broadly validated cancer screenings, further research is needed, potentially evaluated by the USPSTF. Novel screening tools like blood tests for multiple cancer types are in development, but AI-based tests have yet to undergo review by relevant bodies for efficacy and recommendations.

 

Sources:
onlinelibrary.wiley.com
michiganmedicine.org
Openai.com

How Covid Impacted Vital Health Screenings

So many aspects of our lives have changed since the outbreak of COVID19; shopping, working, education, entertainment, and our everyday lives look pretty different, even from a few years ago. The pandemic has also impacted our health and the way we approach medicine. Advancements in technology are moving quickly in medicine. Telehealth and remote medical services are becoming more mainstream, however, convincing patients to get health screenings, particularly for cancer, has become a challenge. It’s important, now more than ever, to keep up good health practices and let patients know they shouldn’t delay getting screened.

Timely screenings are incredibly important, says Imaging Technology News. Since the pandemic began there have been massive delays that have continued into 2023. Many facilities closed temporarily during the lockdown and many other facilities had severe staff shortages, says National Cancer Institute. When facilities did open back up, people were fearful of going to hospitals and other places where COVID might be prevalent, says the article.

covid impact on health
The COVID pandemic has caused many to delay important screenings

According to a survey between June and November of 2020, 11% to 36% of the 7,115 participants delayed their screening. The screenings ranged from mammograms, stool blood tests, pap smears, colonoscopies, and HPV tests. In another study done by Tulane University, screening rates decreased to nearly zero in 2020 of the 45,000 women enrolled in Medicaid in Louisiana. Should this trend continue, it’s predicted that later-stage cancer diagnosis will be significant, says Imaging Technology News.

 

How Can Medical Facilities Encourage Patients to Get Vital Screenings?

What medical professionals can do is encourage their patients as much as possible to get screened. This may be tricky, with COVID still lingering around the country. Appealing to patients’ health, and letting them know that a screening can save their life can be the most effective, says Imaging Technology News, as well as encouraging patients through evidence-based interventions, says the National Cancer Institute.

campaigns to increase mammogram awareness
Cancer prevention begins with screening

When cost is a barrier, says the article, there are options. Through the Affordable Care Act there are affordable cancer screening tests available as well as low-cost screening options for those without insurance or physician referrals. Medical professionals and facilities may also consider expanding the locations and access to screenings through mobile screening programs, says the article. Many of those in low-income areas who do not have transportation to access screenings can take advantage of mobile programs, says the American College of Surgeons.

For people who aren’t visiting doctors or medical facilities, making the general public aware of how important screenings are can help, says the National Cancer Institute. Social media, campaigns, and patient education are a few ways to reach everyone. In a multipronged approach, some hospitals educated virtually through community focus groups, asking specific questions as to why the people in the area weren’t getting screened, said the article. Hospital staff also worked with parish nurses to encourage and educate congregations on screening. In addition, some hospitals encouraged their own staff to be screened.

In our strange, new world, amidst COVID, staff shortages, and so much fear, we still must take care of ourselves and encourage others to do so. As healthcare professionals, we have the power to empower others to take charge of their own health.

 

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