Annoying radiology mis-calls

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
RADRULES said:
Dude, the hate in your reply simply supports his point. Neurologists are a bunch of haters who wish they were smart enought to get into something else. They want to do imaging and neurointervention.... gimme a break.

Bunch of haters.

How many radiologists do you see trying to get into treating neurology patients? Speaks volumes.

Please. Spending my days in the dark going from in box to out box is not my idea of fun. You can consider yourself a test and only a test. From your little window, it looks like your test is the end all and be all of medicine and neurology. Just like it looks to the guy who enters the sodium levels into the computer.

Dentists do face lifts?

Anyway, the point is not that all of neurology hates radiologists. That is the sort of generalization that only a really stupid person could possibly make. In the vast experience of a medical student who rotates on neurology and contradicts himself in going from single to plural there is obviously little to argue with. The point is that radiologists tend to be clinically isolated. Their readings tend to reflect this. There are several points made above where I think this is telling, like where a radiologist thought that blood within a stroke was a contraindication to anti-coag. This sort of ignorance makes radiology a lot less helpful than it should be. It also opens up a window where a neurologist should read films to shore up these types of errors.

BTW, the reason I failed to match into radiology was because I failed to apply to radiology. I also failed to match into OB. And just because I think you're a ***** doesn't mean that I hate you.

Members don't see this ad.
 
neglect said:
BTW, the reason I failed to match into radiology was because I failed to apply to radiology. I also failed to match into OB. And just because I think you're a ***** doesn't mean that I hate you.
:D

Those posts were beginning to get to me too, as an ophtho married to a neurologist. I can assure you that the said neurologist never considered radiology as a career choice. Different strokes for different folks (pun intended) ;)

On second thought, anyone who gives a pretty good indication of their IQ/maturity by saying "Neurologists are a bunch of haters who wish they were smart enought to get into something else." is probably not worth responding to, don't you think?
 
NR117 said:
:D

Those posts were beginning to get to me too, as an ophtho married to a neurologist. I can assure you that the said neurologist never considered radiology as a career choice. Different strokes for different folks (pun intended) ;)

On second thought, anyone who gives a pretty good indication of their IQ/maturity by saying "Neurologists are a bunch of haters who wish they were smart enought to get into something else." is probably not worth responding to, don't you think?

So true. I was on the fence as to respond or not. Either way it's bad: lower to the stupid level or allow the stupidity to exist. Eventually I took my cue from: all that needs be done for stupidity to exist is for smart people to stand idle. So I bravely ventured forth.

Ophtho is wonderful though. Another example of a specialty that probably knows their own stuff well enough to read films - if they wanted to.
 
Members don't see this ad :)
I certainly did not say that all neurologists have rad-envy. I simply said that suprisingly at all sites I rotated through--4 different hospitals--there was a disproportionate amount of time spent disparaging radiologists.
While I am not interested in radiology, the "I'm smarter than you" attitude that a surprising number of these residents had when dealing with the radiologists was definitely shocking, considering the fact that most current neuro residents could not match in rads if they did, in fact, apply to a program in this specialty. (Of course, you knew this is what I meant in my initial post). While this may not apply to you, this is how you come across in your posts...as a fellow stuck in a lower-tier specialty desperately seeking the recognition of a radiologist. You say you are interested in patient care, but you just don't come across that way.

By the way, the comment on dentists and face lifts refers to a situation in my state where dentists were, indeed, looking to do face lifts.
 
RonaldColeman said:
While this may not apply to you, this is how you come across in your posts...as a fellow stuck in a lower-tier specialty desperately seeking the recognition of a radiologist. You say you are interested in patient care, but you just don't come across that way.

I disagree. While neglect may have been venting a bit, there was nothing in any of those posts to indicate bitterness or sour grapes. I don't know what would give you that idea. Maybe people see what they want to see.
 
neglect said:
So true. I was on the fence as to respond or not. Either way it's bad: lower to the stupid level or allow the stupidity to exist. Eventually I took my cue from: all that needs be done for stupidity to exist is for smart people to stand idle. So I bravely ventured forth.

Ophtho is wonderful though. Another example of a specialty that probably knows their own stuff well enough to read films - if they wanted to.

You started the thread disparaging radiologists, not the other way around. Sure, the response by some of the rads was immature. They're just jabs at what we perceive (quite accurately) to be an entire thread attacking radiology (which you have a history of doing anyway).

