Ken Keller, MD

Another October has rolled around and we are immersed in all the various “pink” campaigns to increase breast cancer awareness and the value of mammography for early detection of this common disease. Many of us will wear pink, make public appearances, have different speaking engagements or be interviewed on radio or television. Many Americans will contribute millions of dollars to any number of different fund-raising activities for breast cancer research. As a former supervising radiologist for the mammography department, I willingly volunteered for these duties for many years. I’m sure hundreds (or thousands) of radiologists have done the same over the years. Kudos to all of you for your efforts!

However, I recently got to thinking specifically about this perennial phenomenon and more generally about this disease. The American Cancer Society still says that the chance of a woman getting breast cancer in her lifetime is one out of eight.  Despite decades of experience and improvements in imaging techniques, the incidence of breast cancer hasn’t changed over the past three decades. Clearly early detection is critical, but come on colleagues, is that the best we (in medicine) can do?

While we may lack understanding of the specific cause of this disease, the argument that we don’t know how to prevent breast cancer is both specious and ubiquitous. It is easy to sit back and say “We just don’t know what causes breast cancer, so make sure you get your annual mammogram so we can find it early.” For years that is what many of us have done and continue to do. Our female patients and, particularly, the women in our lives deserve better.

There are a number of things that we, as radiologists, can do to aid in prevention. Because of our role at the forefront of breast cancer detection, we are superbly positioned to increase patient (and public) awareness of not only the benefits of early detection through mammography, but also

 of the disease in the first place. With respect to prevention, we should be speaking out whenever we can, rather than acquiescing. We should promote healthy lifestyle changes such as maintaining proper weight control and regular intentional exercise, reducing processed food intake, avoidance of GMO products, and increasing dietary consumption of turmeric/curcumin and omega-3 fatty acids.[[{"type":"media","view_mode":"media_crop","fid":"53297","attributes":{"alt":"Breast imaging","class":"media-image media-image-right","id":"media_crop_6547036533927","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6644","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©karelnoppe/Shutterstock.com","typeof":"foaf:Image"}}]]

However, recent high quality clinical investigation trials

 have revealed that the current best method of breast cancer

 is through proper maintenance of therapeutic serum concentrations of 25-hydroxyvitamin D which resulted in striking, statistically significant prevention of breast cancer in the study groups. This prevention is most easily accomplished by inexpensive dietary supplementation with vitamin D-3. However, regular blood level testing is necessary since there can be notable variations in serum concentrations even between individuals taking the same dose.

In radiology, many of us have taken pride in diagnosing a breast cancer in its earliest stage. How much more impactful can we be if we could

 it from developing in the first place? Beginning this October in Breast Cancer Awareness Month, I encourage all radiologists to get the word out to our patients and referring providers about breast cancer prevention as well.

Lappe J, Travers-Gustafson D, Davies K, Recker R, et al.

Articles

Radiologists can do more to increase awareness about breast cancer.

Increasing Breast Cancer Awareness, Prevention

It is likely this mantra has echoed around reading rooms all across the country. Although I’m no financial planner or lifestyle advisor, I have reached this critical juncture in my career and have repeatedly reflected on this subject. Through this process, I have learned a few caveats that I think deserve careful consideration by any radiologist contemplating “career conclusion” through retirement.

Many of us may be attracted to the concept of retirement with perceived enticements of no call, no meetings, no axe to grind, no (or less) responsibility, loads of free time, etc. Some of us may feel this idea actually resonates with our own future philosophy or our goal for how we want to spend the latter part of our lives. The only thing is that many of us who say we want to (or will) retire, don’t exactly understand what “retirement” actually means, let alone fully comprehend the ramifications of “giving up our day jobs.”

Perhaps the most important lesson I have learned as I enter my retirement is 

do not give up all of your active income. 

Although good general advice for anyone contemplating retirement, this is even more important for us as radiologists than for nonphysicians since we have become accustomed to a lifestyle that has traditionally been maintained by a large active income. We have become used to expensive cars, dining, traveling, entertaining, spending, and living in a manner that is not sustainable if we no longer have a similar level of income. Oh sure we can say we will cut back or scale down how we do things, but frequently those plans go awry.

