Disturbing Article or Hot Air??

[neurologist]

. . . .If any of them would sit and readout with just ONE of my faculty ONE time they would understand their own ignorance and sit in awe of the knowledge and deep understanding of these guys.

Um, gosh, I actually HAVE read out films with neurorads faculty at "top programs." I have to admit I DO get pretty awed and impressed with reports like "there is a T2-FLAIR hyperintensity in the subcortical white matter. This could represent demyelination, or ischemic change. A low grade glioma cannot be ruled out. Clinical correlation is necessary. A repeat study in 6 months may be helpful."
I don't begrudge you guys the interventional stuff, but I stand by my belief that any neurologist who's worth anything doesn't need much help on MRI/CT.

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[Fantasy Sports]

Um, gosh, I actually HAVE read out films with neurorads faculty at "top programs." I have to admit I DO get pretty awed and impressed with reports like "there is a T2-FLAIR hyperintensity in the subcortical white matter. This could represent demyelination, or ischemic change. A low grade glioma cannot be ruled out. Clinical correlation is necessary. A repeat study in 6 months may be helpful."
I don't begrudge you guys the interventional stuff, but I stand by my belief that any neurologist who's worth anything doesn't need much help on MRI/CT.

The funny thing is, almost ALL radiology reports are such hedged drivel like above that its no wonder every subspecialty is taking over their own imaging.

Here is what a typical radiology report looks like:

"Blah blah blah blah. List of things it could be that were determined by exam anyway. Blah blah blah.

A (worst case scenario diagnosis) cannot be ruled out. Clinical correlation is necessary. A repeat study in X time is recommended."

Thanks for nothing... and you wonder why people talk about outsourcing imaging studies or doing them yourself as subspecialists...

 

[RADRULES]

Geez... you guys have such weak smack.... especially this medical student joker.

Please... don't hurt my feelings with the "hedge" smack... oohhhh...

I suppose if I spent all day making love to my reflex hammer I would have weak smack too.

We, as neuroradiologists, are the best neuro imagers... this is a fact. You can believe what you want... hell, I don't care, but when you disregard the radiology report and get sued, I won't feel bad nailing your ass to the ground. So, do what you will, but most good doctors know and understand the value of a subspecialized radiologist.

Next time I have a tough case, I will be sure to look in all those wonderful imaging book written by NEUROLOGISTS....

Really, the insecurity displayed on this thread towards your own choosen profession is very telling - not to mention blatant jealousy by the local medical student monkey.

 

[Whisker Barrel Cortex]

The funny thing is, almost ALL radiology reports are such hedged drivel like above that its no wonder every subspecialty is taking over their own imaging.

Here is what a typical radiology report looks like:

"Blah blah blah blah. List of things it could be that were determined by exam anyway. Blah blah blah.

A (worst case scenario diagnosis) cannot be ruled out. Clinical correlation is necessary. A repeat study in X time is recommended."

Thanks for nothing... and you wonder why people talk about outsourcing imaging studies or doing them yourself as subspecialists...

First off, as I have said before, this is a small percentage of rads reports. Second, do you have enough imaging knowledge to realize that findings ARE non-specific. Obviously not. There are multiple findings that can look the same way.

 

[SpinEcho]

Perhaps that was because the neurologist actually had to go out on a limb and make the diagnosis, as opposed to being able to hedge a meaningless statement onto his report and move on to the next case?

Unless fellowship-trained, a radiologist is just dead (paper)weight on the neurology service anyway. And its amazing how slow the turnaround times are on studies. I can't wait to outsource the easy stuff (and yet it comes back to me faster than dropping it off a floor below!), and then get a real fellowship-trained neuroradiologist to consult on the harder stuff. That seems to be the way the field is progressing, especially since radiologists at many local hospitals here refuse to work normal doctors hours, leading to a backlog for everyone else. And think of all the money patients will save too, with no loss in their standard of care.

Remarkably bold statement from someone who doesn't read MRIs and CTs.

I guess I'll just have to accept my dead-weight status and tell the neurologists and neurosurgeons that refer to me that someone on the Internet, who knows everything about everything, told me how I was actually useless and that I had not actually been a help to them, despite how it seemed to them during my previous six years of private practice.

I don't know where 'here' is for you, but we have a maximum 30 minute response time on call (typically 10 or less, including telerad transmit time), call reports to everyone who requests them and basically do whatever it takes to take care of the patient...the point of the exercise, if you remember. Part of the reason rad reports can be equivocal is that referring docs can't find the time to give much more than a one-word history, often just an abbreviation. Or better yet, they order the wrong study to answer the question they ask. Referring docs that can dial a phone, tell me the patient's story and actually take advantage of my admittedly scanty four years of postgraduate education will often find themselves with better reports.

If your local rads are so disinterested perhaps it's some of these issues? They can probably do better -- is it possible they just don't like you?

