Re: Informed consent, etc.

["Gibbs, S Julian" <s.julian.gibbs@vanderbilt.edu>]

I agree with virtually all comments made in response to my 
recent post.  However, there are a few problems that have 
not been adequately addressed.

The major issue is qualifications of medical users of 
radiation.  I was also at the recent NCRP meeting and heard 
Joel Gray's presentation on credentialing of users and 
operators.  Only one state now (to the best of my 
knowledge) requires such.  As I mentioned in my last post, 
the portion of medical radiologic procedures performed by 
untrained operators (and under the supervision of 
inadequately educated physicians) is growing.  At least 
part of this is the result of managed care's insistence 
that all procedures be performed by personnel who are at 
best minimally qualified, under the assumption that so 
doing will reduce costs (lower salaries, etc.).  How do we 
possibly expect these people to provide patients with 
adequate and accurate information for informed consent?

I think most radiologists and radiology departments are 
making an effort to educate patients.  Success rates 
vary widely.  The problem is cost; time is money.  In 
Tennessee we have a program called Tenncare, which is an 
extension of Medicaid to include the working poor--an 
admirable idea but woefully underfunded.  For example, my 
department is now recovering much less than half of costs 
of studies performed for Tenncare patients.  One of the 
contract HMOs with this operation has taken bankruptcy, 
leaving millions of dollars in unpaid hospital and 
physician charges.  We have been forced to reduce 
patoemt-care staffing while our workload is increasing.  At 
the same time, our administrative staff has grown to cope 
with paperwork.  I think we have it backwards.  It is just 
plain wrong to lay off busy technologists in order to hire 
more administrators.  But our legal friends give us no 
choice.

This is not meant as a defense of the current system.  
There are clearly problems.  However, it is just 
as important that the health physics community understand 
the limitations of our current health care system as it is 
for patients to be informed on radiation risks--or the 
absence thereof. 
***********************************************************
S. Julian Gibbs, DDS, PhD               Voice: 615-322-3190
Professor of Radiology                    FAX: 615-322-3764 
Dept. of Radiology & Radiological Sciences
Vanderbilt University Medical Center
Nashville TN 37232-2670 Email:s.julian.gibbs@vanderbilt.edu
***********************************************************
If it's free, it's advice;
If you pay for it, it's counseling;
If you can use either one, it's a miracle!

************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html