Better ways to address self-referral than impugning integrity of physicians

LETTER — Posted July 5, 2004

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Regarding "Entrepreneurial imaging centers raise important issues about self-referral" (Letters, June 7): As an internist in a large multispecialty group who indirectly benefits by testing done within our facility, I take issue with letter writer and radiologist Michael Komarow, MD, the chief medical officer of a radiology benefit management company.

First, the ease of testing and receiving results on-site probably does result in more testing, but not necessarily because of physician greed. The presumption here is that physicians are more motivated by profit when ordering ancillaries than when performing our other duties, from which we also profit. I believe the welfare of the patient primarily motivates most physicians, whatever their specialty. In my clinical experience, radiologists are some of the most likely to self-refer, e.g.: "Finding of undetermined significance. Consider CT, MRI, PET scan, etc."

Whether, in Dr. Komarow's words, "the potential for profit is influencing a clinical decision" is an ethical question applies equally well to radiologists and insurance executives. They are no less susceptible to having their behavior altered by the profit motive than those who directly care for the patients.

I feel that better utilization of clinical guidelines and reimbursement for the medical management required to implement these would be more effective at restoring our reputation as a profession than internecine turf wars and impugning the integrity of other physicians.

Mark F. Kevin, MD, Munster, Ind.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/07/05/edlt0705.htm.

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