Change the Conversation

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Cat VaskoHere’s a confession: Though a bit of a snob about most of what’s on television these days, I’m obsessed with AMC’s “Mad Men.” I’ve watched every episode more than once, analyzing each for hidden meanings and recurring themes; I even read recaps online in case there’s anything I missed. An oft-repeated truism on the show, trotted out when its ad executives are dealing with clients in difficult situations, is: If you don’t like what’s being said, change the conversation. I wonder, sometimes, what the creative geniuses of the fictional ad agencies of “Mad Men” would make of imaging’s biggest current problem. Too often, in the conversations that I have with the progressive thought leaders running radiology practices—on both the business and the clinical sides—I hear this phrase: You really shouldn’t print that I said this, but . . .. It happens so frequently that I’d probably benefit from programming a keyboard shortcut for the phrase. What follows inevitably is an admission that imaging, as a field, has an image problem—one that it earned, all on its own, after enjoying years of comparative prosperity and ease. That so many people confess to knowing this is one thing. That so many are afraid of the retaliation that they might incur by admitting it publicly is quite another. It is beginning to appear that everyone is thinking the same thing while saying something else entirely. Imaging has an image problem, and the solution that seems to have been tacitly agreed upon by its community is to pretend that the problem doesn’t exist until it goes away. There’s a reason that the truism isn’t if you don’t like what’s being said, don’t say anything at all. We know, all too well, what many adjacent to the field have to say about imaging: that it drives up health-care costs, perhaps owing to inappropriate, profit-motivated utilization; that its providers earn an unfair portion of the health-care pie; and that it gets away with service levels that would be unacceptable elsewhere in the system. By zipping our lips every time the subject is raised, however, we allow these notions to dominate—and by responding to them defensively, we imply guilt. Imaging needs to change its conversation, and the best way to do so is to be proactive, not reactive. Instead of racing to respond to every accusation—or worse, ignoring every accusation on the grounds that it is meritless, while secretly confessing to some degree of agreement—the field needs to generate new and exciting ideas about how it can contribute to improving health care. I love studies indicating that inappropriate utilization is rare as much as the next girl does, but the past couple of years show us that no one is paying attention to them. Why should we? They’re part of an old conversation, and it’s one that’s not worth having anymore. The new conversation—the one about how radiologists can and should be the linchpins of coordinated, efficient, cost-effective care delivery that results in better outcomes—is the one that we should be focusing on now. Cat Vasko is editor of and associate editor of Radiology Business Journal.