Radiology obsolete?

[DO chooser]

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I recently shadowed an interventional radiologist who mostly does blood vessel work (aneurysms). Admittedly, he was a pessimistic guy, but he painted a grim picture for the future of radiology. In a nutshell he said with neurologists, surgeons, internists, and other specialists learning to read rads, CTs, and MRIs by themselves they aren't needing radiologists to do their own diagnosis.

Is this old news? Is this guy in a bad mood? It makes me worried to enter radiology if you take him by his word. Of course you will need radiologists for things like taking the pictures and doing arteriograms, but if what he says is true radiologists will be in a hard spot.

Mark Philips MS-2

 

[doepug]

While there are lots of armchair film readers in various specialties, the standard of care is to have studies interpreted by a radiologist. Ultimately, the radiologist is responsible for the official reading, and relying on anything less could result in undesirable medico-legal consequences.

If anything is obsolete, it's osteopathy.

Cheers,
doepug

 

[DO chooser]

I'd hate to start a slingfest, but you are an ignorant ass. This thread has nothing to do with OMT, so why bring it up? All you did was prove you are an insecure MD who obviously knows nothing about osteopathy. Next time formulate an argument instead of making a general statement, and don't hide behind your computer's anonymity.

Mark MS-2

 

[doepug]

Sorry, didn't mean to start a flame war. What I should have written is that "manipulation is obsolete." I brought it up because your topic involved obsolete practices.

Having worked with a number of DOs at a community hospital (who function just like MDs), I find that their approach to patient management is equivalent to anything done by an MD. I've never seen anyone (DO or MD) refer a patient for manipulation, hence my comment about such practices being obsolete. In fact, I've seen osteopaths refer patients with muscular pain, etc to physical therapy and orthopedists instead of to a DO for manipulation.

I don't disrespect anyone for having a DO behind their name... I just don't know that manipulation has a role in modern medicine.

Don't automatically assume that I'm trying to belittle you.

-doepug

 

[LuckyMD2b]

Originally posted by DO chooser
I recently shadowed an interventional radiologist who mostly does blood vessel work (aneurysms). Admittedly, he was a pessimistic guy, but he painted a grim picture for the future of radiology. In a nutshell he said with neurologists, surgeons, internists, and other specialists learning to read rads, CTs, and MRIs by themselves they aren't needing radiologists to do their own diagnosis.

Is this old news? Is this guy in a bad mood? It makes me worried to enter radiology if you take him by his word. Of course you will need radiologists for things like taking the pictures and doing arteriograms, but if what he says is true radiologists will be in a hard spot.

Mark Philips MS-2

It's funny you should say that actually, because I recently attended a lecture by a radiologist who said the exact opposite. I'm a med student, and I was really impressed by the stuff that was presented. Most of it had to do with breast cancer, imaging and biopsies, and how it's so much better than getting a gen. surgeon to go foraging around in there.

He also mentioned ultrasound ablation and how with advances in IR and molecular biology, "[radiologists] are going to put the surgeons out of business." It was thoroughly facsinating.

It sounded to me that radiology was the future of medicine. Is it too good to be true? Seeing as how radiology has been traditionally concerned primarily with diagnosis, what is the potential of radiology as becoming increasingly therapeutic?

Also, I'm assuming that due to the incredibly high price of all this technology, radiology based treatments must be only available to patients of the upper echelon of the sociecomonic ladder... or am I completely of base?

 

[droliver]

Originally posted by LuckyMD2b
He also mentioned ultrasound ablation and how with advances in IR and molecular biology, "[radiologists] are going to put the surgeons out of business."

This would be a reasonable statement if there was not already increasing amounts of image-guided procedures for the breast being done by surgeons during contemporary training. Like Endovascular Surgery, advancing technology has led to adaptations in techniques being taught. Radiologists are not in the catbird's for this field (or for the vascular interventionl work) for the fact that they aren't the ones with access to the patients with breast CA in most circumstances. Breast Surgery is kind of a subspecialty in evolution in General Surgery/Surgical Oncology with increasing numbers of directed fellowships in comprehensive breast care. An increasing # of Surgeons are now doing breast only practices with their own imaging centers & image directed equipment on site. Percutaneous tx. of breast CA is still in its infantcy for perc. treatments so ultrasound ablation & the like are years away from adoption. We routinely did our own image directed (ultrasound) & mammotome breast biopsies @ our clinics when I was still doing general surgery

As for the obsolecence question..... that's pretty silly. There is a huge flood of new imaging techniques coming out frequently which will keep everyone employed gainfully for years. The opposite is true I think - there is a real shortage of people to interpret images presently due to manipulating the supply which has led to historic financial rewards for radiologist's. The thing I'd be a little concerned about is whether imaging studies are going to be slashed for reimbursements (they are a huge component of health care resources) & whether the undersupply of physicians is going to stimulate more interest from the feds and states in allied health providers as potential stop-gaps in the problem (a la the CRNA or NP model). It seems that AHP's are daily gaining more practice privledges for many areas of medicine unfortunately

 

[stephew]

I just had a little wanderlust and popped onto this board; I can assure any med student that radiology - if anything- will become more important over time. Most docs would love to be able to interpret films like the pros and surely insurence companies would love everyone to be a generalist; but the what we know now is that further specialization is inevitable as more and more knowledge is accrued; not everyone can do everything. as the art of reading these films becomes more subtle and the technology changes, radiologists will have an increasing role from my Grandfather's day when he, a gastroenterologist, set up a machine in his office and read his own films. I spend a lot of time looking at radiographic images and I know when to turn to the pros.
Steph

 

[Voxel]

The problem with specialist interpreting images is that everything has to be looked at and subtle things can be missed. For example, the other day, the senior urology resident missed a subtle suggestion of an upper pole collecting system mass on ct. However the senior radiology resident saw the images coming out and reprotocolled the study and what do you know, there was the mass. In the mean time the radiology resident calls up the the urology resident and says did you see the CT on this patient and he says yeah I saw it and everything looked ok.

I think it takes only a few of these misses to make wise clinicians realize the need for expert interpretation. Otherwise you are gambling with people's lives and your malpractice premiums.

Off my soap box.... Back to the books and films.

 

[stephew]

yep, This is very true.

 

[droliver]

On the other hand..... there were many times I could interpret changes in a CT better then radiologists because I knew the patient & had better context to put the changes into. Sometimes those things are hard to communicate to someone else & highlights the importance for the surgeons of good relationships with your rads colleagues. For a lot of complex scans and studies of the abdomen & GI tract with previous surgery you get you best data when both disciplines are present to go back and forth over what you see.

Voxel- As for specialists and image interpreting.... No disrepesct, but there clearly are subgroups of nonradiologists who can read their own specific imaging without the expense of a second read at least as well as radiologists (Vascular Surgeons, Cardiologists, Endoscopists & colorectal surgeons with EUS, hand surgeons, OBGYN's,etc...) These do however make up an exceedingly small % of all imaging studies done.

 

[stephew]

there are always those doctors who are exceptional and not only excell their own field but in tangental ones too. but the need for specialists isn't negated by these few. Your point however is well taken.