I received recently a feverish call from a relative informing me of a new diagnostic test she planned to take. She called it the HealthScan. This test would alleviate her fears about cancer (prompted by a persistent pain in the side) as well as a justified concern for her overworked cardiovascular system. A recent ECG had failed to dispel her fear of a heart attack, though the internist told her the results were within the normal range. Her risk factors include an elevated cholesterol level, which was under control with daily medication, and obesity. She had heard about the procedure while listening to a popular radio talk show host, who had undergone the scan himself and then spent a good deal of golden Los Angeles air time discussing the procedure. Several days after calling a toll-free number, she received a brochure in the mail and called to schedule an appointment for the $770 procedure.

The brochure promised that the HealthScan, offered by a Los Angeles-based radiology group on a dual-slice helical CT scanner apparently equipped with the software to perform both coronary artery calcium scoring and bone mineral density measurement, “is very accurate in detecting the following diseases: coronary artery disease; lung cancer, emphysema; thoracic aorta calcification, pericardial effusion, heart valve calcification; ‘silent tumors’ of the liver, pancreas, kidneys, adrenal glands, and lymph nodes; stomach tumors and inflammation; liver cysts, infection, cirrhosis; abdominal aortic aneurysm; intestinal masses; gallstones; kidney stones; prostate enlargement; bladder tumors; ovarian and uterine tumors; bone demineralization; bone tumors; and spine and hip arthritis and degenerative disease.”

In other words, consumers are invited to peer beneath their skin to see what lurks therein. What more could one ask?

One thing more, actually, and that is the 15 to 20 minutes promised with the radiologist who reads the scan, during which time the images would be reviewed and discussed, in addition to a written report to be forwarded 2 to 3 days later, a copy of which would be sent to the patient’s physician.

Whatever the outcome, this anecdote illustrates three consumer trends that are driving health care into the next century:

  1. a growing proportion of the population is developing an age-related, deepening sense of its mortality;
  2. consumers are becoming self-appointed physician extenders and arming themselves with information gleaned from the Internet, periodicals, and the popular media; and
  3. patients are beginning to self-refer for unreimbursed care.

This final trend requires a willingness on the part of the radiologist to consult directly with the consumer, as did the radiologist who read the scans of the previously mentioned patient, an experience, by the way, she will never forget. Not only did he emerge from the reading room, he was wearing a kilt.

Radiology previously has debated the wisdom of consulting directly with patients, particularly in the realm of mammography. And the truth is, people are messy, time-consuming, and legal liabilities. I happen to know that the patient described here made a follow-up call to the radiologist, further consuming more than the 15-20 minutes of his time promised in the brochure. Her score, it seems, was in the low end of the danger zone. The radiologist recommended a stress test during the consult and in the report to her internist. Ultimately she was referred to a cardiologist, who told her she had wasted her money on the HealthScan. But he did refer her for a stress test, which was not on the radar screen prior to the patient’s whole body scan.

The time for debate clearly has passed. Consumers are increasingly unwilling to wait for an invitation (or referral) for state-of-the-art care. The questions to be answered by individual radiology practices are numerous, but the bottom line is patient care and a willingness to assume the responsiblities of direct consultation.

After decades in the reading room, the waning days of this century are a fitting time for radiology to engage in the soul-searching required prior to making its choice. Kilt is optional.