I mis-spoke when I mentioned the bleed (I think I did this before). First of all, it was not a little petechial hemorrhage. Secondly, instead of anticoagulation, I should have stated thrombolysis. Do to my obvious ignorance of anything clinical (do you even know what we need to learn for the radiology boards?), I wrote the wrong term. The neurologists also agreed this patient should not have been given thrombolysis if that bleed had been picked up. The attending who showed me the case was also boarded in neurology, radiology, and neuroradiology. Thus, your assumptions are incorrect (partially due to my wording error, but partially due to your hubris).

As has been stated several times before in this thread, there are good rads and bad rads. There are good neurologists and bad neurologists. There are neurologists I would trust my own father to, and those that I would want near a patient at all, let alone my father. There are also rads I would not want to read my scan, and those that I would demand read my scan.

I think the immature attacks are just that, immature. But I think the nature of your post is what draws out those attacks.
 
RonaldColeman said:
By the way, the comment on dentists and face lifts refers to a situation in my state where dentists were, indeed, looking to do face lifts.
Are you referring to general dentists or oral & maxillofacial surgeons?
 
Whisker Barrel Cortex said:
You started the thread disparaging radiologists, not the other way around. Sure, the response by some of the rads was immature. They're just jabs at what we perceive (quite accurately) to be an entire thread attacking radiology (which you have a history of doing anyway).

At the top of the page it says this:

Student Doctor Network Forums > Graduate Medical Forums [ MD / DO ] > Neurology

Note the place. For one to attack, don't you have to go off your own territory. It's you who are here, not me who tried to mix it up on a rad forum. Anyway, even if I did attack, I don't care. What did I do, hurt your professional pride?

Whisker Barrel Cortex said:
I mis-spoke when I mentioned the bleed (I think I did this before). First of all, it was not a little petechial hemorrhage. Secondly, instead of anticoagulation, I should have stated thrombolysis. Do to my obvious ignorance of anything clinical (do you even know what we need to learn for the radiology boards?), I wrote the wrong term. The neurologists also agreed this patient should not have been given thrombolysis if that bleed had been picked up. The attending who showed me the case was also boarded in neurology, radiology, and neuroradiology. Thus, your assumptions are incorrect (partially due to my wording error, but partially due to your hubris).

No, I don't know what you need to know for rads boards. However, if you do not know the difference between anticoagulation and thrombolysis, then... Well, pretty much nothing - you'll be par on with the rest of radiology. Because even the people training you don't know. When they did their internship they probably did so without tPA. So you're even further removed from what should be vital clinical thought processes. Getting these wires crossed has no consequences.

The fact that you evaluate and read head CTs done to eval for tPA exactly the same as you do for headache speaks volumes. You couldn't have done a better job to display exactly the seperation from clinical reality that neuroradiology displays. By not knowing how you fit into the overall picture, the overall impression and treatment plan, your reports loose worth.

Every test needs a context. If you can't see the context in which you write your report, then: you are missing things that are important, you are calling things that have no relevance, you are not tailoring your work to be helpful.

And that's my observation. These reports are being generated with no thought to context. This makes them less helpful.

Just another for instance, this time I'll give the answer (especially because no-one bothers to guess at my cases): guy with multiple strokes: right thal, right cerebellum, and left frontal (or something like that). Everyone should be on the same page: these things are cardiac or aortic with a slim chance of being at the intracerebral vascular level. And yet what is the chance that the dictation would mention this type of discussion? I suspect it could occur, but have never seen it.

It's a stupid example perhaps, because it's so easy. But I think these things are telling. You are clinically isolated. You don't know that this patient might have clots on a valve, which is treatable to prevent further events and needs to be known quickly. There is no effort to fit the readings into a bigger picture, to add real value.
 
Why is this thread still going? In case nobody has figured it out yet, all of the arguments here are an embarrassment to both neurologist and radiologist. It's starting to sound like two little five year olds fighting. Allow me to make some points here

First off, both neurologist and radiologist are needed in the medical profession, would you not agree?

Yes, radiologist are going to make annoying mis-calls, it will happen because they are human. And for this reason, it is extremely easy to talk trash on them. But as stated earlier, a well trained radiologist is respected and works very nicely with peers from other specialties. Now, yes, there are some crappy radiologist out there, just as there are crappy neurologist, that's life, but keep in mind, they are not everywhere.

