Presidential Address Calls for Practitioners to Look Beyond the Pocketbook, Prove their Value

Jennifer Erickstad

February 2011, Vol 2, No 1 -


San Diego, CA—Many ra diation oncology practitioners have become obsessed with technology and face potential perils in a new cost-conscious era of medicine, according to Anthony L. Zietman, MD.

“For the last decade, practicing radiation oncology has been like driving a Ferrari at 140 mph down the freeway—there has been forward progress indeed, which is very fast and very thrilling, but very risky,” Dr Zietman said during his presidential address at the American Society for Radiation On cology (ASTRO) meeting.

Beginning by examining physicians’ sense of “professionalism,” Dr Ziet – man highlighted passages from both the Hippocratic Oath and the 2002 Physicians’ Charter. For the most part, we practice medicine according to this charter, and it’s our conscience that guides the way,” leading physicians to put the patient’s welfare “above all else” and to avoid “superfluous tests and procedures.”

However, “life strews our paths with temptation,” he said, leading some physicians to elevate financial incentives over patient benefit. Citing the example of prostate cancer treatment, Dr Zietman noted that far too many low-risk elderly men have received radiation therapy when active surveillance would have sufficed.

In addition to overtreatment, reimbursement issues have caused some radiation oncologists to abdicate clinical care in favor of providing a technological service, narrowing their scope of practice and essentially making them “image-guided deliverers of a physical therapy,” Dr Zietman said.

To survive in a new era of healthcare, he said that radiation oncologists must provide “conscience-based medicine,” where evidence dictates treatment decisions. The specialty should still conduct randomized controlled trials for significant technical innovations to justify their use. In addition, ASTRO will cautiously advocate new technologic codes and will develop credible practice guidelines