Missing Patient Contact

[peduncle]

So I now that this topic has been discussed at lengths but I just wanted to get to the bottom of it since it's been on my mind for quite some time. I know a lot of radiologists don't mind not seeing patients (or not having a patient/doc intereaction), however were there any of you out there that actually had great relationships with patients (in your intern year) and now miss it?

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[peduncle]

haha.. I'm actually in the 2nd grade. Thought I'd get an early start. Thanks for setting me straight.

Any other opinions?

 

[Monica Lewinsky]

As Apache said, patient contact, especially the kind you get during intern year, isn't all its cracked up to be. You are going to be providing great service to patients as a radiologist, just not so in your face at 5 AM everyday like "real doctors" do. I'm sure if you were to find out that its your calling during your intern year, it would be easy enough to get out of the radiology program you matched into and find one of the many internal medicine residency programs with open slots out there. If you are so unsure, you can just hedge your bet by doing a medicine prelim year instead of a transitional year so you'd be ready to start as a PGY-2 in Medicine!

 

[hopefulmed]

So I now that this topic has been discussed at lengths but I just wanted to get to the bottom of it since it's been on my mind for quite some time. I know a lot of radiologists don't mind not seeing patients (or not having a patient/doc intereaction), however were there any of you out there that actually had great relationships with patients (in your intern year) and now miss it?

I'm applying to residency now, and I agonized over this a little too. I think Apache makes a good point, but maybe to the other extreme. I admit, it was painful to deal with the social issues that come with every patient.. and I don't think I can ever do internal medicine or something similar fields where half their heath problems are related to behavioral changes. That being said, there are plenty of specialties with a good component of both. Anesthesiology is one of those with intense, but short-term patient contact where you're only dealing with the issue at hand. ER and its shift-work nature means that no matter how painful the day may be, it's over at 5PM and it probably has the most patient contact of all. Ophthalmology and other surgical subspecialties generally have healthy patients and your role is very direct and focused. Hell, if you can bare through through an IM residency, there are plenty good subspecialties with nice lifestyle and focused patient interactions like GI, interventional cards, or endocrine.

Every specialties have it's downside to some people. I'm sure that it takes a special personality to be able to sit for 8-9 hours a day (for the most part anyway) staring at a computer and going through one film after another.

 

[peduncle]

I don't think the field of Radiology automatically implies that the resident is an introvert. I know plenty of extroverted radiologists.

I wonder why Pathology doesn't get the same crap that Radiology gets... for being people who are introverted or hate patients.

 

[Labslave]

I wonder why Pathology doesn't get the same crap that Radiology gets... for being people who are introverted or hate patients.

At my institution, pathologists get the same crap and more (they're considered weirdos on top of hating patients and liking dark rooms in the basement).

I'm considering rads as a career right now and I, too, am having issues with the lack of patient contact. Call me a tool, but I think it's the "introvert" stereotype that bothers me more than the actual lack of patient contact (especially since I've interacted with some awesome, fun rads residents).

 

[Anitsirhc]

I don't think the field of Radiology automatically implies that the resident is an introvert. I know plenty of extroverted radiologists.

I wonder why Pathology doesn't get the same crap that Radiology gets... for being people who are introverted or hate patients.

uh...we do.

 

[colbgw02]

Patient contact remains the most overhyped aspect of medicine.

 

[peduncle]

I heard recently that the trends in radiology may make for a much busier lifestyle. Private groups are finding the need to pair up with local hospitals to sustain their practice. Hospitals often then dictate their call schedules (or demand more calls).

Also hear that competing NightHawk groups are forcing the price of imaging to decrease.. decreasing reimbursements as well. Can anyone comment?

 

[colbgw02]

I heard recently that the trends in radiology may make for a much busier lifestyle. Private groups are finding the need to pair up with local hospitals to sustain their practice. Hospitals often then dictate their call schedules (or demand more calls).

Also hear that competing NightHawk groups are forcing the price of imaging to decrease.. decreasing reimbursements as well. Can anyone comment?

DRA will hit everybody and radiology will not be an exception; reimbursements will definitely go down. I've never heard of teleradiology companies underbidding each other though. In any case, the workload is still there, so if you still want to make beaucoup bucks then you can just read faster or longer.

I would argue that private practice radiology hasn't been a lifestyle specialty for about the last five years. The workload is tremendous, and studies that used to only be performed by the light of day are now expected by clinicians at all hours of night. Of course, we all know that the trend for some time in medicine has been to increasingly rely on imaging. Final teleradiology reads from within the U.S. help somewhat by providing after-hours coverage, but of course you're sacrificing salary.

