<p>It may be (and I agree this is a slippery slope) they feel that the test is just a hoop to jump through. Which gets back to the notion that if the test is considered a joke, the board ought to revise it so it meaningfully tests physicians’ fitness to practice. But a deterioration in ethical standards? I’ve not seen it. As I said, I work with doctors every day and have done for most of the past 20 years. I am a tough audience. More often than not, I am amazed at the dedication of the physicians at my medical center. I work at a great place; maybe others have horror stories.</p>
<p>Considering all this info being shared here, is it any wonder that the reliability of mammograms, MRI’s etc. are constantly being called into question?</p>
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<p>Who here thinks it’s right to sign your name swearing you won’t do something, then do it? Anybody? When I swear to pay one of them for their radiologic services, can I then decide I didn’t mean it?</p>
<p>@parent1986: Is the reliability of these tests really being questioned “constantly”? I am not denying the validity of what you’re saying, just wondering what evidence you have to support what you say. Speaking for myself, I get my mammograms at a facility where the diagnostic radiologists are fellowship-trained in breast imaging. Makes me feel more comfortable to see someone who does nothing but look at breast films all day. I don’t know of any studies that suggest radiologists make mistakes as a rule (any more than you would expect, and you have to expect errors in any field; no one’s perfect; what matters is how you fix errors when you find them and diagnose causes to prevent errors in the future), that they make more mistakes now than they did before, that they make the kinds of mistakes that routinely put people’s lives at risk, etc. Again, absent evidence, I wouldn’t say such studies don’t exist. I just don’t know of any so would be hesitant to raise the level of alarm.</p>
<p>@CardinalFang: Believe me, I am a stickler. I don’t think it’s right. I just think that if 50 percent of these docs are cheating, which I agree to call it, there’s something wrong with the testing system. If you really think this means radiology residency programs are turning out physicians who are wholly unethical, well, you’re entitled to that opinion.</p>
<p>@24, whether or not mammograms and MRIs are “constantly” being called into question is a question of semantics, IMO. No studies needed, as I think it is common knowledge.</p>
<p>Mammograms and MRIs are two of the most controversial medical tests. The efficacy of mammograms and the age and frequency at which they should be given is constantly changing. The value of the MRI related to cost is also in constant debate.</p>
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<p>This is pretty common in general. The GRE, ACT, SAT anyone? </p>
<p>When I took my certification exam (Board of Certification for Athletic Trainers) there were plenty of questions on there that were pointless. Multiple things that are hardly ever a part of our profession.</p>
<p>Here’s what a leading Orthopedic Surgeon, Dr. Andrews, has to say about MRIs and overuse… posted in the New York Times back in the fall…</p>
<p><a href=“M.R.I.’s, Often Overused, Often Mislead, Doctors Warn - The New York Times”>M.R.I.’s, Often Overused, Often Mislead, Doctors Warn - The New York Times;
<p>Hops, great article. I’m glad my ortho doc belongs to UW Medicine. :)</p>
<p>GRE, ACT, etc. are tests used to qualify applicants (and if the score is low, you can go to Podunk U instead of Princeton); the test you took and the test in question are supposed to test the knowledge of professionals who have been studying the profession and working with patients for many years.</p>
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<p>TIC? I don’t understand what you’re asking, gloworm.</p>
<p>Tongue in cheek</p>
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<p>As far as I know, no reputable organization has said mammograms are not valuable. There is controversy, if you want to call differences of opinion among reasonable people a controversy, over the age when they should be started and the frequency. The frequent review and revision of medical recommendations is part of progress in the discipline, not a cause for alarm. And the fact that it’s not easy to figure all this stuff out is why bright students are wringing their hands over the difficulty of medical school and the challenges of graduate medical education. No one wants to think there’s no foolproof way to screen for breast cancer, but that’s just the reality. Weighing the benefits and risks of testing is responsible medicine.</p>
<p>For the record, the U.S. Preventive Services Task Force now gives a Grade B recommendation to “biennial screening mammography for women aged 50 to 74 years”; that means they recommend the service be offered and conclude that “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.” The highest recommendation is a Grade A recommendation (an unqualified “substantial” benefit). As to the frequency of testing, the task force says the following: “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.” That comes with a Grade C recommendation. </p>
<p>The task force is rather conservative in its recommendations and is admirably straightforward. The American Cancer Society recommends more aggressive breast cancer screening. Many women are probably still getting the tests yearly starting at age 40. There may come a time when insurance companies will no longer support this more aggressive approach, in the face of scientific evidence that this frequency is not necessary. Maybe some already won’t pay for annual screenings. </p>
<p>Here is a link to the U.S. Preventive Services Task Force summary of recommendations on breast cancer screening: [Breast</a> CancerScreening for](<a href=“http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm]Breast”>http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm)</p>
<p>I shared the article with a radiologist friend of mine and he sent me this article which makes a good point that the ABR knew about recalls being used as study guides.
