Most radiologists do not think twice about doing studies requested by clinicians on patients who refer themselves for an annual physical, whether it be a "routine" chest radiograph, a CT scan of the abdomen for vague pain, or an excretory urogram after some RBCs are found in the routine urinalysis. Should we refuse to consider studying patients who self-refer to us directly for CT or any other form of imaging?
Tellingly, it was the Wall Street Journal, and not a medical journal, that raised the awareness for the potential use of whole-body CT scanning as a health screening tool. A front-page article titled "Using the CT Scan as a Check-Up Device" [1] cited the experience of a few pioneering physicians such as Kenneth Cooper (Cooper Clinic, Dallas, TX) and Harvey Eisenberg (Newport Beach, CA) who were applying CT scanning to "preventative medicine" [sic] programs. The article went on to quote Ronald R. Blanck, Surgeon General of the Army: "It is the next generation of medicine," suggesting the Army hoped to gain sufficient funding to cover full-body scans for all its troops. The article also discussed the controversy beginning to emerge around this concept and the emergence of consumerism in health care.
Eisenbergs appearance on The Oprah Winfrey Show heralded the new age of entrepreneurial CT screening centers and helped fuel the growth of self-referral by healthy individuals for such CT studies. A combination of societal, economic, and scientific factors have converged to expand this phenomenon. A major factor is the growing "boomer" population and its associated preoccupation with life span prolongation and wellness. The increased standard of living and the ready access of this generation to medical information through the Internet and other mass media have produced a sense of medical self-empowerment. At the same time, mainstream medicine has pushed patients toward more self-reliance and thus has allowed itself to become consumer-driven. The general perception of many consumers is that the payor-physician culture is excessively paternalistic. It strictly controls the practice of medicine and patient referral pathways. Partly because of greater demand, access to physicians has become increasingly restricted, particularly in the managed care setting. More and more patients, including those in managed care systems, distrust health care providers and sense the aim of the system is managing cost, not care. More are willing to become payers, as well as consumers (the two categories being inseparable in most other industries), as evidenced by significant numbers of individuals in health maintenance organizations who refer themselves for screening CT.
Individuals are already accustomed to periodic screening. Self-referral for mammog-raphy has been condoned and actively recommended by consensus medical opinion, despite some continuing debate as to its value. Lay individuals and many physicians have been inculcated with the notion of "an ounce of prevention..." and do not look for double-blinded studies for validation. Recommendations for routine colonoscopy or sigmoidoscopy and other screening for co-lorectal cancer, Pap smear screening, prostate-specific antigen testing, blood tests for cholesterol and glucose levels, periodic blood pressure measurements, are all part of common medical practice and its recommendations to the general public.