Typical radiology personality or anomaly?

[Caffeinated]

So I have only been on radiology for 6 days, and I have working with the same people for 2 days at a time. So as you can imagine, I haven't really worked with that many people. That being said, I am wondering if some of my observations are representative of most radiologists. Before I started my radiology elective, I was under the impression that radiologists were like detectives working behind the scenes with a top-down view of a patient's clinical situation who then tied together a patient's clinical history with their imaging findings. However, I am finding that most of the time the radiologists don't seem to care very much about the patient's clinical history. They will launch into an explanation of the imaging modality, what they are looking at, etc. When I say "how old is the patient?" or "what is the indication for the study" they usually say "oh, I'm not sure, let's me see...." Unless the study involves imaging of breasts or genitalia, they usually have no clue about the gender of the patient. It seems like they are absolutely clueless about the patient until I bring it up. I can see where this strategy could be used in order to get an unbiased interpretation of the entire study before honing in the segments that are pertinent to the indication. But it seems like these folks are more about being interpretation machines instead of thinking about the patient's clinical situation. On the occasions where I have been with a radiologist when they had to talk directly with a patient, the conversations were full of medical speak. There were a few times when it was clear that the patients were left with more questions than answers.

Maybe I'm not cut out to be a radiologist. I don't want to start any battles or flame wars; I still have a lot of respect for the profession of radiology. I guess I am just starting to feel like I don't fit in.

---

Members don't see this ad.

 

[MD Dreams]

MS IV here, but I'll give you my opinion. Individuals who go into non-clinical specialites are not interested in getting to know the patient. They are interested in the pathology and in playing their role. This does not mean that they do not care about other people, it's just not their style. They are contributing to the well-being of others in their own way. If it's important for you to get to know your patient, then non-clinical specialties may not be your forte. Personally, I can relate with the radiologists. I'd be much more interested in interpreting an imaging study, in knowing the pathophysiology behind it, in assisting other physicians with my knowledge, than knowing the name of the patient, their age, their favorite color, how many kids they have, etc. In fact, it's hard for me to understand why anyone would desire these things. It's just a matter of personailities.

 

[colbgw02]

So I have only been on radiology for 6 days, and I have working with the same people for 2 days at a time. So as you can imagine, I haven't really worked with that many people. That being said, I am wondering if some of my observations are representative of most radiologists. Before I started my radiology elective, I was under the impression that radiologists were like detectives working behind the scenes with a top-down view of a patient's clinical situation who then tied together a patient's clinical history with their imaging findings. However, I am finding that most of the time the radiologists don't seem to care very much about the patient's clinical history. They will launch into an explanation of the imaging modality, what they are looking at, etc. When I say "how old is the patient?" or "what is the indication for the study" they usually say "oh, I'm not sure, let's me see...." Unless the study involves imaging of breasts or genitalia, they usually have no clue about the gender of the patient. It seems like they are absolutely clueless about the patient until I bring it up. I can see where this strategy could be used in order to get an unbiased interpretation of the entire study before honing in the segments that are pertinent to the indication. But it seems like these folks are more about being interpretation machines instead of thinking about the patient's clinical situation. On the occasions where I have been with a radiologist when they had to talk directly with a patient, the conversations were full of medical speak. There were a few times when it was clear that the patients were left with more questions than answers.

Maybe I'm not cut out to be a radiologist. I don't want to start any battles or flame wars; I still have a lot of respect for the profession of radiology. I guess I am just starting to feel like I don't fit in.

i remember feeling the same way when i first rotated through radiology. many radiologists, especially the ones who were formerly clinicians, lament the loss of patient contact, etc., etc., etc. for the rest of us, the benefits of radiology outweigh the loss of patient contact, and then, after awhile, you just stop thinking about many of the clinical issues when they don't pertain to the radiographic findings.

even still, it sounds like your experience is different from what i'm used to. on nearly every study we want to know the indication as provided by the clinician, and it's bothersome when the ordering physician gives an incomplete clinical picture. also, if it's a procedure then you can obviously ask the patient and get information directly.

something else to consider is that the radiologist is responsible for everything seen on the study, irrespective of whether or not it's related to the clinical issue. paying too much attention to the history may cause a radiologist to narrow his/her search too much, so that he/she will stop looking after he finds the PE and miss the horrible pneumonia - a phenomenon known as satisfaction of search. as such, it can be advantageous to ignore the clinical history, at least temporarily.

