Radiologists fending off telereading relearn the art of schmoozing

November 27, 2006

You can tell a lot about current trends in radiology just by walking around the exhibit halls in McCormick Place. I can remember when some of the largest displays were film companies and x-ray tube producers. No more.

You can tell a lot about current trends in radiology just by walking around the exhibit halls in McCormick Place. I can remember when some of the largest displays were film companies and x-ray tube producers. No more.

This year the booth du jour is teleradiology. Every combination of the words night, hawk, on-call, and quality you can imagine appears in the names of various companies. The telerad firms are surrounded by the PACS and image processing companies. Interestingly, there is a near-complete absence of interventional vendors. I guess the SCVIR meeting is a more productive place to spend their advertising budget.

I heard an interesting conversation about the pros and cons of teleradiology today. Clearly, it is a growth industry. Two of the largest companies have gone public, with amazing street values. I haven't counted, but I would guess at least 25 new companies are hawking themselves on the exhibit floor this year. They will read everything. I saw one that will operate your digital mammography department and read all the studies remotely.

To compound the problem, overseas companies are more than willing to provide readings for pennies on a dollar. More and more, our work is being treated as a commodity, which brings us back to that distinguishing feature, quality.

It is ironic that one of the early benefits of PACS was the decrease in the number of interruptions in our workday from clinicians coming in to discuss cases. Now, we may find ourselves promoting the advantages of having an onsite radiologist to talk to. Reading the study correctly may not be enough "added value" if someone elsewhere will read it correctly for half the price. So what else can we add?

As I mentioned yesterday, Dr. Stephen Swensen made some excellent points on quality. One that really hit home for me is "trying harder doesn't work." I cannot count the times I have made left/right mistakes in my reports. After cursing at myself and whoever pointed out my mistake, I always commit to try just a little harder to check for these errors.

Swensen is right. Trying harder doesn't work. As hospital radiologists, we must take the lead in devising and implementing systems in our department that eliminate the errors. And we need to make sure everyone is aware of these contributions.

I have often toyed with the idea of developing a radiology lunch: a daily casual meeting with a free lunch for any referring physicians who happened to attend. We would discuss current cases on our PACS, perhaps emphasizing a specific topic from time to time.

This notion never got beyond the blueprint phase, because I am basically lazy and busier than I want to be. But this may be the kind of proactive step local radiologists need to consider. Not only would we redevelop personal ties with our increasingly distant staff, but I suspect we could prevent a lot of unnecessary studies from being ordered.

I have always tried to do the best I can for my patients. Apparently, with the coming globalization of radiology, I will have to do better. That is until my new company, Quality Hawkeyed Radiologists On Call All Night and Day Cheap for You, goes public. Then I'll retire.