Friday, April 10, 2009

So Why Does Does a Radiologist Treat Osteoporosis?

Radiologists in general don't typically see patients directly. They spend most of their time interpreting imaging studies. The sterotypical radiologist spends their days in a dark room looking at x-rays.

Although that is true to some extent, interventional radiologists typically take a more active role in seeing patients and directing patient care. For example, as an interventional musculoskeletal radiologist, I see patients on a daily basis with vertebral compression fractures.

Like many radiologists, when I started fixing these fractures with vertebroplasty and kyphoplasty I sent them back to thier doctor, presuming that the primary care physician to take care of medical management of osteoporosis. After several years of experience, however, I began noticing that we would see patients back again and again. Their doctor never did get them started him on appropriate therapy.

My intention is not to bash primary care physicians (PCPs)--far from it. Actually, there are many reasons for this phenomenon. First, PCPs have less time than ever to do their job. Two big factors are pressures from HMOs and insurers to see more patients in less time and the sheer number of medications that the average geriatric patient is on.

Second, osteoporosis management is complicated and requires a high degree of sophistication and diligence in order to achieve satisfactory management. Try doing that in a five minute visit with a patient on 20 medications.
Yet, a recent industry study looked at a list of things a doctor needs to address with patients during a routine visit. Osteoporosis didn't even make it into the top 10.

We kept seeing our patients coming back with more fractures and never placed on medication. So, we took ownership of managing this disease in our patients. I have personally devoted lot of time and energy, including continuing medical education compromise management for my patients.

Of course, there are many capable PCPs who prefer to continue managing osteoporosis in their patients. However, there are many more who would appreciate our approach and actually prefer to let us handle this work for them.

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