Dr. Centor is optimistic about The American Journal of Medicine’s Patient Centered Imaging initiative:

The secret to slowing down and even reversing the continuing increases in health costs will require many interventions. We must use diagnostic tests more intelligently.

The premise seems to be that a lack of knowledge of the effectiveness of these tests is what causes them to be ordered when they are low yield. I would argue that be if from literature or experience, the low yield of these tests is well known to the ordering physicians and therefore this educational mission will do nothing to decrease their utilization.

Rather, I suspect that tests are overused for many reasons with the strongest being to avoid the possibility of a lawsuit. Sure, the likelihood of a CT of the head helping in a low impact cranial injury in a child is minimal, but if anything goes wrong, even if the CT scan wouldn’t have shown anything at the time it’s done, does anyone want to be the poor chap stuck at the defense table across from a parasitical lawyer and sympathetic family? Which do you want on your side, a crying, tragic mother wondering “what if” or a cold, sterile copy of the green journal?

Our society has no tolerance for the cruelty of random chance. When bad things happen, it must be due to malignant forces or criminal negligence.

I applaud the effort and look forward to the information, but I wouldn’t hold my breath for it to save any money, as proposed.