Journal of the American College of Radiology : JACR
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Review
An overview of the ACR Committee on Ethics: from hospital contracts to expert witness testimony.
Professional medical ethics has challenged physicians since time immemorial. Difficult questions about whether physicians appropriately interact with patients, staff members, and their medical colleagues seldom yield ready answers. Like other professional societies, the ACR offers guidance for its members on medical ethics issues. ⋯ It also has received complaints that a member's conduct allegedly violated the ACR's Code of Ethics. Many recent complaints have alleged that a member failed to provide nonpartisan and accurate expert medical testimony in a legal proceeding. The committee carefully screens each complaint and has established a process for investigating and deciding whether the testimony has violated the code.
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In light of the proliferation and pitfalls of expert witness testimony provided by radiologists, this article offers an overview of the standards for such testimony, as enforced by the courts, the relevant professional societies, and peer-review processes. The article also offers practical suggestions that encourage radiologist expert witnesses to be both ethical and effective in spite of the often inconsistent ambitions, expectations, and obligations of the expert's role.
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The participants of the 2004 Intersociety Conference met to discuss the growing problem of self-referral. The United States spends more of its gross national product on health care than other countries, especially Japan and those in Western Europe. Imaging accounts for a large and growing portion of those costs. ⋯ Thus, conference participants agreed that the real problem is inappropriate use, which may arise from (1) ignorance of what specific imaging studies are needed when, (2) high public expectations for imaging tests, (3) the fear of liability for a missed diagnosis (defensive medicine), and (4) self-referral. The Stark laws have been largely ineffective in preventing self-referral because there are many loopholes, and the laws are inconsistently enforced. Among the many potential solutions are the education of our clinical colleagues on appropriateness criteria; the education of the public on the costs of inappropriate use; tort reform; and working with third-party payers, especially the private insurance industry, to develop vigorous privileging programs, to require precertification for self-referred studies, or to establish differential payments for self-referred and non-self-referred imaging.