Patient self-referral for radiologic screening tests: Clinical and ethical concerns
Patient self-referral for radiologic screening tests: Clinical and ethical concerns
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DOI：
10.3122/jabfm.16.6.494
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发表时间：
2003-11-01
期刊：
影响因子：
--
通讯作者：
Deyo, RA
中科院分区：
文献类型：
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作者：
Fenton, JJ;Deyo, RA
放射筛查测试的零售营销在美国越来越普遍。无需医生转诊，患者现在可以直接购买筛查计算机断层扫描（CT）或超声扫描。在这篇文章中，我们考虑了用4种常用的市场测试对低风险人群进行广泛筛查的临床和伦理后果：全身CT、基于CT的心脏扫描、骨质疏松症的脚跟超声和颈动脉狭窄的颈动脉双工超声。对于低风险人群的筛查来说，所有这些检测都太不准确了，而且没有一项检测被证明能导致早期有益的干预。如果假阳性测试导致广泛或侵入性的诊断评估，筛查可能是有害的。最后，广泛的检测可能会增加医疗成本，而对公共健康几乎没有好处。患者可能应该避免放射筛查试验，直到这些试验在对照研究中得到适当评价，并得到无偏见的国家小组（如美国预防服务工作组）的推荐。初级保健医生和他们的专业协会应该强调在健康、无症状的消费者中不确定的益处和潜在的危害。
Retail marketing of radiologic screening tests is increasingly common in the United States. Without a physician referral, patients can now directly purchase screening computed tomography (CT) or ultrasound scans. In this article, we consider the clinical and ethical ramifications of widespread screening of low-risk populations with 4 commonly marketed tests: whole-body CT, CT-based heart scans, heel ultrasound for osteoporosis, and carotid duplex sonography for carotid stenosis. All the tests are too inaccurate for screening in low-risk populations, and none has been proven to lead to early, beneficial intervention. Screening could be harmful if false-positive tests lead to extensive or invasive diagnostic evaluation. Finally, widespread testing could increase health care costs with little public health benefit. Patients should probably avoid radiologic screening tests until the tests have been appropriately evaluated in controlled studies and recommended by unbiased national panels, such as the United States Preventive Services Task Force. Primary care physicians and their professional societies should emphasize the uncertain benefits and potential hazards of indiscriminate imaging among healthy, asymptomatic consumers.