Many retirees (and their financial planners) will say they have enough funds in various accounts that they can live off the proceeds. However, if you are forced to maintain your lifestyle from your profits, the manner in which you invest those funds will fundamentally change, because now you have no alternative source of income, since you cannot cover any losses with additional active income. Suddenly there will come the realization that there may not be enough funds to do the things you want to do as a retiree.[[{"type":"media","view_mode":"media_crop","fid":"48416","attributes":{"alt":"radiology retirement","class":"media-image media-image-right","id":"media_crop_9444949716689","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5770","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 122px; width: 179px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©www.BillionPhotos.com/Shutterstock.com","typeof":"foaf:Image"}}]]

Fortunately, radiology (in retirement) offers a unique position in the medical marketplace since we can “work” long after many other physicians have felt the need to physically retire. We don’t have to lift heavy things. We don’t have to stand in the OR all day long. We don’t have to answer to the rigors of an office full of patients. We don’t have to be awakened from sleep to work.

I am not suggesting “retiring” to go to work for a teleradiology company. Teleradiologists that I know work hard and typically work several hours a day, several days consecutively, followed by a similar number of days off. Week in, week out, month in, month out…that’s not my concept of retirement and I doubt any of those that do it would say they are retired. However, there may be a few companies that have small niche opportunities for part-time teleradiologists who don’t have such rigorous schedules.

Or, there may be local opportunities that have occasional coverage needs, perhaps to cover vacations, conferences, meetings, or even leaves of absence. Radiology circles are relatively small and almost all of us know lots of other rads or practices that might lend themselves to create arrangements where decades of experience can be brought to bear in a productive manner, perhaps even teaching at some level.

Unlike CT scans and other on-call exams, these “retirement” opportunities will not be relentlessly incoming, but the inquisitive and insightful radiologist will be able to uncover such situations. They may be a week, a month, or even every other month, but it may be just what the rad ordered to properly “cash flow” the bills of retirement in a way that makes life after retirement that much more enjoyable and sustainable.

There are options for radiologists regarding retirement.

So You Want to Retire

There’s been recent media attention on participation trophies and ribbons for children’s athletic activities. Various professional athletes have claimed these awards are overdone since the majority of these “pediatric players”, including their own children, have not won anything and, therefore, not earned them. The polar opposite position is played by executives of various trophy and award companies that are trying to improve their bottom lines by claiming this practice improves kids’ self-image since we are trying to cultivate well-adjusted teens and adults as they enter into various societal and workforce games played by all of us.

The parents of these participants are typically somewhere in the middle of this milieu as they try to weave their way through parental guidance of their children in hopes that their kids will grow up to be self-sufficient, well-adjusted, contributing adults in society, knowing full well that the vast majority will never play competitive sports.

This phenomenon got me to thinking. Although the majority of radiologists will never practice “competitively” (such as) writing papers, serving on boards or committees that decide important or specialty-influencing issues, or advising leaders that shape national policy, shouldn’t we all be recognized, just the same? Shouldn’t we all get participation awards? After all, we try hard, almost every day. We try to come to work on time, try to avoid long lunch breaks and be considerate of our colleagues.[[{"type":"media","view_mode":"media_crop","fid":"40996","attributes":{"alt":"trophy","class":"media-image media-image-right","id":"media_crop_6412421547164","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4256","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 160px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Dacian G/Shutterstock.com","typeof":"foaf:Image"}}]]

We participate in daily reading, committee meetings, and tumor boards. We participate in the call schedule, curb-side clinical consultants, and the occasional spontaneous media spot promoting our latest imaging modality, explaining how it will help us better serve our patients and our committees. We contribute our thoughts, opinions, and suggestions when asked, and occasionally even when we are not asked. We may even contribute our dollars to fundraisers and foundation activities.

Gee whiz, don’t we “deserve” some kind of participation award, trophy or ribbon for our efforts as radiology team participants? Tongue-in-cheek humor aside, I’d wager that many of us can recall (sadly) radiologists who do think we should be awarded simply for our participation in our day-to-day activities.

