In his excellent talk during a refresher course on communication in cancer at RSNA 2016, Fergus Coakley, MD, professor and radiology chair at the Oregon Health and Science University in Portland, made a compelling value case for deep subspecialization—for this particular talk, especially in specific situations in which cancer is suspected.
For example, he offered up the case of a man diagnosed with pancreatic cancer who was referred to a major academic medical center for a Whipple procedure. The PET scan on which the diagnosis was made was unavailable, but Coakley recognized the halo sign typical of autoimmune pancreatitis on a subsequent CT, the pathologist was asked to re-examine the specimen, it was found to be benign, and the surgery was averted.
“This is the only patient I’ve ever ‘cured’ of pancreatic cancer,” Coakley noted.
Coakley pointed to a consistent theme of major changes in patient management 10% to 20% of the time when subspecialists provide second reads, with the subspecialists correct about 80% to 90% of the time. “Nobody’s perfect, obviously, and sometimes the subspecialists are wrong,” he said, “but consistently you can expect an actionable change in about 10% to 20% of those reinterpretations.”
Three primary points were made:
- If value equals quality/outcome over cost, then radiology, as a significant cost to the system, needs to do something above the line to improve the outcome for patients.
- You don’t need to prevent too many Whipples in order to justify many reinterpretations of a studies by a seasoned subspecialist (see article for description).
- Providing a formal second-opinion service not only documents your clinical impact, but it can provide reasonable compensation for your services.
Vox Percipio is closed for business next week. I am looking forward to pulling down the shades, going for a few long hikes, reading several books, and otherwise staying away from the monitor.
I’d like to give a shout-out to those of you who will be keeping the wheels of health care turning while so many of us check out and savor the season of miracles. (I’ll never forget the five hours I spent in the ER after rotating my ankle one day after Christmas 2006, the midnight visit from the orthopedic surgeon to the ER, and the 8 AM surgery the next morning.) Happy Holidays, and all good things in 2017!