Why is Ordering X-rays Different from Referring to Other Specialists?

Peter Elias asks a provocative question:

If I diagnose symptomatic gall stones or an incarcerated hernia, I refer the patient to the surgeon. I don’t pick the procedure the surgeon will do. My office and I don’t schedule the operating room time and notify the patient.

But if I want a CT scan or an ultrasound or MRI, I am forced to pretend I am a radiologist and determine how the study is to be done, such as whether or not to use contrast. I am expected to do the prior authorization to ensure that the radiologist is paid by the insurer. This routinely involves a series of phone calls between my office and the radiology department. It often involves my having to reach a radiologist, interrupting them and disrupting my day, present the case and my clinical question, so the radiologist can tell me what test he wants me to do and how, after which I start the order and my staff does the prior authorization.

It would be better care for the patient, more efficient for my office, and better billing for the radiologist if I ordered a radiologic evaluation of abdominal pain or hemoptysis or thyroid nodule with weight loss and tachycardia, included a copy of my note or a summary of the relevant clinical information, and then let the radiologist determine how best to proceed.

The radiologist knows far more than I do about which is the best radiologic study in a given clinical setting. The best test in the wrong setting gives the wrong answer 100% of the time.

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