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Counterpoint: Where Teleradiology Falls Short

Counterpoint: Where Teleradiology Falls Short

I, like many of my radiology colleagues, have had to explain to the curious friend or family member exactly what the term “radiologist” means. “Are you a physician?” they ask. That’s a fair question.

Are radiologists in fact physicians? Not in the eyes of many patients, nor in those of a good many of our medical colleagues. Why is that? Do you examine patients? Do you treat patients? Are you available to talk with a patient when he or she has a question, especially after hours? These are the benchmarks patients and other physicians most often employ to determine if someone is a “real doctor.”

I began my career as an interventional radiologist. Surely, this subspecialty makes the grade. The interventional radiologist examines and treats patients day and night, and he or she is routinely bombarded with questions from patient and family.

But interventional radiologists are not alone in this regard. Mammographers are an integral part of the care of the woman with breast disease, and engage patients and families on a daily basis. In fact, in many areas of radiology, the willing physician has the opportunity to talk with, examine, and even treat patients.

So what about this new breed, the teleradiologist? Examine patients? No. Treat patients? No. Talk with patients? No.

In fact, in his blog series, “Memoirs of a Teleradiologist,” Dr. Eric Postal stresses the benefits of working with a large enough teleradiology company that just about every distraction is eliminated, including talking with patients and clinicians except in the most serious cases.

I understand that a radiologist can read studies faster with all distractions eliminated. Many would add that a radiologist can read more accurately when not interrupted. That would seem logical, except it ignores the fact that the patient is most often the best source of information about his or her disease. On innumerable occasions I have teased out the diagnosis from a patient after just a minute or two of conversation. Clinical history remains the cornerstone of diagnosis, even for the radiologist.

Radiologists can be — should be — doctors. It is as real doctors that we have the opportunity to maximally contribute to the overall care of our patients. That means talking with, and when necessary, examining patients. You can’t do that from a computer screen 1,000 miles away long after the patient has left the medical facility. Our physician colleagues look for us for help in the diagnosis and treatment of their patients. Your stock will soar if you can tell a clinician not only what is on the film, but can also nail the diagnosis after obtaining a piece of missing history or discovering an important fact garnered from a brief and focused physical examination.

If professional and personal fulfillment is your goal, then interacting with patients is the ticket. Nothing is more rewarding than having a patient thank you for listening, for taking the time to hear her story, and for caring. For most patients, that’s all they want or need.

Is there a place for teleradiology? I’m sure a case can be made for this option, especially in our bottom-line world. But if you went to medical school to be a doctor, to do your best to make the world a bit better each day by caring for patients, then think twice before you sign up for either a large or small teleradiology company. In this case size does not matter; neither can provide the personal and professional benefits that interacting with patients routinely delivers. And for sure neither will ever say, “Thank you, doctor, for taking the time to listen to me. I feel a lot better now.”

Mark E. Klein, MD, is a radiologist at Washington Radiology Associates.

Bravo Mark,

Spoken like a true MD. Try for fun breaking out your old stethoscope to listen to heart and lungs occasionally. You'll feel an added glow
David Bloom (not verified) @
I agree with Dr. Klein one hundred percent. In addition to talking with the patient, the protcol and appropriateness of each exam is equally important. An onsite radiologist helping in these matter is definitely a good patient care. The teleradiologist cannot contribute in these areas. The discussion between the radiologist and the referring physician is also more meaningful and satisfying if they know each other well.

Teleradiology is good only if it provides service where no exists. It is simply not good for patients, referring physicians, techs or radiologists themselves, if it replaces the onsite radiologists.
Mahendra Shah (not verified) @
I came from a long career in video conferencing, admittedly in a different industry (automotive) but I do similar benefits, especially with today's more affordable / available / user friendly technology. I, along with other members of my company have been researching the healthcare field and there are many opportunities that we see on the horizon.

Having a multi-point video conference in the comfort of the doctor's own office or even the patient's home is very do-able with a radiologist and/or other specialist. Seeing the patient eye-to-eye, carrying on a conversation, even collecting certain testing data (using a medical assistant at times) and even having authorized access to the patients EMR records can be accomplished - it's not rocket science any more. The biggest part that could be missing in teleradiology is the actual personal presence / contact. If a radiologist is on-staff or available then that is the way to go but if there is a certain specialist that is needed for consultation or is only available off-site, then teleradiology, if done right, can provide great benefits to a doctor and their patient.

Medical tourism . . . opportunities are open to these benefits using this technology too.
Poly Endrasik (not verified) @
Dr. Klein makes a number of assertions that are becoming increasingly irrelevant in the delivery of care model that the US healthcare industry is aggressively moving toward. His narrow definition of what it is to be a physician, while stirring all the passion and idealism that led most of us to the profession, is being made obsolete by the crush of demographics and the advancement of technology. Radiology may be the best example of this, but it isn't the only one. We can lament the passing of this notion of the pure physician, but I doubt that we can prevent it. After 20 years in the academic and private practice setting, I know full well the satisfaction a radiologist can derive from examining, treating and speaking with patients. Now, as a full time teleradiologist, I don't believe that I am any less a radiologist or physician. I "examine"patients in great detail. I contribute to their treatment by speaking with and guiding the physicians who are at the point of care. I take phone calls from local physicians seeking guidance on imaging studies and on how they should counsel their patients. Interventional radiologists and mammographers have always been unique among radiologists in their access to patients and have enjoyed the satisfaction they derive from patient interaction. Does that make other radiologists less valuable? Should they view themselves as something less than a physician? We have trained for many years to learn a set of skills that have proven indispensable to our colleagues. Indeed, it is impossible to practice modern medicine without radiologists. We cheapen ourselves and our contributions to the medical team when we conclude that some are "more equal" than others based on a decaying ideal that, in the end, is more about the personal satisfaction of the idealist than it is about taking care of the patient.
RAY MONTECALVO (not verified) @
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