We should all realize that there are certain expectations and guidelines that should govern our participation in our daily radiology practices, regardless of what we do or where we are located. Common to all practices should be open communication between all associates, consideration of the others’ positions and situations, timely arrival and departure for work activities, avoidance of imposition on others, timely completion of our work duties, etc. This list could go on and on, but is self-evident to those with insight into how practices should work together for the greater good of all.

Our collective (and individual) mantra could be “It’s not about me.” For these kinds of activities, we should not expect participation awards. We should expect to put forth this kind of effort on a regular basis since this is what we originally signed on for.

We will receive metaphorical participation awards, trophies or ribbons when we do our work so well that our peers, referring physicians, administrators, and, particularly, our patients stand up and say “Well done”! These are the kinds of achievements that we should be striving for on a daily basis.

Doing a good job in radiology should be rewarding enough.

No Awards for "Participation" in Radiology

So I’m reading online news last week and come across the 

Breast Biopsies Leave Room for Doubt, Study Finds

”. Just in case any of you missed this leading lay medical journal exposÃ©, the catalyst was also in last week’s JAMA entitled “

Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens

”. The gist of these articles was that 1) Breast biopsies can be challenging for pathologists, particularly when they encounter features of atypia or atypical ductal hyperplasia; and 2) The recommendation for pathologists to seek a second opinion from colleagues or consider consultation with larger center pathologists when they encounter difficult cases.

I quickly shot a suggestive email to our MD Pathology Director and VP of Marketing encouraging a collaborative campaign to inform not just our patients, but also the entire population of our city and all surrounding communities, that we already routinely do the things that these articles recommend. I waxed…“Our patients need to know that we are state-of-the-art and that they are in good hands and completely safe when they come to our hospital.”

Lest my fervor for a non-radiology specialty get the best of me, I realized that the same passion for radiology should pervade all of us. It is well known that the general public is only vaguely aware of who radiologists are or what we really do. We all need to go on the educational band wagon for our specialty.[[{"type":"media","view_mode":"media_crop","fid":"33564","attributes":{"alt":"Ken Keller, MD","class":"media-image media-image-right","id":"media_crop_7596883296529","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3539","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Ken Keller, MD","typeof":"foaf:Image"}}]]

Patients need to know that when they saw their doctor in the office, or when they ended up in the Emergency Room or when they followed up with their oncologist after chemotherapy, their pulmonary nodule, their appendicitis, or their cancer remission was diagnosed, in large part, by the radiologist, not their own physician. They need to know the fallacy of their own words when they tell their friends “my doctor found” this or that when, in reality, it was the radiologist that actually made the discovery and then told their physician, who in turn received the credit from the patient. It’s not that radiologists are looking for accolades; on the contrary, we are more than happy to be part of the team. Nonetheless, let’s give credit where credit is due. The radiologist typically finds the lesion and then the treatment flows from there.

We need to capitalize on every chance we get to break our mold of dark reading rooms, quiet personalities, or silent practitioners. We need to sensationalize our life-saving IR procedures and make everyone aware of what a radiologist is and what he or she brings to the table. No other specialty knows the depth or breath of pathophysiology across all patient profiles, regardless of age or sex of the patient.

How do we do this? Volunteer to address issues of concern, perhaps in the local newspaper, or radio or TV spots. Maybe community meetings or letters/appearances to individual patients or patient groups like cancer survivors, support groups, community service groups, etc. As radiologists, there may be a tendency to say nothing when something should be said or to retreat to the comfort of a work station or reading room when an appropriate comment would be timely or on queue. We need to resist the temptation to say nothing and embrace the opportunity to tell the world who we are and what we do.

Our colleagues and profession will be better for it.

Give credit to radiologists when credit is due. 

Ken Keller, MD

Articles

Increasing Breast Cancer Awareness, Prevention

So You Want to Retire

No Awards for "Participation" in Radiology

Tell Them Who We Are and What We Do