The formula is relatively simple and can be applied to pretty much any specialty: it's a balance between location, lifestyle, and salary. The bottom line is go into a specialty because you love the content; everything else is just gravy.

 

[Greenman]

You must be an undergrad or junior med stud.

Let me make it crystal clear: patient contact blows. Got it? It's nothing like House or Grey's Anatomy -- that is fairy tale land. Avoid patient contact as much as possible. You will be glad you did.

Surfing over to the rads forum since Im on a 4th year elective I think I found the king (or queen) of hyperbole. Perhaps Apache's hatred of patient contact has more to do with their inability to form a relationship with patients. Dealing with some patients can be difficult but so does sitting in a dark room all day. Developing meaningful relationships with patients is extremely rewarding. Unfortunately the way 3rd year is set up, students rarely get to have any continuity with their patients and do not get to establish lasting relationships. This is like standing around passively watching surgery in the OR and then saying one hates doing surgery. When deciding on any speciality one has to think about what their life will be like after residency. If radiology is intellectually satisfying and you spend your free time thinking about rads and reading then its probably a good fit. If you are choosing it because its 9-5 with good pay then you are going to be spending then next 30 years of your life dreading every morning. Thats a painful way to spend a life.

 

[ScooterBanks]

Surfing over to the rads forum since Im on a 4th year elective I think I found the king (or queen) of hyperbole. Perhaps Apache's hatred of patient contact has more to do with their inability to form a relationship with patients. Dealing with some patients can be difficult but so does sitting in a dark room all day. Developing meaningful relationships with patients is extremely rewarding. Unfortunately the way 3rd year is set up, students rarely get to have any continuity with their patients and do not get to establish lasting relationships. This is like standing around passively watching surgery in the OR and then saying one hates doing surgery. When deciding on any speciality one has to think about what their life will be like after residency. If radiology is intellectually satisfying and you spend your free time thinking about rads and reading then its probably a good fit. If you are choosing it because its 9-5 with good pay then you are going to be spending then next 30 years of your life dreading every morning. Thats a painful way to spend a life.

Apache's hatred of patient contact likely has much more to do with the fact that he's done an intern year and has seen what true patient contact is. By your own admission, you note that you have no idea what it's really like as a medical student.

You will learn. The mythical ideal of what you have invisioned patient contact to be will soon be shattered once you become a doctor. By the time you realize the truth, it will be too late. Don't worry, you will naturally develop self defense mechanisms to convince yourself that everything is ok so that you can simply wake up every morning without completely hating your job.

One year from now, Fat Man's Law #8 "They can always hurt you more" will take on new meaning in your life and you will have a different concept of what patient contact is.

 

[colbgw02]

Apache's hatred of patient contact likely has much more to do with the fact that he's done an intern year and has seen what true patient contact is. By your own admission, you note that you have no idea what it's really like as a medical student.

You will learn. The mythical ideal of what you have invisioned patient contact to be will soon be shattered once you become a doctor. By the time you realize the truth, it will be too late. Don't worry, you will naturally develop self defense mechanisms to convince yourself that everything is ok so that you can simply wake up every morning without completely hating your job.

One year from now, Fat Man's Law #8 "They can always hurt you more" will take on new meaning in your life and you will have a different concept of what patient contact is.

I could not agree more with the bolded portion above. It amazes me to see the rationalization that some of my medicine or surgery colleagues go through to convince themselves that their lives aren't horrible. It's an understandable response, but they have lost all perspective on what is normal and what isn't.

 

[Greenman]

Apache's hatred of patient contact likely has much more to do with the fact that he's done an intern year and has seen what true patient contact is. By your own admission, you note that you have no idea what it's really like as a medical student.

You will learn. The mythical ideal of what you have invisioned patient contact to be will soon be shattered once you become a doctor. By the time you realize the truth, it will be too late. Don't worry, you will naturally develop self defense mechanisms to convince yourself that everything is ok so that you can simply wake up every morning without completely hating your job.

One year from now, Fat Man's Law #8 "They can always hurt you more" will take on new meaning in your life and you will have a different concept of what patient contact is.

I was not precise enough before, as a 3rd year student its hard to assess what patient contact is really like. However, as a 4th sub intern its easy to see the benefits "patient contact." My patients looked towards me as their doctor and for me personally this is very rewarding. If someone else does not get the same enjoyment thats fine. However to take their own feelings about patients and say that everyone should feel the same is inane. I might have my own feelings about radiology but Im not arrogant enough to tell someone else they should think the same.