Okay, now on the other side of things, neurologist constantly are ordering brain/spine imaging. No, they are not board certified radiologist, but I would expect that they know just a bit more neuroradiology docs from other specialties. Yes, we can all state examples where a radiologist made a bad call and the neurologist saves the day. This prompts radiologist to come here and bad talk neurolgist and start a turf war. But a turf war doesn't exist! Neurologist have no desire to sit in a dark room and read head films, that is not what we were trained to do. The delusion that all neurologist secretly want to be radiologist and were just too stupid to match in rads makes no damn sense what so ever?? IIf a person wanted to be a radiologist and couldn't match, why would they choose neuro as an alternate? It appears to me that this imaginary turf war started on this board was started but a bunch of *****s who know little about either the profession of neurology of radiology.

At all institutions I have worked at, including my current position, radiologist and neurologist have a respect for each other and work very well together despite the occasional rads mis-call which is expected because rads are only human after all. Everybody, calm down and get over yourselves.
 
A stupid thread started by a stupid person deserves a stupid reply.

I am a board certified rad from an elite residency who finished an elite neuroradiology fellowship. Yeah.. I am pretty dumb. In fact, many of my friends/collegues are in neurology, but they are reasonable people without such pathetic self-esteem issues as yourself.

The fact is, a guy like me and a guy like you could never get along. I prefer to deal with people without such internal weakness. My training and expertise in neuroimaging being challenged by a neurologist like you is silly... laughable actually. It is akin to an owner of a Aston Martin DB9 getting questioned about horsepower from the driver of a Jetta.

Really, the examples you give sound so absurd to me and laughable that I cannot take you or this thread seriously. If at any point you would like to challenge my expertise in neuroimaging, I would gladly accept. How about you take the CAQ exam, just for kicks?

By the way, we neuroradiologists do not exsist in a clinical vacuum. I know a great deal amount clinical neurology and neurosurgery, believe it or not most of us read your journals on top of our imaging journals.

Why don't you and I take cases side by side, I would enjoy making you look stupid, exposing your ignorance and squashing your arrogance. It's pretty simple, put up or shut up. You don't see me challenging your abilities with the "reflex hammer".

This is a joke to me.
 
neglect said:
At the top of the page it says this:

Student Doctor Network Forums > Graduate Medical Forums [ MD / DO ] > Neurology

Note the place. For one to attack, don't you have to go off your own territory. It's you who are here, not me who tried to mix it up on a rad forum. Anyway, even if I did attack, I don't care. What did I do, hurt your professional pride?

I don't give a crap if you care. I was telling you that the response of radiologists on this thread is in response to your attack. Does it hurt your professional pride when someone says you couldn't get into a radiology residency?

I agree that clinical context is key. Whenever I read a head CT from the ER, before giving any interpretation, I will ask the emergency physician or the neurologist for more history. I agree this is vital to interpeting imaging. What the hell do you think I do everyday!

Yes, I look at every CT the same way. Once I have made my findings, I will either discuss it with the clinician, when possible, or review the history, when needed and available. Based on that informormation, I will render an opinion. It is an entirely different, and in my opinion more valid method than what most clinicians do, which is focus only on what their history is pointing to and gloss over the rest of the brain.

Again, your knowledge of radiology may be good for a neurologist and may rival a general radiologist. However, it is not in the realm of a neuroradiologist. Instead of being on the attack constantly, try discussing with the radiologist or including in the order your clinical context. It makes a world of difference.

Every radiology resident I know knows the difference between thrombolysis and anticoagulation, as does every single neuroradiology attending and fellow I know. Your statements regarding this lack of knowledge speaks volumes to 1. your disdain for radiologists, 2. The apparent lack of communication and cooperation between neurologists and radiologists at your institution (if all the neurologists have your attitude, I'm not surprised).
 
RADRULES said:
A stupid thread started by a stupid person deserves a stupid reply.

I am a board certified rad from an elite residency who finished an elite neuroradiology fellowship. Yeah.. I am pretty dumb.

You certainly are (dumb) if you take this as proof of smarts.

RADRULES said:
In fact, many of my friends/collegues are in neurology, but they are reasonable people without such pathetic self-esteem issues as yourself.

Make sure you let them know that you feel this:

RADRULES said:
Unfortunately, Neurology doesn't get much respect in the medical community

And this is something I think is completly worng. Neurology is widely regarded as drawing the smartest people, who do the best exams, and who's formulations are the envy of the hospital. As is true of all stereotypes, it can be correct or incorrect on a person to person level, but one of the best things about applying to jobs is that in every place, neurology is well respected automatically.

RADRULES said:
By the way, we neuroradiologists do not exsist in a clinical vacuum. I know a great deal amount clinical neurology and neurosurgery, believe it or not most of us read your journals on top of our imaging journals.

