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Attitudes of family physicians, specialists and radiologists about the use of computed tomography and magnetic resonance imaging in Ontario

You JJ, Levinson W, Laupacis A. Healthc Policy. 2009; 5(1):54-65.

Background — Despite efforts to reduce wait times for computed tomography (CT) and magnetic resonance imaging (MRI) in Ontario, little is known about physicians' attitudes regarding contemporary patterns of CT and MRI scan use in this province.

Methods — We interviewed 19 Ontario family physicians, specialists and radiologists from diverse settings between November 2006 and April 2007. Our detailed written notes were independently reviewed to identify major recurring themes.

Results — Major themes were grouped under two categories (a) non-clinical reasons for ordering CT and MRI ("defensive ordering," indeterminate imaging reports, patient demand, supply-induced demand, marked variation in ordering practices) and (b) communication among groups of physicians (increasing isolation between clinicians and radiologists; specialists and family physicians working in silos).

Conclusion — These interviews revealed infrequent communication among physician groups and marked variations in ordering practices that are often driven by a number of non-clinical factors, such as fear of litigation and patient demand. Recent increases in CT and MRI capacity may not be leading to better care for patients. Our findings, however, are very preliminary and require validation in other studies.

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Keywords: Diagnostic testing/imaging Health care evaluation Health care services