To the OP, Id recommend doing an early sub I during 4th year. See If you like working directly with patients without having an intern between you and the patient.

 

[peduncle]

one things for sure. sometimes the day goes faster when you're in a clinical profession (or it feels it does). You're hustling and bustling moving from floor to floor, interacting with all healthcare professionals (cute nurses anyone?). Get the true sense of the scope of the hospital. Every time I sit to take care of a patient, I have a healthy and fun convo with all the personalities around me. It is nice to feel empowered from the patients. I have had only 1 or 2 out of 100 patients be disrespectful (which is when I employ the HOUSE technique and be preachy back to them)

One thing that a relative Radiologist told me was that when you work or get hired by a hospital, sometimes Radiologists are the most easily expendable. In fields like cardiology (and many other Face-time professions) the hospital wants to keep you because you bring something more to the setting... a good reputation.. good patient contact.. a great personality. My relative told me that you don't get that with radiology and in a sense, the hospital will dictate you salary (which don't get me wrong.. is great) but also be quick to dismiss you if they want (rarely happens though) because you are not providing anything more than a machine-like service.. unless of course you are interventional.

 

[deleted77919]

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[peduncle]

yeah well excluding the ED.... ED just sucks in general

 

[peduncle]

Hindsight is 20/20 and this is why I ask many current practitioners of their experience so far. Radiology is great. Provides a good schedule and great pay and it's ever advancing, but that doesn't mean it's on only sweet deal.

Outpatient clinical medicine (minus cardiology) is really not that bad once you start working. You have the luxury to work as much or as little as you want depending on how much you want to make. You have the luxury of telling your secretary to clear your schedule a particular day next week. I once shadowed a doc that schedule her patients from 7:00 to 3:30 every day so she could have enough time later to pick up her kids and enjoy "family time". She was easily making 200+ on that schedule. Fields like GI, Allergy Immunology, Pain, ENT (and the list goes on) have very little emergencies. You see patients in your office, see consults some of the days for variety, do procedures for variety (GI, Pain, ENT, etc..) and enjoy the atmosphere and company of a collective of medical practitioners who you will have one on one face time with on a daily basis (for which you will undoubtedly have conversations on your family, weekend, and hobbies and not just what this or that imaging study shows).

Radiology is still great, dont' get me wrong.. but there are other fields that can be great also. Patient contact is not as hellish as you would think. The ER is a different story... the ER Is so caustic and with so many ungrateful patients that it's not wonder there is a high burnout rate.

 

[Flankstripe]

However, as a 4th sub intern its easy to see the benefits "patient contact." My patients looked towards me as their doctor and for me personally this is very rewarding.

Just wait until you are been q4 for several months as an intern, cross-covering tons of patients and getting slammed from the ER for admissions, and then come back and talk to us about "rewarding."

Patient care is highly over-rated. The adoration from a patient for you being their physician is highly over-rated. These are the same patients that think nurse practitioners and physician assistants provide better care then their supervising physicians because of how much more time they spend with them.

one things for sure. sometimes the day goes faster when you're in a clinical profession (or it feels it does).

My months as an intern on clinical services like surgery or inpatient medicine were some of the worst and longest months of my medical life. Endless reams of scut, admissions, inane phone calls, non-stop pages, and getting dumped on by every other clinical service in the hospital. In contrast, my days in radiology are some of the shortest, both in terms of actual and perceived hours. Time flies on the radiology service because we are actually doing useful work. There is a minimum of wasted time, and little to no scutwork.

One thing that a relative Radiologist told me was that when you work or get hired by a hospital, sometimes Radiologists are the most easily expendable. My relative told me that you don't get that with radiology and in a sense, the hospital will dictate you salary (which don't get me wrong.. is great) but also be quick to dismiss you if they want (...)

Most radiologists are not directly employed by the hospital, nor do they get reimbursed by the hospital. They may work IN the hospital, but receive the majority of their reimbursement from billing the insurance companies/Medicare/Medicaid for the studies which they interpret.

Many other radiologists work in outpatient settings reading for imaging centers, or through teleradiology. If one hospital contract becomes too onerous, you can easily move venues. Unlike most clinical specialties, where you spend years building up a pool of patients and referring physicians, radiology is one of the most portable specialties. Just like Emergency Medicine or Anesthesiology, if you don't like the place that you work at, switching jobs or locations is much simpler than if you had an office or a patient base to uproot.

As well, since the rate of imaging studies continues to climb dramatically each year, and there is a relatively fixed pool of radiologists, you are unlikely to see many/any unemployed radiologists in the near future. What is more likely to happen is that there will be global cuts in the technical and professional components of all sorts of imaging studies in the future to try to reign in costs.

