The Wall Street Journal published an article (1) on the increasing role of radiologists in diagnosing. The announcement maybe the recognition that we need to return to our roots.
Historically the radiology department was a frequently visited venue with morning work rounds by specialty coming to the department sequentially and reviewing active cases. The social and dynamic nature of the specialty was one of the major attractions for me. I was on a first name basis with the entire medical staff and had personal knowledge of the clinicians family situation and even their hobbies. With the advent of PACS systems, the review of imaging studies was most often performed remotely and radiology work rounds were abandoned. Imaging review occurred far from radiology. Radiology was no longer the hub. PACS is a wonderful tool which makes imaging studies more accessible for clinicians. It has enormous strengths of convenience and timeliness.
For Radiologists PACs has been a superb resource as well. Comparisons to previous exams and reports was automated and the medical record became accessible. The steep price that was paid was the loss of collegial interactions and discussing the clinical information which often completely changes the understanding and significance of findings which are identified. The clinical information we received on requisitions increasingly became misleading since it was more driven by reimbursement criteria rather than the real symptoms and signs of the patient. Further the commoditization of the profession became apparent. The role of radiologists as consultants fundamentally changed. Sitting in a dark room churning through worklists with hardly a human being with whom to interact became the norm. Many administrators and ordering clinicians didn't care if interpretation occurred in the hospital in which they worked or half a world away in Australia.
New opportunities abound. Now we can rise from the ashes and reinvent ourselves by traveling to the clinicians and patients and interacting with them. The adoption of integrated practice units as suggested by Porter and Lee (2) may be a future paradigm shift with geographically distributed imagers. Some departments have placed radiologists in specialty clinics and on hospital floors embedding them and creating new primary work space. We need to take this to the next level. Using technology all departments should institute a "Live Chat" function and all radiologists should have video conferencing (skype like but secure) capabilities to interact with referring clinicians and patients. Patients increasingly want access to their reports and the ability to consult with radiologists. When radiology reports are delivered electronically to both ordering physicians and when requested, to patients directly, embedded links to live chat and videoconferencing to radiologists should be provided with key images included and annotated. Radiologists do have the ability to take the technology to the next level and again become, in real time, an appreciated diagnostic colleague who can provide outstanding customer service.
In a value based world of reimbursement with a commoditized service, radiologists need to provide the highest level of service. By directly interacting with clinicians and patients, radiologists secure their positions. While you may not be able to shake hands... you can make virtual eye contact and greet your colleagues and patients with a warm smile. By closely working with caregivers and patients we can enhance patient safety and quality by getting the most pertinent clinical information from the source. For those willing to embrace change and technology, the future is bright for radiology.
Nicolas Argy, MD, JD
Copyright © 2016 Nicolas Argy