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I'm not going so far as to say that radiology shouldn't exist, but the specialty strikes me as one that exists out of, perhaps, fear of getting sued rather than a real medical need.
I'm an ENT resident. I was on trauma call last night and sure enough we had an MVA involving some facial injuries. I read the CT myself. Went over it with my chief resident. Discussed it with our attending. And we took the patient to the OR without ever seeing the "official read" from the radiologist on call. In fact, the official read wasn't available until a few hours after the patient was wheeled into the PACU. This is the routine. Not just for my service, but for most services. The official read on images is often an after-thought.
In reading the official read, the radiologist noticed a calcified cervical lymph node. Great.
My problem with radiology is this:
First, what other service in any hospital, with infectious disease being perhaps the only other, is automatically consulted for every test, diagnosis, or treatment that falls within its scope? For example, could you imagine if hematology was automatically consulted to evaluate every CBC/diff that was ordered? Or nephrology consulted for every urinalysis? Or plastic surgery for every wound? So why is it acceptable for every last image ever taken in a hospital from a brain MRI to an ankle x-ray to be required to be evaluated by a radiologist (who will then make money for reading the film....often a couple hours after the fact even in the middle of the day).
I had asked this of the radiology residents at my hospital and he said this: "Because we may catch something that other people missed".
This statement really angers me because 1. It applies to consulting every specialty out there, and 2. because it justifies radiologists' automatic involvement in every study by incidental, serendipitous, irrelevant findings (e.g. the calcified node I mentioned above).
Yes, radiologists make plenty of findings on images that the doctor ordering the study was not even looking for. Even if some of these findings are serious and worthy of further investigation, it needs to be noted that radiologists aren't doing this for free as a favor for patients. They are getting paid ungodly amounts of money to make these incidental findings. And the key word here is incidental. If a patient gets an abdominal CT for a uterine mass and the radiologist identifies the the uterine mass (after the OBGYN identified it), but also identifies an inguinal hernia or a kidney stone or whatever, this does not justify paying a radiologist.
Having a radiologist read the image to make extraneous findings unrelated to the "targeted" pathology is a luxury. But in our system, it is a luxury that takes place by default, and radiologists have been raking in piles of money for this.
Combine that with the fact that any cardiologist can read an echo every bit as well as a radiologist (and identify its clinical significance far better), any neurosurgeon can read a head/spine CT or MRI as well as a radiologist, any pulmonologist a CXR or chest CT, and so on, one becomes very hard-pressed to see why it is that radiologists make so much money. And the reality on the ground supports this question, as I mentioned above. Clinical decisions are made routinely without even bothering to look at the radiologist's read. And there seems to be a lot of out-sourcing of images for evaluation.
Anyone care to discuss this?
I'm an ENT resident. I was on trauma call last night and sure enough we had an MVA involving some facial injuries. I read the CT myself. Went over it with my chief resident. Discussed it with our attending. And we took the patient to the OR without ever seeing the "official read" from the radiologist on call. In fact, the official read wasn't available until a few hours after the patient was wheeled into the PACU. This is the routine. Not just for my service, but for most services. The official read on images is often an after-thought.
In reading the official read, the radiologist noticed a calcified cervical lymph node. Great.
My problem with radiology is this:
First, what other service in any hospital, with infectious disease being perhaps the only other, is automatically consulted for every test, diagnosis, or treatment that falls within its scope? For example, could you imagine if hematology was automatically consulted to evaluate every CBC/diff that was ordered? Or nephrology consulted for every urinalysis? Or plastic surgery for every wound? So why is it acceptable for every last image ever taken in a hospital from a brain MRI to an ankle x-ray to be required to be evaluated by a radiologist (who will then make money for reading the film....often a couple hours after the fact even in the middle of the day).
I had asked this of the radiology residents at my hospital and he said this: "Because we may catch something that other people missed".
This statement really angers me because 1. It applies to consulting every specialty out there, and 2. because it justifies radiologists' automatic involvement in every study by incidental, serendipitous, irrelevant findings (e.g. the calcified node I mentioned above).
Yes, radiologists make plenty of findings on images that the doctor ordering the study was not even looking for. Even if some of these findings are serious and worthy of further investigation, it needs to be noted that radiologists aren't doing this for free as a favor for patients. They are getting paid ungodly amounts of money to make these incidental findings. And the key word here is incidental. If a patient gets an abdominal CT for a uterine mass and the radiologist identifies the the uterine mass (after the OBGYN identified it), but also identifies an inguinal hernia or a kidney stone or whatever, this does not justify paying a radiologist.
Having a radiologist read the image to make extraneous findings unrelated to the "targeted" pathology is a luxury. But in our system, it is a luxury that takes place by default, and radiologists have been raking in piles of money for this.
Combine that with the fact that any cardiologist can read an echo every bit as well as a radiologist (and identify its clinical significance far better), any neurosurgeon can read a head/spine CT or MRI as well as a radiologist, any pulmonologist a CXR or chest CT, and so on, one becomes very hard-pressed to see why it is that radiologists make so much money. And the reality on the ground supports this question, as I mentioned above. Clinical decisions are made routinely without even bothering to look at the radiologist's read. And there seems to be a lot of out-sourcing of images for evaluation.
Anyone care to discuss this?
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