When that happens, there will still be plenty of studies to read, we just won't be making as much money. I'll still take that any day over a patient-care job.

It sounds like radiology isn't for you. All the better, because that means another residency spot open for someone who would actually appreciate what radiology has to offer.

 

[peduncle]

"It sounds like radiology isn't for you. All the better, because that means another residency spot open for someone who would actually appreciate what radiology has to offer."

haha... I love when people say stuff like this. Just because someone adds a counter-argument or likes to play devil's advocate doesn't mean a whole field is not for them. Of course I appreciate what rads has to offer.

 

[UCLAstudent]

one things for sure. sometimes the day goes faster when you're in a clinical profession (or it feels it does). You're hustling and bustling moving from floor to floor, interacting with all healthcare professionals (cute nurses anyone?).

It's the opposite for me. I feel like I'm constantly checking the clock and counting down until I can go home whenever I'm on the wards. Radiology days, on the other hand, fly by for me --- probably because I enjoy it so much.

 

[PeepshowJohnny]

One thing that a relative Radiologist told me was that when you work or get hired by a hospital, sometimes Radiologists are the most easily expendable... My relative told me that you don't get that with radiology and in a sense, the hospital will dictate you salary (which don't get me wrong.. is great) but also be quick to dismiss you if they want (rarely happens though) because you are not providing anything more than a machine-like service.. unless of course you are interventional.

So many things wrong here I have to jump in.

First, as stated above, the vast (VAST) majority of radiologists working in private practice (which is what it looks like you're referring to here) are in some manner of group practice, which can be large or small which contracts to hospitals. The hospital cannot thus dismiss a single radiologist on a whim and replace him, that falls to the group to decide if they want to keep you or not. But in that situation, you're working with colleagues and the decision will likely not be as capricious as the one you describe.

That said, yes a hospital could decide to cancel their contrat with a radiology group under the logic that the group is a faceless machine that can easily be replaced. Now, conceivably it would be much easier to not renew with one group and replace them with another than it would be with a cardiologist group or a pediatrics group because patients don't usually have relationships. However, this doesn't happen often because

A) Good radiology groups are at a premium. Even if the job market is slowing and their are oversaturated regions, it's more often to see a single group expanding what hospitals/clinics they read for because the hospital/clinic desperately needs their service than to have multiple radiology groups competing for a single hospital's business.

B) There is a relationship between physicians. This is a whole other topic in itself, but I don't think I've met many physicians who don't care about who's reading their film because they know what radiologists they can trust.

C) Radiologists talk. The main scenario I've seen proposed is "Hey, let's cut ties with the private practice group and then hire our own radiologists! We'll make a ton of money!" And each time it falls flat on its face because no radiologist wants to go to work for that place because they know they'll be used like a mule.

 

[Flankstripe]

haha... I love when people say stuff like this. Just because someone adds a counter-argument or likes to play devil's advocate doesn't mean a whole field is not for them. Of course I appreciate what rads has to offer.

You seemed relatively clueless about the professional situation for radiologists, and a number of your prior posts give the impression that you are either naive or uninformed about our specialty.

The point still stands. If you enjoy patient care, and time goes quickly for you when you are "in a clinical profession (or it feels it does)" as you are "hustling and bustling" from "floor to floor" while "[getting] a true sense of the hospital", then perhaps you should be in a patient care specialty.

Few radiologists would prefer the above situation versus being in the reading room or procedure suite taking care of studies. If you need patient care to be happy as a physician, radiology is a relatively poor choice given the multitude of clinical specialties that have far more patient interaction and longitudinal followup.

 

[smq123]

I'm considering rads as a career right now and I, too, am having issues with the lack of patient contact. Call me a tool, but I think it's the "introvert" stereotype that bothers me more than the actual lack of patient contact (especially since I've interacted with some awesome, fun rads residents).

Don't let the stereotypes bother you too much, or sway your decision excessively.

The stereotypes do NOT go away, regardless of which specialty you consider. People are always going to assume that you're choosing a specialty because of something that you "dislike," as opposed to <gasp> actually liking the specialty!

MS3: I'm going into peds.
Response: <gasp>! You must hate adults!

MS3: I'm going into OB.
Response: <gasp>! You must hate men!

MS3: I'm going into psych.
Response: <gasp>! You must hate the sane!

MS3: I'm going into family med.
Response: <gasp>! You must hate real medical knowledge!

MS3: I'm going into radiology.
Response: <gasp>! You must hate people!