 

[SpinEcho]

I for one know that I could have gotten into any specialty, including neurosurg and rads, and at top places. But I am choosing neurology because I believe that neurology will be where cardiology is today. I am sorry that radiologists are worried about losing their turf yet again, but the US lawmakers only care about the bottom line, and giving neurologists power to take care of stroke patients themselves and reduce disability across America just makes the most sense. As you guys hopefully realize now, about 1/3 of interventional neurology fellows are neurologists. And the growth will continue simply b/c radiologists don't want to forgo their 50 hr wk, $300,000 lifestyles to lead lifestyles like neurosurgeons. Most neurologists are not trying to become diagnostic neuroradiologists. We have you guys for that. We are simply trying to save our specialty because we care about patients, not to be in a *competitive* specialty to make a ton of money.

And just to flip around your argument of why neurologists shouldn't read films... radiologists should do what they are good at: reading films. Leave patient care to us.

B

Here's a little medicoeconomic dose of reality for you, Skippy.

Imaging costs are growing faster than anything, including pharmacy costs.

Self-referral, or as you say it, "giving neurologists power to take care of stroke patients themselves" is what has made cardiology the single greatest source of increased imaging costs. If you think insurance plans are so hot to build another beast like that, you should consider that they are already moving to eliminate payment to single-modality or even dual-modality imaging centers. Yes, radiology is across the ball from the rest of medicine on this one, but so are the people who actually pay for healthcare. When you line up GM, GE, Wal-Mart and a couple of others against your grand scenario of a Super-Neurologist faster than a speeding thrombus and able to leap tall pressure gradients in a single bound, the truth is that your specialty missed the boat -- you should have seized your territory 30 years ago.

Rather than your boutique POS MRI unit and crap CT scanner milking the populace of their healthcare dollars while you're busy in the interventional suite, if you want a health plan to actually pay for the pretty toys you want for your imaging center you have to provide a FULL SERVICE imaging center. Welcome to the wonderful world of "neuromammography". Oops.

Furthermore, there is still the ability to get hospital priviliges to work your feats of derring-do. If you don't co-opt the radiologists, who likely have a contractural hammerlock on things like that, you're sunk. And you can't even argue restraint of trade, likely because you never had that trade there before.

There are a lot of barriers to your vision of interventional neurology. Namely money, people and inertia. Good luck, you'll need it.

edit: And BTW, I work 50 hours on a call /weekend/, much less the week.

 

[Mitogen79]

Let's face it folks, this is just a big messy turf war... I would hope that as physicians (or future physicians for some of us), that we can all rise above our own short-comings and realize the value of the other specialty.

A neuroradiologist/radiologist is just that... someone who has tremendous expertise in imaging and the interpretation there-of... I would not doubt for one second my ability would be vastly inferior to a neuroradiologist's ability to read a scan... However, I highly doubt there are radiologists who feel comfortable diagnosing a neurological condition AND also having the knowledge and expertise to treat it... here in lies the difference...

I respect the neuroradiologists tremendously, and I would hope that they too would respect the neurologists... for what we do, ultimately has an impact on the patient...

peace~

 

[jasonhlv]

Interesting article. All I have to say is that I am glad I'm going into general practice.

 

[eddieberetta]

In my experience neurologists and neurosurgeons strongly value the opinion of radiologists. I am only months into rads residency. Even in my limited experience, staff neurologists [let alone residents] come to me for my opinion on every imaging test they order on call. On my first night on call one staff called me to say that they had checked an MR already and "didn't see much." Diagnosis: diffuse leptomeningeal enhancement. Many of us have found aneurysms missed by staff neurosurgeons. That dosen't mean we are better people -- we are just focussed on imaging, and over time we get good at it.

I love radiology and neurorads and I respect neurologists immensely. It is not an easy job. Neither is ours. Even in general radiology we seen orders of magnitude more volume than clinicians, and orders of magnitude other pathology [bone, muscle, orbit, neck, ear, spine] that shows up in "neuro" imaging. We focus our training on honing the visual search, anatomy, pathology, physics, and procedural skills relevant to radiology, and other specialists just do not have the training or experience we do.

And as for being lazy? We are one of the busiest residents on call. And when we are up, even a momentary lapse can result in a miss that can injure a patient. And our scans eventually get over read by a staff -- once you start signing off on your own reports, that missed lung nodule on the ct c-spine will present 5 years later in court. Try reading every ct/mr of the HEAD alone that is done each night in your hospital.

 

[tru-wellness]

Is the future of neurology really as bleak as these two authors seem to indicate? I'd like to get a second opinion from current residents, docs, and/or those on the interview trail. My whole purpose for entering medicine at 40 was to practice neurology, a dream I've had since high school. I haven't even considered other options (as yet). Should I?

You should really take a look at glycobiology.

http://www.glycoscience.org and

http://www.glycoinformation.info

 

[GopherBrain]

You should really take a look at glycobiology.

http://www.glycoscience.org and

http://www.glycoinformation.info

I sense a very short SDN affilliation in your future.

 

[f_w]

> I sense a very short SDN affilliation in your future.

It did breathe new life into this languishing rotting thread.

 

[GopherBrain]

> I sense a very short SDN affilliation in your future.

It did breathe new life into this languishing rotting thread.

This thread deserves to die. For the two neurologists that actually care about neuroimaging, we already have a thread going.