Medicine gets exciting, but who wants to do it?

November 27, 2007
Bradley M. Tipler, MD
Bradley M. Tipler, MD

Radiologist and NIH director Dr Elias Zerhouni gave yet another talk on trends in the imaging sciences. He deserves special attention, since he is probably the only radiologist at the meeting who can actually direct those trends. I can talk about trends all day, but I have trouble controlling my seven- and nine-year-old sons.

Radiologist and NIH director Dr Elias Zerhouni gave yet another talk on trends in the imaging sciences. He deserves special attention, since he is probably the only radiologist at the meeting who can actually direct those trends. I can talk about trends all day, but I have trouble controlling my seven- and nine-year-old sons.

Zerhouni said a lot of fascinating things, and you should read his lecture when it shows up in Radiology. A couple of things stood out for me, especially the evolution of medicine from a curative model to a preemptive model. As Martha would say, "this is a good thing." One of the least favorite parts of my job is finding bad disease, well along its biologic course. I suspect that is one of my attractions to mammography, where most of the disease we find now is small and potentially treatable.

My take was that traditional anatomic imaging will be around for some time, in the diagnosis and treatment of acute disease. Dramatic changes will initially come in the realm of chronic disease. Imaging resolution will be measured in angstroms, not millimeters, and data will be far more quantitative. Function and biologic activity, along with detailed anatomy, will guide preemptive medicine, and if we are willing to step up to the plate, we can stay in the ballgame.

This is all very exciting, but I have to wonder who is going to do it. Physician polls in every specialty show doctors looking to retire ASAP. Most caution their kids away from medicine. Nonmedical frustrations and the economic pressures on providers are overwhelming, while the intangible benefits that used to come with being a "doctor" are nearly nonexistent.

This is not going to be work for dummies. Without those intangibles, are the best and brightest going into medicine or investment banking? One hopes the system will evolve back so we can concentrate on radiology and medicine, because that is the best job around.

On a lighter note, I spent much of the day seeking technologic solutions for a problem I see daily: biscuit poisoning. More specifically, imaging patients with BP. Clinicians can't examine these behemoths, so they send them to me. Ultrasound, plain films, and fluoro are often useless, so I want a CT designed for Mama Cass. I need a machine with high kV, higher mA, and a bore the size of the Lincoln Tunnel. I want to be able to turn off the dose modulators or whatever the vendor wants to call it. These folks suck up photons like Big Gulps, and I need clear images.

When I talk to the vendors, they all want to talk about radiation dose. Cow pies. If these patients were risk-averse, this wouldn't be an issue. You don't weigh over 350 pounds if you are truly worried about your health. Every one of them rode to the hospital in a car, and any ride in a car is far riskier than a CT done for appropriate clinical indications. I haven't found the perfect McScanner yet, but I'm looking.

Enough writing. It's time to go to the annual Philips party at the Art Institute. If this was the only thing I did in Chicago all week, the trip would be worth it. Mine is not a department committed to one brand, and I have always liked Philips machines. But I make sure they are always included in every search, because I like this party.