Originally posted by Whisker Barrel Cortex
Dunehog,
I like how you respond to negative posts and but fail to mention anything about what I posted (which was not at all negative).
Good luck in ENT. By the way, I know plenty of people who went into ENT because they liked surgical specialties but wanted a better lifestyle than neurosurgery or general surgery. Just see samsoccer's post in the surgery forum. So please stop the holier than thou attitude.
Well, I guess if your going to call me out then I better respond. If you re-read my post, nowhere did I say there was anything wrong with wanting to go into radiology to make money. Truth be told, I seriously considered radiology myself at one time and the money was certainly a factor. I'm not trying to be "holier than thou," just stating my belief that money is a major factor for many people who go into radiology.
What you say about ENT is absolutely true and had a lot to do with my specialty choice. I think general surgery is cool as hell and I'm having a great time in internship. But my priorities are such that I want to have time for family and leisure at some point in my life, and I don't think general surgery would permit that. Otolaryngologists do some incredible operations involving what I think is the most interesting and complex anatomy in the body while at the same time taking care of a relatively healthy patient population, which allows for a better lifestyle for the surgeon.
Now all of the counter attacks begin.
First, as a radiologist in training, I can confidently say that, with the exception of some of the mentioned highly subspecialized physicians (neurosurgery, ent, ortho), radiologists are MUCH better at interpreting studies than clinicians. Even on something as basic as a chest x-ray or abdominal film, you would be surprised how much differently and more critically you can examine a study than the vast majority of clinicians. when it comes to MRI and CT, clinicians don't even come close. If you consider the reports as an afterthought, you will miss things and get burned.
Second, clinicians do often discuss scans with radiologists. Maybe you don't see your attending doing it, but trust me, they do. I see them all the time. We receive multiple calls daily to assist in interpreting every imaging study, from plain films to CT to MRI. Have you ever read a trauma CT or cervical spine x-ray? I'd like to see any of your expertise on interpreting transplant liver ultrasound. I have yet to see a non-radiologist who can pick up a small PE on CT angio or tell it apart from an obvious artifact. Thats ok, cause a PE is an incidental finding that will not affect patient care, right!
Third, part of the radiolgists role is to assist physicians who are not experts in a field. I reviewed a cervical spine film today with a internal medicine physician who kept mentioning the odd appearance of the C3 vertebrae posteroirly. It took me a while but soon I figured out that she was referring to the normal spinous process. I am not pointing this out to show the ignorance of clinicians, just that they do not know imaging beyond their scope. Of course, if this were a trauma surgeon or ED physician they would know what normal looked like. Another internal medicine physician asked what the large mass near the liver was. I told him he was looking at the stomach abutting the liver. Again, not enough experience. A surgeon would have known. An ED doc asked be to look at a foot film on a diabetic with a neuropathic foot. Only after I pointed it out did he notice that the enitire proximal 5th metatarsal was gone. I'm sure an orthopod would have seen it. Multiple times surgery residents have missed decent sized pneumothoraces on truama patients until I told them about it. One time they did not notice the growing apical fluid cap (luckily only due to sternal fracture). All of these and more and I have been a radiology resident for only 4 months! I did not realize how little I knew about imaging until I started doing it full time.
All of you need to realize how much more the radiologist sees on an image than you do and utilize this resource or you will be bound to make mistakes. Anyone can pick up the huge finding. Undertanding what exactly you are seeing is another issue. Moreover, subtle, sometimes relatively unimportant, but often very important findings will be missed by clinicians 9 times out of 10.
As far as your previous post about radiology, you presented a lot of anecdotes about clinicians missing things. It's hard to argue with anecdotes, but I still maintain that the radiologist's report provides no contribution to patient care at least 90% of the time. The are at least three reasons for this that I can think of.
- First, it is often the most obvious findings on imaging studies that have the biggest impact on patient care. Examples include the big intracranial hemmorage, the large pneumothorax or the large intrabdominal abscess seen on CT. A large intracranial hemmorage is much more likely to need mannitol or an emergent craniectomy. where as a small one can often be treated conservatively. A large pneumothorax needs a chest tube, whereas a small one usually resolves by itself. A large intrabdominal abscess usually needs emergent drainage, whereas a little bit of fat stranding can usually be treated with antibiotics and observation.
- Second, when there is clinical concern for a particular problem that may be seen on imaging, the patient is often treated emprically before the results of imaging studies are available. One of the best examples for this include the small pulmonary embolus on CT angio you mentioned. If there is a real clinical concern for PE, the patient is usually heparinized anyway.
- Third, often when there is clinical concern for a particular problem that one needs imaging to diagnose, a specialist has already been consulted. These specialists are usually at least as proficient at interpreting imaging studies in their area of specialization as any general radiologist. Examples include: 1) patients with neurologic deficit that needs head CT: neurology/neursurgery is consulted, 2) patient with recent liver transplant that needs liver ultrasound to r/o hepatic artery thrombosis : transplant is obviously involved since they did the friggin surgery, 3) pregnant patient that needs ultrasound for whatever reason: OB already involved and probably did the ultrasound 4) patient with cold foot and rest pain that needs lower extremity angiogram with possible angioplasty : vascular surgery already involved and may even do the angioplasty themselves if their not too busy.
Realize however that I am by no means saying radiologists serve no purpose. Radiolgists often provide meaningful and useful contributions and in certain situations (less than 10% I would estimate) they are invaluable. But they are nowhere near as crucial as your buddy RADRULES thinks they are, and it is very unlikely that "the hospital would shut down" were it not for the radiologists (also a Radrules quote).
