Posted on 06/16/2004 10:22:11 PM PDT by FormerACLUmember
There is a reality radiologists have faced for several years: Mammography, performed and interpreted by experts, can not survive. It is a technology besieged by conglomerate forces that will drive it into extinction, with many other important procedures and technologies to follow. Radiologists see four major reasons for this destructive phenomenon: HMO’s, government regulations, special interest groups ( THE MAMMACTIVISTS) and trial lawyers.
President Clinton’s overblown health care crisis and ill-conceived reform project of the early ‘90’s catalyzed the conversion of fee-based private health insurance into the HMO chimera we now face. Positioned as middlemen – with profits their sole motivation-- HMO’s are driving down reimbursements to the point where it is no longer economically possible for reputable physicians to do mammography and balance the books.
MAMMACTIVISTS -- special interest groups fanatically focused on breast cancer -- have railroaded thousands of pages of Federal regulations and compliance requisites through Congress affecting every aspect of mammography. These disease-specific laws are enforced by regular inspections and audits; this, despite the fact that mammography is one of the most straightforward procedures in radiology and is little more complex than a chest X-ray. No such regulations exist for neurosurgery, heart transplant, treatment of pediatric malignancy, or any other medical procedure. These laws have increased operating costs of women’s centers significantly, yet neither the HMO’s nor the government recognizes this exigency with increased compensation. Micromanaging individual diseases with laws leads, at best, to inefficiency and inflated costs.
A mammogram is an inherently limited study with relatively low sensitivity and specificity. Unfortunately, the public does not understand these limitations because the exam has been oversold as a diagnostic modality (We are told this is for the public’s “own good”). As a result, people have a difficult time understanding why breast abnormalities are “missed” or “misinterpreted” during routine mammography. Personal injury lawyers ruthlessly take advantage of this dilemma by scavenging mammograms involved in breast cancer cases. They prey on this ignorance by holding radiologists to impossible standards bolstered with retrospective analyses of mammograms done by venal physicians in their stable of “experts”. As a result, mammography is the single highest liability risk for radiologists (and the second highest risk in all of medicine). For a $15 reading fee, radiologists can face multi-million dollar lawsuits.
In their practices, the few radiologists left who interpret mammograms are seriously considering abandoning the procedure. Some argue that radiologists have an ethical obligation to do the procedure. This may be so, but radiologists cannot be the sole bearers of this obligation. If the businessmen, the politicians, the lobbyists, and the lawyers cannot share in this ethical challenge then radiologists will increasingly refuse to shoulder the burden alone.
Sheesh... We're starting to sound like the socialist countries.
What a shame!
A very interesting article, if you ask me.
I've been thinking of setting up a Midnight MRI Mammogram service. There has to be a lot of unused MRI capacity between, say 9 pm and 6 am. I'll buy up some capacity and hire a limo, with champagne, to deliver women from their homes to the clinic. Instead of the cold plates, the women will experience the inimitable stillness of the MRI for 20 minutes, and then be taken home again.
oh, man--i didn't expect the mammactivists!
(Reply, from off-stage): NOBODY expects the MAMMACTIVISTS!!!!
2 words: Tort reform.
"inimitable stillness of the MRI"?!!
I sure hope that the MRIs have gotten better since my wife had one a few years ago. I was in the waiting room and it sounded to me like she was in a metal garbage can with several chimpanzees hitting it with baseball bats. She tolerated about 30 seconds of that.
When I was a boy I thought a mamogram was when somebody received a pair of boobs in the mail.
For that, I'd pay good money!
When my Mama got her first mammogram (at about age 70), she told me how much it hurt, and that she was bruised! When she went to her doctor a few weeks later, he told her happily that she had no tumors. She replied that even if she HAD had any tumors, after that procedure, they would have been mashed FLAT!
Mammograms are more "conventional" medicine madness. Your grandma was right. Her tumor would have opened up and then spread to other parts. It that insane or what?
Can you do this before next Wednesday?
I feel this was irresponsible as she was already 87 years old and this thing was very small--too small to even have a lump.
My mom's mom died of breast cancer, but NEVER had any treatment and lived seven years AFTER she told the family about her lump. She was in her late 70s when she died.
My mom has continued to have her mammography. Why, I don't know because to remove the breast of a 89 year old woman would be ridiculous. Medicare should not be paying for routine mammograms on elderly women and there are far too many surgeons who are eager to remove their breasts.
The same gal has been doing mine for the past few years and last year she was stressed out from the day and had just had her cig fix.
This year I am going to refuse to do it if she is so under pressure.
Then they always have to do the one side over and make the same comment you must take high doses of synthroid.
OMG My left breast is panging just reading this thread and the right one is chiming in now too.
I don't do it for a totally different reason: I personally see no difference between many modern "cures" and sacrificial medicine performed by witch doctors. So what if the technician decides that I do have breast cancer-- what's the "conventional" cure? -- to sacrifice my breast to the great god Cancer?
I refuse to open myself up to that kind of fear-mongering mindset. The solution is to live a life in moderation, like the ancient Greeks. And yes, I believe the mind can sure anything. I've proved it on myself.
I don't get the exam anymore. I've had some serious bruising result from faulty technique, and it HURTS! Plus, three times I've had lumps, three times the mammogram was unable to diagnose the lumps.
That meant sonograms three times, which also did not provide a diagnosis or rule cancer in or out, so three biopsies (lumpectomies). All benign.
If I get another lump, I'll HAVE to get a mammogram, and they'll do a biopsy anyway, so why do I need the mammogram? Honestly!
Yes, the treatment is barbaric. The alternative is worse. Two years out and I am still here. A breast is a VERY small price to pay.
i have never minded mammograms, personally, but i shudder to think of women staying away from having them. I lost a dear sisterinlaw, several other acquaintances and now a good friend is in the throes of Stage 4 breast cancer. a little bit of pain or even a LOT Of pain from a mammogram is a small price to pay to stay on top of breast cancer.
the same is true of the PAP smear for pathologists
you are so incorrect
I can't help noticing all the male doctors who seem to like mammograms. It is about the most unholistic medicine I can think of.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.