Put a name tag on an invisible specialty

Uh-oh, here come the wives. Look like you're enjoying this fundraiser. Sweetheart, I'd like you to meet David. He was just about to tell us all what he does for a living."

"I'm a radiologist."

"Really . . . hmm. Wasn't the traffic horrible?"

"You don't know what a radiologist is, do you?"

"Of course I do. You fix radios."

"No, I . . ."

"You have to excuse my husband. He's an idiot. Radiologists study radiation in the environment, right?"

"No, I . . ."

"Barbara, they study radio waves."

"No, we . . ."

"You're the guys who irradiate cancer patients, right?"

"No, but you're closer. Actually, we . . ."

"You take x-rays!"

"Right, sort of."

". . . for doctors to read."

"I am a doctor, and-"

". . . and a radiologist? Does doctoring pay so poorly that you have to be a radiologist, too, to make ends meet?"

"I have four years of college, four years of medical school, one year of internship, four years of residency, and two years of fellowship-all necessary to become a radiologist, which is a type of doctor."

"I think you're mistaken."

"What?"

"I knew this girl who became a radiologist right out of high school. She didn't need to go to medical school to take x-rays."

"Well then, she would be a radiographer. They take the x-rays."

"Right, just like you."

"No, I read them."

"But doctors read them?"

"I am a doctor. A doctor who reads x-rays."

"My doctor reads his own x-rays. He takes his own x-rays too."

"What type of doctor?"

"My chiropractor."

Do you know what your Q score is as a radiologist? Marketing Evaluations, Inc., developed the Q score in 1963 as a measure of appeal/likeability that can be applied to movie stars, TV shows, and products. There is also an F score that deals with familiarity. Someone like Hitler can have a high F score but a very low Q score.

Most celebrities receive frequent updates on their Q scores, because these directly influence what the celebs can charge to star in movies or ad campaigns. Advertisers want a spokesperson with both high Q and F scores. Hitler wouldn't be the best spokesman for Coke. Howard Stern, on the other hand, has high Q and F scores for a certain demographic, but he would not be a good spokesperson for, say, Depends, since his appeal is mostly to insecure, socially backward white males. Think Hummer.

What does this have to do with radiology? Well, I recently was on a cruise, which brings you into contact with hundreds of new people. The most frequently asked questions were "Are you enjoying the cruise?", "Where are you from?", and "What do you do for a living?" I realized I would say I am a physician, because if I said radiologist, I would watch people walk away thinking I fix radios. If they ventured to ask what kind of physician, I might as well say xzyghypologist, since that would result in the same blank stare as radiologist. Most people have a pretty good knowledge of the different types of doctors, but not of radiologists.

I started my own survey on board ship and found only three people who knew what a radiologist is: a nurse on vacation, an Italian tourist from Milan who had been in a motorcycle accident, and the ship's doctor. Yet everyone I asked knew what a chiropractor was.

Chiropractors have high Q and F scores. People trust the familiar, while they are often distrustful of things they are unfamiliar with. That is why advertisers use people familiar to consumers, like TV and movie stars, to act as spokespeople for new products. Consumer Reports did a study comparing name brands with generic store brands and found that the quality in all but one group was the same or even better in the generics, yet most consumers prefer to pay for higher priced name brands. They trust most what they are most familiar with.

What impact does this have on you?

Until now, Medicare has not allowed radiologists to be reimbursed for x-rays ordered by chiropractors. In 2003, however, Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act, which authorized a Demonstration of Coverage of Chiropractic Services in five states: Maine, New Mexico, Illinois, Virginia, and Iowa. In those authorized states, chiropractors will be allowed to bill Medicare Part B for radiology services and can even order, but not perform, CT and MR scans.

I suspect that many people would trust a chiropractor more than a xzyghypologist to read their studies. Chiropractors have a much closer physician-patient relationship with their clients, and their malpractice rate is a fraction of that for radiologists. They are more likely to be burglarized than sued. One of my local chiropractors treats asthma and otitis media with cervical manipulations, and people wonder why half the kids who bag groceries at the grocery store are hard of hearing. As a "brand," chiropractors have much higher Q and F scores than radiologists, and this influences legislators and legislation. What can radiologists do to increase their scores?

Joe Taylor, director of public education and media relations for the RSNA, attributes the skimpy knowledge that most people have about radiology to the fact that radiologists have very little contact with their patients. The RSNA and the American College of Radiology have formed a joint public information committee to try to disseminate more information about radiology.

"The ACR has just launched a project to encourage radiologists to increase their visibility to their patients by introducing themselves to at least five patients a day. Radiologists have to make the public aware that radiologists are one of their doctors, too," said Shawn Farley, public relations manager for the ACR.

I frequently visit my clients' hospitals or imaging centers and am amazed to find no mention of who the radiologists are: no names, no pictures, no diplomas on display. Visit a neurosurgeon's office, and that doctor's name is prominently displayed. In a cardiologist's office, you may see not only a picture and diploma but report cards from kindergarten on up and bronzed baby shoes. Cardiologists know marketing and branding, and patients will pay a premium for their expertise. The joke goes: How do you hide money from an internist? Put it behind the patient. From a surgeon? Put it in a book. From a cardiologist? You can't hide money from a cardiologist!

Radiology has never been so well positioned to get its brand name out there in front of patients and to build loyalty based upon our expertise and quality. I can't pick up a Scientific American or Wall Street Journal without reading about advances in functional MRI, molecular imaging, interventional imaging, or cardiac imaging. What is so exasperating is that these articles rarely mention the radiologist. Functional imaging studies feature neurologists, molecular imaging has oncologists, interventional imaging shows surgeons, and cardiac imaging, of course, touts cardiologists. The articles are always accompanied by the obligatory CT, MR, or chest x-ray hanging in the background upside down.

Buy some books on branding and apply what they have to offer to your practice. Hang your photos and diplomas in your waiting room. Have the front desk announce to each patient who their radiologist will be today. Place literature in your waiting room announcing all the wonderful and exciting developments in our specialty. Greet your patients and let them know the value, expertise, and quality that you offer as a radiologist. Otherwise, your family will read in your obituary about your successful career in radio repair.

Dr. Trefelner is a radiologist and cofounder of NightShift Radiology. He invites comments by e-mail at ericxray@pacbell.net or fax at 650/728-5099. He also answers questions posed by readers in the "Ask Eric" column on diagnosticimaging.com.