Familiarity with Radiology Breeds Contempt

As radiologists we pride ourselves on the service we provide, and that service is nothing short of amazing. Although JCAHO guidelines recommend a 24-hour turnaround time for radiology reports, most of us are providing near real-time reporting. Since the incorporation of voice recognition into our practices, even after hours studies have final reports generated and auto-faxed to the requesting physician frequently within minutes of the procedure being performed.

The quality and volume of images being performed is well documented and is a major contributing factor to imaging being the fastest growing component of health care expenditures every year. With all these advances in our craft radiology should be the most admired specialty in modern medicine.

But I submit that when we are considered at all, we are considered with something approaching contempt.

There was a particularly demanding surgeon at one of the hospitals I covered in the 1980s. He was a leading admitter, operator, and complainer at this busy community hospital. It was our goal to meet or exceed the expectation of every referring physician in our practice, including him. At one point we were delivering final mammogram reports on his routine patients within an hour of the patient’s registration in our department.

Remember, these were the days of xeromammograms, cassette recorders, and typed reports. His response: “That’s not good enough.” Ultimately, he got his wish and the group was replaced. Incredible service did not earn his respect - only contempt.

In the early days, high technology imaging such as CT scanning was time consuming and limited in resolution and display capability. Modern CT scanners can now scan faster than the scans can be interpreted. Scanning from the top of the head to the bottom of the feet takes only seconds and so many images are generated that they must be viewed on a PACS workstation. Because of the availability, productivity, and quality of modern CT scanners, CTs have become first line imaging studies frequently performed before or even instead of radiography, especially in cases of trauma.

This is not of itself a bad thing as the desirability of surveying large areas of the body and identifying significant injuries or abnormalities cannot be argued. However, CT scans are no longer considered a “special” exam. They are commonplace and garner all the respect that something commonplace demands. Just look at the reimbursement for CT scans if you have any doubt.

Just as the lab turns out serum chemistries and blood counts around the clock, we produce the imaging requested 24/7/365. We have even produced a breed of radiologists to provide the service on our behalf when we sleep further diminishing our image in the sight of clinicians who view us as interchangeable with radiologists they have never met.

Our clinicians now include physician’s assistants, nurse practitioners, nurses, and residents as well as practicing physicians. When we take orders from family practice residents to perform routine lumbar punctures that they are “too busy” to do themselves, how much respect can we expect?