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Imaging Machine Ownership Presents Conflict of Interest

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Patients expect their physicians to make health care decisions based on the best available science rather than financial gain. But a new study suggests that financial incentives may have an influence on doctors' behavior. The investigators tracked how often primary care physicians and orthopedists ordered magnetic resonance imaging or MRI scans. Specifically, the scientists compared scan rates before the doctors purchased or leased an MRI scanner to after they obtained such expensive equipment.

The primary care providers increased their self-referred MRI scan orders by 13 percent and the orthopedists increased their MRI recommendations by 32 percent after they acquired an MRI machine. Perhaps even more worrisome, patients who consulted an orthopedist who self-referred the person for an MRI scan, were far more likely to end up with back surgery over the next several months. The lead author of the research notes that she does not want patients to doubt their physicians' recommendations, but she does point out that patients may need to realize that "financial incentives may influence the care they receive."

[Health Services Research, Online, April, 2011]

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This reminds me of when I was pregnant with my first child in 1981. Sonograms were still a bit new but I wanted one to determine the sex of my baby. I even offered to pay for it myself since it wasn't medically needed. My doctor was a bit conservative and would not order it.

He told me then that most doctors who ordered the sonograms also had a financial stake in the machine. He felt this was a bit unethical. But I also have to wonder if doctors buy the equipment because they feel strongly that the equipment is very helpful. That would also explain why they order more tests. I guess things haven't changed all that much over 30 years.

In some states, inspection of medical devices is only required of hospitals and "clinics."

I am involved with a study of the possible causes of autism. The initial information on the calibration status of ultrasound devices in obstetrics offices raises a cause for concern about all devices.

I suggest the patient ask to see the most recent certificate or record of calibration. Much new equipment has self-calibrating ability. However, there is a large market for used devices so a device new to a physician's office may not be the latest version.

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