Radiology and Primary Care

Abstract

Much is being debated in the news and in the political arena regarding health care reform.Amajor componentof the problemofhealthcare is theshortageof primary care physicians, which is expected to worsen with the increase in aging baby boomers [1]. Key aspects of primary care are to provide diagnostic evaluationofsymptomaticpatientsand to prevent disease through appropriate screening. Traditionally, these services have been provided in an office setting by a primary care physician who develops a long-term relationship with a patient. However, the traditional method of delivering primary care is changing with the advent of large group practices, hospital systems absorbing primary care practices, 24-hour emergency care centers, telemedicine, and health care reform. These changes are expected to improve the efficiency and reduce the expense of delivering primary care. Radiology is a significant contributor to the delivery of primary care that, unfortunately, is often overlooked or ignored. It is important for the profession to address this oversight and raise the awareness of radiology’s participation in primary care. In many ways, radiologists perform primary care by using imaging to diagnose and prevent disease. For instance, imaging to diagnose disease is typically performed when a patient is referred by aphysician for a specific setof signs and symptoms. However, it is common for imagingtodiscoverdiseaseunrelatedto the indicated reason for the examination. In these situations, the radiologist serves as the primary care physician making thediagnosis. In thepreventive disease arena, mammography, virtual colonoscopy, ultrasonography for carotid and aortic disease, and coronary artery CT evaluation are successful screening programs. In many of these cases, the patient presents without a physician referral, and the radiologist directly performs the primary care function of early detection and prevention. The application of imaging to preventive care has made a significant reduction in the impact of a number of diseases. The continued application and evaluation of other imaging technologies, such as lung cancer screening with low-dose CT, will increase radiologists’ participation in primary care. In certain specialties of radiology, the physician-patient relationship rivals that seen in traditional primary care, particularly mammography, vascular interventional radiology, and pediatric radiology. Many patients have longstanding relationships with their breast imaging subspecialists and credit them with saving their lives by detecting breast cancer at an early stage. Pediatric radiologists examine young patients in the presence of parents and often discuss findings and disease progress with them. In many areas, imaging modalities and radiologist’s reading rooms are located adjacent to ERs to provide immediate interpretations and consultations. Because many ERs are set up with triage systems to accelerate patient throughput, a radiologist may be the first physician to encounter a patient and discuss the emergency. Additionally, radiologists are discussing imaging findings directly with patients at the time of their studies, and some even send radiology reports directly to patients. There are institutions that pro-