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Counterpoint: Where Teleradiology Falls Short


In response to Eric Postal, MD's series "Memoirs of a Teleradiologist," Mark Klein, MD, offers his take on how radiologists can maximally contribute to the care of their patients.

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.

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