The future looks bright and muddy

Not long ago, at a holiday gathering of our extended family, someone asked my four-year-old if he thought his mom's new hairstyle was pretty. From that mysterious place that kids get those things they surprise you with he said, "Oh yeah, mom is young and foxy. Dad is old and tired."

Today I feel it.

I thought I was going to spend the day reviewing neuroradiology. The beauty of the RSNA meeting is that so much is going on I'm constantly doing something unexpected.

I started the day with the bus ride from hell. I boarded the first morning bus to McCormick Place at 6:30 to get to a 7 a.m. breakfast meeting. It normally takes 10 minutes to get there. There was no traffic. Then the driver announced that we should "bear with me because I've never driven here before." After a 45-minute tour of Chicago, I made it to my meeting.

Over breakfast, I listened to some of the best minds in radiology discuss the future. The discussion was so good, I missed my first neuro course. The disturbing thing is no one knows what is coming, they just know it's changing. Will we be in megagroups? Will referring physicians own all the equipment? Will general radiology exist? What studies will we be doing in five years? Can we control the cost of imaging? Is there any limit to our technology? Can we hold on to our slice of the pie? The only consensus seemed to be that this is the best of times and the worst of times.

I made it to the 10:30 case-based review of neuroradiology session on the spine. Excellent.

After lunch, I gave up my ticket to the neuro program to hear Michael Phelps give the New Horizons lecture on molecular medicine and nanotechnology. A fascinating lecture on a field I could discuss intelligently for perhaps 20 seconds. The effects on all of medicine are going to be dramatic, probably during my career. Here again, no one really knows where we're going, we're just going. A high-tech Thelma and Louise.

Phelps pointed out that Darwin never talked about survival of the fittest. He talked about survival of those that could adjust the best to the changes in their environment. Clearly, our environment is changing. Referral patterns, reimbursements, technology, etc. The future holds some great things for us, I just can't tell what. I wonder if I'm too old and tired for all this change.