Eric Postal, MD

At times, image ordering by clinicians seems downright random. Courtesy of roulette and certain game shows, I propose the Wheel of Protocols.

The Supreme Court has now given us the means to strong-arm the citizenry into having better, cheaper care - whether they want it or not.

Radiology visits me in my sleep. My radiology dreams are bare-bones, no-frills affairs. There are no characters or situations in them - just imaging studies.

Clinical histories can help radiologists improve differential diagnoses. They also can help me avoid the misfortunes of those being imaged.

Batman works best in the dark and employs sonic gizmos; his alter ego Bruce Wayne could easily be rewritten as a radiologist. Here’s my reimagining of Batman as radiology’s hero.

Imagine taking radiology to the open seas in a medical cruise - escaping the day-to-day pressures in favor of a vacation atmosphere for doc and patient alike.

Radiologists are familiar with receiving lousy clinical histories for imaging studies, so when I get a case with a thorough history, I like to give kudos.

Serious bending of the cost curve could be accomplished by targeting the less mission-essential elements of our overburdened health care system.

Remember the cartoon Goofus and Gallant from Highlights? Introducing teleradiology’s version, Doofus and Valiant, with quite different approaches to their jobs.

From med-mal to reimbursement, radiologists have quite a few metaphorical guns to our collective heads.

Radiologists generally seek to have an impact on things. We want to know we are making a difference - in patient care and department protocol.

To sum up my previous thoughts regarding the state of voice recognition typically available to us in radiology: We’re not yet living in the days of Star Trek.

You don’t need to have had personal experience with voice recognition software to know it’s still a work in progress.

In the teleradiology field, I’m partial to working with larger, more established groups, but are there advantages of the smaller startup enterprises?

I get it. You’ve got some issues with this business model, and you feel the need to push back against it.

Previously, I addressed one of the major reasons why I would advise anybody considering telerad to work with a large, established entity as opposed to a smaller outfit: Support.

The government and insurance companies will eventually run out of ways to further complicate the system. Until then, I'd like to suggest some categories of diagnostic codes that we would actually find useful.

Working remotely inherently guarantees that you’ll never get called away from your desk to place an IV, operate a fluoro case, or spend five to 10 minutes in the sonography room because the tech is in over his head.

Whatever the reason, when I got my performance report for last quarter’s radiology work, I found myself musing about the stats used to measure us.

So I took the plunge, and became a teleradiologist.

In our bizarre world of getting paid not for what we do but rather why we did it, we often find ourselves holding the bag when a referrer ordered a study that the insurer decided was “inappropriate.”

The problem with making rules that define cheating is that he who makes the rules needs to have a plan of action to enforce them.

There are chemicals (neurotransmitters and otherwise) central to the physiological process of pain, and I envision an imaging modality that could depict where in the body these chemicals are active.

“Clinical correlation is recommended.” Them’s fighting words, in the right environments. Some clinicians react about as warmly to this phrase as they would to an extended middle digit or an unflattering maternal reference.

I’ve noticed an unsettlingly growing trend, in which I reach a clinician to communicate results of an imaging study on one of their patients… and the clinician refuses to take those results. This is the ugly successor to an older (yet ongoing) issue, in which I can’t get ahold of anyone at all regarding a patient, whether to give results, to better protocol a study, or simply to get some clinical history beyond “R/O pathology.”

So you’ve had enough of seeing your colleagues traipsing through the workload, selecting easy reads while leaving the tougher stuff for you, and you’ve decided to study their tricks - either to counter them, or fight fire with fire. I’m here to help.

As long as the Powers That Be continue to rule that all cases are created equal, and that a normal CT which gets read in three minutes is to be reimbursed identically with a train-wreck CT that takes half an hour and bears a boatload more liability, this will continue to happen.

Is it any wonder that getting physicians to form ranks, toe the line, and obediently comply with subsequently-imposed rules and regulations is a mite challenging? Let alone agree and join together in common cause on matters social and political. Why would you expect them to? This is an entire population of smart folks who spent many years of their lives learning how to gather and assimilate data to arrive at well-thought-out conclusions, ready to defend their reasoning if challenged.

(With apologies to Jeff Foxworthy) You might be a teleradiologist if…

Radiologists, by and large, are rather smart folks. They’ll definitely notice persistent inequities in their workload. If such imbalances aren’t eventually matched by differences in compensation, you can expect one of two things: Your workhorses will find greener pastures, or they’ll realize that the reward for their extra effort is merely the opportunity to continue to pull more than their share in the future - and slow down to emulate the slackers around them.