Dr Bhavin Jankharia, Radiologist and Partner, Picture This by Jankharia, emphasises on the importance of radiologists as clinicians who play vital roles in the practice of medicine
When I was a resident in Lokmanya Tilak Municipal General Hospital (LTMGH), I was denied a room in the RMO quarters by the warden, who told me that those who were in paraclinical branches did not deserve individual rooms…we would only get duty rooms. I was livid because even as a resident, I could see that we, radiologists were clinical doctors, not just some ‘paraclinical’ people.
A ‘clinician’ is defined as ‘a doctor having direct contact with the patients rather than being involved with theoretical or laboratory studies’. In what part of the universe does this not make radiologists, ‘clinicians’?
Radiologists themselves also perpetuate this ‘paraclinical’ meme. Virtually every radiologist, when speaking of other physicians and surgeons will say, “the clinician called me” or “when a clinician asks us to do this, we must…”. Invariably, my first instinct is to stop the person and say, “we too are clinicians…”. I use ‘physicians’ or ‘surgeons’ or ‘referring physicians/ doctors’ or sometimes ‘treating doctors’, but never clinician to denote that ‘we’ are therefore something else or different.
When a radiologist does a barium study, he/ she is a clinician. Every radiologist who does an ultrasound study is a clinician. Every radiologist who speaks to or deals with a CT scan or MRI patient is a clinician. Every radiologist who intervenes and treats or does procedures and biopsies, etc. is a clinician.
You can of course choose to be ‘paraclinical’, by hiding in a room full of monitors and doing teleradiology for remote locations, with nothing but images being thrown at you one after the other on the work-flow list alongwith a brief history, if at all, working hard to meet the 6-10 cases per hour deadline. Any idiot can be an ‘image reader’ and if that is all we choose to be, sooner rather than later, machine-based interpretation and artificial intelligence will make us redundant. Or as is already happening, we become commoditised, easily replaceable by someone who can read an MRI knee two minutes faster than the previous person, without a real understanding of ‘why’ that particular patient had the knee study done in the first place.
We must realise that we are doctors first and radiologists second. And, as doctors who work with patients, though we interface with them using machines and instruments, our responsibility continues to be alleviating pain and suffering as well as helping in the management of the patient’s problem. This means to understand at all times why the patient is with us, why that particular study has been ordered, what is the information the referring doctor and/or the patient wants from us and working towards answering these questions in a relevant way.
For e.g. a patient with interstitial fibrosis on a CT scan can have a report given in one of two ways. The firstway is to say that there is interstitial fibrosis…advise clinico-pathologic correlation and leave the onus of clinical interpretation of the fibrosis on the referring doctor. The other is to sub-classify the fibrosis, and to then use the clinical history (smoker/non-smoker, connective tissue disease or not, occupation, etc) to arrive at a specific diagnosis or differential, which will tell the referring doctor and the patient that you are interested in making a difference and are more than just a reader of images or radiology signs and patterns.
Being a clinician also means taking responsibility. It means that if the patient or the doctor asks whether a particular test is relevant or not, to be honest and truthful and to suggest better alternatives if they exist, even if it means loss of business.
Being a clinician means having clear systems and processes that put patient safety at the top and prevent accidents related to radiation, contrast media, pregnancy, etc.
It also means that the focus of the practice is around the patient at all times to ensure that the correct test is done, the area in question is covered in detail, pathology picked up is covered in its entire extent, all the necessary parameters have been mentioned in the report and that a CD of the images is handed over.
Being a clinician also means that after a biopsy or intervention is over, we follow up with the patient regularly, depending on the situation to make sure that everything is fine.
The clinical context is always critical and understanding that is the key to being a good radiologist, someone who other physicians and surgeons respect and a person they will turn to in times of need. It means understanding a few things about the management of the conditions we deal with so that the report can be tailored accordingly. For e.g. knowing that a malignant bone tumour like osteosarcoma will be treated by limb salvage using a megaprothesis. This will ensure that the correct measurements are taken, a whole limb survey is done, the films have the scale on them for the surgeon to measure as well, and the patient is given soft copy images on a CD for the surgeon to look at on his/ her workstation for more accurate measurements.
As more and more physicians and surgeons start interpreting their own scans or performing their own studies, the only way we can stop being ‘glorified technicians’ is to be relevant to them…to be better than them and be able to use the clinical information that we garner to interpret the images better than them and thus add value to the management of the patient.
In institutes, this has therefore led to the radiologists being central to various disease management groups (DMGs) that now work in concert to provide holistic care to a patient. A malignant bone tumour in such a tumour board is typically discussed by a team consisting of a medical oncologist, pathologist, radiation oncologist, orthopaedic oncosurgeon and the radiologist, sitting together and discussing the management options, so that a more inclusive and cohesive decision is taken. This is where the radiologist becomes redefined, a super-clinician and a part of the decision making team to enhance patient care.
The times are changing. People expect more from those who provide them services. Physicians and surgeons want more from those they rely on to give them information. And if radiologists do not have the depth of knowledge that comes from a certain amount of sub-specialisation and do not work together and be visible in patient care and management, they stand a good chance of being one of the first casualties of attrition. Yes, as long as the PC-PNDT laws in our country continue to make those who do ultrasound prized commodities and as long as the use of cross-sectional imaging continues to rise by 15 per cent year-on-year, there will be work. But work without respect, without involvement and without having the feeling of being indispensable, is just drudgery.
We radiologists need to come out of our closets, out of the ‘dark-rooms’ of our minds and take centre-stage positions. It’s time we became the clinicians we were always meant to be.
- Advertisement -
Comments are closed.