Radiologist-Service Provider or Gatekeeper-NEJM Article Questions

An interesting article by Dr Saurabh Jha in NEJM, From Imaging Gatekeeper to Service Provider — A Transatlantic Journey, author contrast difference in radiology practises, highlighting gatekeeper approach in UK where he cites an example of one radiologist was nicknamed “Dr. No,” since his first response was always to deny requests for any imaging other than a plain radiograph.  He further comments since imaging was a scarce commodity in the National Health Service (NHS), radiologists acted as gatekeepers. And then he contrasts it with his experience in US with abundance of CT scans, MRIs, and technologists. 

Although the scenario is a comparison between UK and US way of radiology practise article raises questions for all even for our Indian practise, there are places where imaging is overutilized and the there are places of underutilization as well. Need to educate all clinicians on appropiate use of imaging is need of the hour. Will radiologists take the lead in this case? There are incentives for utilization of imaging but are there any incentives for appropriate use? Does increasing consumer mindset of patient help in this any further? We cannot deny imaging if the consumer will sue us for missed pathologies?

What are your views and comments?
Some comments on our various social media channel - Radiology Resident Club on Facebook

Dr Ramesh Kumar Pandey Hmm..may be my comments can b considered as Narricistic by many/few...well in Indian setup if Patient is on Panel or cashless category then he/she gets A toZ and X to Y investigations which isn't limited to Radiology only...it includes pathology also. Paying patients get categorized as per paying capacity...but why to blame doctors, Insurance covered patients are willing to go under knife if no penny they have to pay...once it comes to paying category then all patients become fussy...n start lecturing doctors sans social n moral ethics...

In era of consumer forum and mistrust, everyone wants to play safe..that old time when doctors were considered noble has gone kaput...it's businesses now...patients think after paying money they deserve to get facilities...respect n regard have taken backseat....surprisingally Trained doctors get most lessons from most unqualified persons...persons who don't know what Government college educated doctor had to sacrifice in his/her life...N this will continue only:-):-)

Dr Sanjay Gandhi: We can optimise use of radiology and reduce radiation burden to patients and society if more clinicians can use resources like this : Making the best use of clinical radiology services (MBUR).
These guidelines are available as an online version, an app or as a booklet.
RCR members and Fellow can access iRefer Free online via the RCR website.
http://www.irefer.org.uk/index.php/about-irefer
iRefer is now available for NHS professionals from the e-LfH Portal to all members of the NHS for free as part of an agreement with the Department of Health. NHS Doctors Login to http://portal.e-lfh.org.uk/ to access the guidelines.

I am proud to be Contributor to these MBUR Royal College Guidelines, which are not only good for our patients, but also useful for our clinical colleagues in deciding best investigations and care pathway.


 Dr. B. B. Thukral Consultant and HOD, Dept. of Radiology and Imaging, Safdurjung Hospital and VMMC, New Delhi 
Dear Dr. Sumer Sethi, You have really stirred hornets nest by raising a debate GATE KEEPER VS SERVICE PROVIDER.I hope it will also stir the conscience of not only radiologists but clinicians as well. A very pertinent issue has been raised. In the current scenario of business practices of multinationals has caused havoc on the health care system particularly in poor and developing nations. It goes without saying that optimal utilization of resources can provide health care to all instead of lucky few who can afford insurance or are rich enough. Side by side there is immense need of improving teaching. it must include a chapter on finances of health management and treatment.Laws pertaining to so called consumer protection acts as in India has made patient a consumer,there by forcing treating doctors to over investigate and over treat the poor patient and making him poorer money wise and also health wise.Radiation is also becoming an issue which is being exploited in favour of costly investigations by generating higher demand on non radiation technology.There is no doubt that the Radiologist has to function not only as Gatekeeper but also as Service provider. Simultaneously it has to be ensured that enough trained manpower is available to be a good service provider as most of it is getting concentrated in the metros and big cities leaving the poor rural population in the lurch by providing sufficient services in their area. A prudent and balanced use of technology with change of mind set of medical fraternity is essential so the advantage of technology is shared by all humanity in equal proportion for better and healthy world population and better future for coming generations. Amen!