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How is Medicine practiced when the Physician owns the Diagnostic equipment?

A number of years ago I worked in a small Louisiana emergency department. That hospital did about 50 CT’s of the head per year for the evaluation of head injuries, headaches and various other lesser reason to do a head CT. At that time, the price of a head CT was a little over $300 per scan. All of the scans were done in Monroe, Louisiana, which was the location of the nearest CT scanner. After a couple of years of sending the revenue of 50 CT scans per year to Monroe, the local doctors got together one day and questioned why they shouldn’t start doing their own scans. Of course, they were doing this for patient convenience.

They did not have to make the half hour drive to get their radiology study. It had absolutely nothing to do with the fact that now the local doctors could pocket that $15,000 per year split between them once the scanner was paid for. And goodness sakes, perhaps if they practiced medicine a little better they could even find additional reasons to do head scans. What a self-prophesying thought that was.

The medical acumen of these doctors increased to amazing degrees. Now they were ordering over 150 CT scans of the head per year. I think they even ordered CTs if they thought a patient’s ear was higher on one side than the other. No matter their head was tilted. I am being facetious of course, but the justification for using the new CT scanner rose to outlandish heights. I am only talking about heads here not the myriad of other uses they found for their new machine.

My observations of this came to an abrupt stop one night. One of our local doctors had me admit one of his patients through my emergency department. The patient was a 95 plus year old patient that had an obvious neurologic catastrophe. The CT scan, which really was not necessary, showed a massive subarachnoid hemorrhage. Our local doctor asked me to write orders for head CT scans every hour on the hour. I refused saying the patient was going to die in the next several hours if not much sooner and no further testing was necessary. The doctor informed me it was not my call and to write the orders. I informed him I was not going to commit malpractice to pad bills and if he was having trouble making his house payments perhaps he should show up in the emergency department and write his own orders. After some swearing at me he said I no longer had the job of administrator or physician in their emergency department.

Needless to say my tenure was very short following this episode.

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