[Radiology</a>, Residents](<a href=“http://www.auntminnie.com/index.aspx?sec=sup&sub=res&pag=dis&ItemID=97990]Radiology”>Controversy erupts over CNN article on board 'recalls')</p>
<p>He said that the people who make up the questions are also the ones in charge of all the Radiology departments and of course know that there is study material collected in their departments to advise the residents what to study for the exam. So if they really thought it was cheating, they should have done something about it. He also pointed out that the written exam is not the major exam and the oral exam is more important. Yet the ABR plans to discontinue the oral exam. What a convoluted system.</p>
<p>If, under pressure to pass, doctors took shortcuts, why wouldn’t I think that, under the pressure of time and insurance requirements to work quickly, doctors wouldn’t also take shortcuts? (I think I would make a general assumption that they would, especially in a cutthroat environment where time is money, until shown otherwise.)</p>
<p>Neither College Board nor colleges particularly seemed to object in the SAT cheating scandal either. As to which a radiologist thinks is the more important exam, why should I care? From SAT to radiology exam to reading scans under pressure, it’s all the same thing, isn’t it?</p>
<p>“If you really think this means radiology residency programs are turning out physicians who are wholly unethical, well, you’re entitled to that opinion.”</p>
<p>Enough unethical that I’d think there is cause for worry if they are expected to act under pressure.</p>
<p>“Doctors who have been found to either share answers or use shared answers should be required to pay a fine and retake tests made up with entirely new questions.”</p>
<p>I certainly wouldn’t allow them to take the exam a second time if they cheated the first. Why would I want a known cheater who takes shortcuts related to his/her training to have a “quality designation”?</p>
<p>I think incompetent is a bigger concern than unethical. How often are these tests misread unintentionally?</p>
<p>Don’t know (I’ve heard lots of anecdotes, but no data) - but I’m not sure it is an issue of competence, but cutting corners under pressure of time, etc., or just laziness.</p>
<p>I’ve just finished a book - “The Invisible Gorilla and Other Ways Our Intuitions Deceive Us”. It’s all about selective attention (and inattention), selective memory, memory misattribution, misplaced confidence, illusions of knowledge, illusions of cause. There was a long discussion of radiologists who routinely miss diagnoses because they only look for things that they expect to find, and under pressures of time, simply don’t recheck for things they are not expecting to find. One could call it a “competence” issue, but I would think that, in cutting corners, it butts up against an ethical one.</p>
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<p>It’s a big part of the culture in college. Especially if you start talking Greek. So many Greek organizations have test banks…</p>
<p>I’m not saying it’s right; I’m just telling how it is…</p>
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<p>Whether or not that’s true (or, if true, to what extent), there’s a chance that one day you or someone you care about is going to need the services of a radiologist. All a layperson can do is thoroughly check the credentials of the physicians who treat them and assess the quality of the facilities where they receive their care. The book you mention sounds interesting.</p>
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<p>Very discouraging.</p>
<p>“Whether or not that’s true (or, if true, to what extent), there’s a chance that one day you or someone you care about is going to need the services of a radiologist.”</p>
<p>I have (massively!!!) I think I’d feel better if they were read in India. (I’m being perfectly serious - because of the larger number of health conditions that Indian physicians deal with, I think they would be more likely to look for the “unusual”. This is one of the reasons why U.N. missions in Africa are employing fewer and fewer U.S. physicians and more trained in India and elsewhere.)</p>
<p>Here’s the book: <a href=“http://www.amazon.com/Invisible-Gorilla-How-Intuitions-Deceive/dp/0307459667/ref=sr_1_1?ie=UTF8&qid=1326852775&sr=8-1[/url]”>http://www.amazon.com/Invisible-Gorilla-How-Intuitions-Deceive/dp/0307459667/ref=sr_1_1?ie=UTF8&qid=1326852775&sr=8-1</a></p>
<p>mini,</p>
<p>Thanks for the link! As for this:</p>
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<p>Hmm. I think docs who did their training in major academic medical centers have seen their share of difficult and unusual cases. But … I’m sure there are good radiologists in India who have seen plenty.</p>
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<p>Yes, this is what it comes down to.</p>