IMAGING & ONCOLOGY - Society of Radiographers

Do the ‘worried well’ deserve to bedemonised for seeking private imagingexaminations? What is the future ofself-referral imaging and the aggressivemarketing techniques adopted by someprivate companies? Is tighter regulationthe answer?IntroductionOver the last few years there has been an increase in the number of privatecompanies offering imaging tests to self-referring members of the public, and someof these have adopted aggressive marketing campaigns. This increase has attractedinterest, concern, and implied condemnation from some professional organisationsand individuals as illustrated by the recently published special feature ‘Let’s all jumpon the bandwagon: further debate on the use of ultrasound’ in the journal Ultrasoundearlier this year 1 . The conclusion reached in the article is sound since it advocatessonographer registration and the compulsory training and regulation of all cliniciansusing ultrasound, regardless of professional background. Who is doing the scan andhow they deal with the fi ndings is of utmost importance since it is widely acceptedthat ‘the greatest hazard from ultrasound is the misinterpretation of the appearancesby poorly trained or undertrained operators’ 2 . But, arguably, why and where a scan isperformed is not as important.However, that is not to say that scans should be available at the back of church halls orthe public rooms of the local library because, aside from turning ultrasound provisioninto a circus, there are health and safety issues. Patients’ privacy and safety may becompromised and staff may be at risk of developing work related upper limb disorders ifthey are expected to conduct high volume lists in inappropriate settings.scans for pregnant women and by inviting the asymptomatic ‘worried well’ of thepublic to pay for an ultrasound examination for reassurance’.Forgive me for stating the obvious, but a trawl through the myriad of companiesadvertising such services in the UK on the internet shows that the majority of thesecompanies are either owned or staffed by (dare I say it?) the core imaging specialistsof group one and clinical specialists of group two. The very people who are laudedby Edwards in the opening paragraph are the ones who, a few sentences later, arelabelled at best, as profi teers and at worst as charlatans.Is it any wonder thatthe general public isscared witless?There have always been ‘self-referrers’ or the ‘worried well’ as they are so frequently(and in the author’s opinion, disparagingly) called. Can any ultrasound practitionerreading this article say honestly that they have never scanned a patient where theclinical information has simply said ‘anxious’ or ‘for reassurance’? Or never scanned acolleague (or themselves) without a referral? The Biblical phrase ‘He that is without sinamong you, let him fi rst cast a stone...’ springs to mind here. However, before I go anyfurther, let me declare an interest:I am a sonographer who in 1995 set up an independent ultrasound company. Itwas to offer an ultrasound service somewhere between the two delivery modelsavailable at the time: the National Health Service (NHS), where ultrasound wasoffered almost exclusively in the secondary care setting, and the private sectorwhich catered for the insured or affl uent members of the public and which offered achoice of hospitals and convenient appointment times. At fi rst, all our patients werereferred by GPs, were scanned in the primary care setting and were paid for out ofthe NHS budget.41This article aims to add to the debate on ‘self-referrals’ and in some way ‘decriminalise’both the patient – ‘the worried well’ – and those who offer some of the services.Who exactly is offering these scans?Edwards 1 states that ‘In the UK those using ultrasound can be divided broadly intothree groups’, and goes on to describe the fi rst group as ‘core imaging specialists,including radiographers and radiologists, whose primary role is to produce andinterpret images’. The second group is ‘clinical specialists...midwives, physiotherapists,emergency physicians’ who use ultrasound to ‘enhance their diagnostic power’. Thethird group ‘employs ultrasound in a non-medical capacity by providing ‘bonding’However, it soon became apparent that many people would be willing to pay to havean appointment that fi tted in with their lifestyle (something that the NHS was notproviding) as long as the cost was not prohibitive. We now also accept self-paying andinsured patients referred by clinicians and self-paying patients who self-refer.To date, my team of experienced committed sonographers and radiologists have,between them, scanned and reported in excess of 80,000 patients for my company.I admit, and I don’t feel guilty for saying this, I pay them – they do it for the moneyand I do not know of anyone in groups one and two who scans patients purely forphilanthropic reasons because philanthropy does not pay bills.2010IMAGING &ONCOLOGY