And I'm sure you really believe that book knowledge equates to clinical abilities. Your amazing skills are probably needed right this moment up in the ICU. Dr. House has nothing on you! Don't waste yourself reading another lumbar spine with stenoses all over the place. Somewhere there is a cleverly disguised case of zebra syndrome that only you can unravel! You could also avail yourself to the ER.

But before you go, I'd like to avail myself on your awesome knowledge. What is the deal with periventricular white matter changes? Why can't we all just agree these are age related and do not require further comment? Somewhere, sometime, there has been some poor innocent who's 70% stenosis was thought to be symptomatic based on this nonsense.
 
Wow I read this thread. Its fun. Learned a lot. But I mostly agree with F_w. You gotta bark on the correct tree.
 
Members don't see this ad :)
Sorry my bad I could have just enjoyed it myself.
 
Rereading it made me realize I was right. Well, I already knew that.:cool:
 
hmmm, 10 years since this thread....so tell me neurologists, how have the radiologists been contributing to your clinical work nowadays? positive/negative experiences? Do you often interact with the radiologist to discuss diagnostics or do you just log on and review the imaging yourself? updates please :)
 
Ugh. Zombie thread. 5% review with Nrad. 95% make own opinion, review Vitrea and discuss with neurosurgeon. YMMV.

Please do not give in to throwing services under the bus.
 
  • Like
Reactions: 1 user
Well it's 2015 and the tables have turned. In general, across medicine physical exam skills are at at an all-time low, and even experienced attending physicians frequently come back to tell us they have confirmed signs and symptoms that were predicted by the radiology not the reverse. Even those with excellent physical exam skills are often too busy to fully assess the patient, as they are squeezed by declining reimbursements
Those of us who work in interventional neuro are clinically integrated in neuroscience programs and are directly involved in the assessment and treatment up of acute stroke patients and patients with acute neurovascular pathologies from a clinical through to management and follow up so the lines are becoming blurred between imaging and clinical specialties, a natural progression I suppose.
Overall, I think patients are well served probably better than ever in the past however The healthcare system struggles to deal with the cost of all the advanced imaging .
 
Last edited:
Well it's 2015 and the tables have turned. In general, across medicine physical exam skills are at at an all-time low, and even experienced attending physicians frequently come back to tell us they have confirmed signs and symptoms that were predicted by the radiology not the reverse. Even those with excellent physical exam skills are often too busy to fully assess the patient, as they are squeezed by declining reimbursements
Those of us who work in interventional neuro are clinically integrated in neuroscience programs and are directly involved in the assessment and treatment up of acute stroke patients and patients with acute neurovascular pathologies from a clinical through to management and follow up so the lines are becoming blurred between imaging and clinical specialties, a natural progression I suppose.
Overall, I think patients are well served probably better than ever in the past however The healthcare system struggles to deal with the cost of all the advanced imaging .

I think we're all getting screwed, but radiology has lost more, with more cuts coming. When I was a resident I had a med student who was a class-A douche, stumbled into medicine and somehow didn't join his frat bros at a hedge fund. As a symptom of this, he was interested in making the most amount of money for the least amount of work. Rads was top of the list. And that's not my insult against rads, please don't take it that way, he was such a jerk he didn't figure on the deep knowledge and responsibility it is to read a human's scan. I did say he was a douche, right? Where will a kid like that end up these days? Probably having dropped out of med school altogether, it has all gone belly up. But I think he'd be more interested in derm/gas/ophtho these days.

I do think you're right on the money on the decline of the H&P. I'm also seeing history and exam skills eroding, sadly, but I think this is due more to being out in practice, time constraints, and the over-reliance on medical technology that we teach med students and residents. But, to my point above, I think this has turned radiology from an incredibly respected position (I remember ending internal medicine rounds with radiology rounds) to a churn job. Now I read "This report is in agreement with the report generated overnight by someone who lives in a condo in Oahu or somewhere else foreign." Odd thing about medicine: the more we do something, the more we get good at it, the more the prices fall. And that's something that hits us all. In study budgets I get 800-1000 for an LP, which is the fair market price by definition. Clinically I think we get about 150. We still do them because someone's ass is on the line, but it is NOT in fiscal proportion (or, when we fail, is it fair to you guys to do it under flouroscopy).

Interventional neuro is a bubble just about ready to pop, overpopulated by providers, not that many relative interventional patient candidates (that should be a study: percent of all strokes with LVO's who are also candidates for endovasc).

If my kid were interested in rads, I'd say go for it! But I'd also remind them that they have to love it.
 
  • Like
Reactions: 1 user
:corny:
 
  • Like
Reactions: 1 user
Top