MS3: I'm going into surgery.
Response: <gasp>! You must hate the world!



I mean, really. The stereotypes never go away, so forget about them. Ultimately, do what makes you happy, and don't worry about what everyone else thinks.

I was not precise enough before, as a 3rd year student its hard to assess what patient contact is really like. However, as a 4th sub intern its easy to see the benefits "patient contact." My patients looked towards me as their doctor and for me personally this is very rewarding. If someone else does not get the same enjoyment thats fine. However to take their own feelings about patients and say that everyone should feel the same is inane. I might have my own feelings about radiology but Im not arrogant enough to tell someone else they should think the same.

It's the radiology forum. The OP asked a question, and ApacheIndian answered it in his own particular way. I'm not sure why there's such a drive to try and prove him wrong. (For the record, I'm going into a patient-oriented specialty.)

It's not like he posted that response in the Family Med forum, or something....

So I now that this topic has been discussed at lengths but I just wanted to get to the bottom of it since it's been on my mind for quite some time. I know a lot of radiologists don't mind not seeing patients (or not having a patient/doc intereaction), however were there any of you out there that actually had great relationships with patients (in your intern year) and now miss it?

What year in med school are you?

If you're an MS4, and interested in rads, usually you take multiple radiology electives, which remove you from patient contact for several weeks, and give you an idea of what that is like. If you miss patients, then rads may not be a great fit for you. If you don't miss it, then rads may be a great fit for you. This isn't a difficult question to figure out.

I had to do a path elective earlier in the year. The hours were great, but Oh. My. God. I was so bored without patients, that it effectively answered that question for me.

The experiences of other posters is immaterial - you have to figure this one out for yourself.

 

[Sioux Indian]

Patient Contact BLOWS!!!! They stink, and they are stupid. The WORST kind of stupid, the kind that is so stupid they don't even realize how stupid they are.

But by all means if you want to deal with these creatures help yourself to a life of the following:

Cardiologist: Sir you had a heart attack
Patient: (eating a cheeseburger) huh...
Cardiologist: You had a heart attack
Patient: I'm fine... (continues to eat cheeseburger)
Cardiologist: You should think about a statin
Patient: I heard they are bad for you
Cardiologist: You heard that huh
Patient: Yeah, my Uncle Fred said ....
Cardiologist: Well, at least consider quitting smoking
Patient: Nah, I'm under alot of stress

 

[jabramsface]

Patient Contact BLOWS!!!! They stink, and they are stupid. The WORST kind of stupid, the kind that is so stupid they don't even realize how stupid they are.

But by all means if you want to deal with these creatures help yourself to a life of the following:

Cardiologist: Sir you had a heart attack
Patient: (eating a cheeseburger) huh...
Cardiologist: You had a heart attack
Patient: I'm fine... (continues to eat cheeseburger)
Cardiologist: You should think about a statin
Patient: I heard they are bad for you
Cardiologist: You heard that huh
Patient: Yeah, my Uncle Fred said ....
Cardiologist: Well, at least consider quitting smoking
Patient: Nah, I'm under alot of stress
Cardiologist: Fine. Have a nice day Mr. So-and-so

Unfortunately I was exposed to radiology a bit too late in the game to consider going for it. Plus I am not some superstar student. Everything about me is average.

That being said, I will end up in a patient care specialty.

The secret to dealing with idiotic patients is to not give a damn. Tell them the ropes, and if they dont agree, fine. Its not like youre the patients mother. Delving into the deepest regions of their psyche to determine why they are too lazy to take a walk everyday is hogwash. Like I said, just lay out the facts. You get paid the same whether they agree or not.

 

[Neuronix]

...

Are you the Apache Indian fan club?

 

[Doublecortin]

Patient Contact BLOWS!!!! They stink, and they are stupid. The WORST kind of stupid, the kind that is so stupid they don't even realize how stupid they are.

But by all means if you want to deal with these creatures help yourself to a life of the following:

Cardiologist: Sir you had a heart attack
Patient: (eating a cheeseburger) huh...
Cardiologist: You had a heart attack
Patient: I'm fine... (continues to eat cheeseburger)
Cardiologist: You should think about a statin
Patient: I heard they are bad for you
Cardiologist: You heard that huh
Patient: Yeah, my Uncle Fred said ....
Cardiologist: Well, at least consider quitting smoking
Patient: Nah, I'm under alot of stress

Boy, rads forum must be the most entertaining on SDN

God Bless Rads!

 

[Neuronix]

Not even close... Go check out Anesthesia sometime