 

[rad_one]

We are so used to getting a piss poor clinical history that we just get used to reading the studies "blind".

 

[Flankstripe]

You might have a combination of crappy clinicians and unit clerks who consistently give weak histories like "abdominal pain", when the CT abdomen/pelvis shows three drains, a colostomy, free air, and what appears to be a transplanted pelvic kidney, as well as radiologists who have lost the ability to care about digging into the chart/computer to figure out which surgery happened when. Other recent stellar indications have included "Trauma with a history of trauma" and "Sick baby".

It continues to astound me that we get orders for CT's of the chest, abdomen, and pelvis (which has an effective dose of somewhere in the range of 300-500 chest x-rays; more if you scan twice for with and without contrast exams) with weak histories like "pain" or "fever".

Our hospital system has a wonderful EMR which integrates all the clinical notes, H&P's, labs, etc. I'll frequently check it when the supplied history is useless (roughly 60-70% of the time) and I feel like I need more information because there's something concerning on the study. I dictate blind when I think the exam is normal, or the findings stand for themselves.

Radiology is a detective game, and its a very interesting one at that for the right personality type. I think that most people in radiology (at least in my residency program) are relatively normal people who enjoy spending time with people, just not with patients. Many liked patient care enough to miss the positive aspects of it; but not a single person misses the incessant pages, ridiculous amounts of scutwork and paperwork, and incredibly inefficient rounds and clinics that are an inevitable burden in patient care specialties.

 

[GammaRay]

Hey, wait a minute now...

Although many radiologists are disinterested in patient contact, that's not always the case. In fact, some specialties in radiology require significant patient contact. Women's imaging and IR are the best examples. I'm going into IR and, believe it or not, I actually enjoy talking to patients, seeing them in clinic, coordinating their care with the referring physician/team, and, yes, even learning their favorite color. I also happen to enjoy diagnostic radiology. I have friends doing breast imaging fellowships who feel the same way. Radiology is a many-faceted profession with lots to offer. There is no "single" personality that describes the "average" radiologist.🙂

 

[Caffeinated]

Thanks for all of the great replies. I have picked up on the fact that radiologists are compulsive about reading everything on the studies -- and I think that is very cool. I guess I am torn about my interest in radiology because I am drawn to rads because of the breadth of the specialy. It touches all branches of medicine, and I am the guy with interests across all specialties. I am also drawn to rads because of the anatomy, pathophysiology, and the physics of imaging technology. In theory, radiology should be everything I was looking for in a medical specialty. It's very academic, and it encompasses physics and medicine -- two of my passions. But I guess I can't get beyond the fact that all of those images I seen in the reading room are of people who might be sick, hurt, dying, and in all likelihood are pretty frightened. To the average guy on the street, radiology has to be one of the top 3 most intimidating places in the hospital (big, expensive machines that make lots of noise and warning signs about radiation or magnetic fields on almost every door). I don't really have much interest in hearing every patient's full life story, but at the same time I am not looking to distill patients down to composites of lucencies, densities, and various signal intensities. I guess maybe I am a little more of a "bleeding heart" than I originally thought.

I realize that IR is a potential option if I felt that I wasn't professionally fulfilled by diagnostic rads or fitting in with my diagnostic rads colleagues. I have to admit that the days I spent on IR were a blast. Even though I was only watching the procedures, I got the sense that it must be very satisfying to do these procedures under image guidance. But I don't know if going into a diagnostic rads program with the singular intention of doing IR is a great option either. I would like to be a little more content with doing 4+ years of diagnostic rads before fellowship. That's the big unknown--I might enjoy diagnostic rads once I am in the driver's seat, but it's hard to know.

I cannot really tell if what I am feeling is normal "cold feet" that people going into any medical specialty feel, or if this is a warning sign that I need to direct my efforts towards a different specialty. It seems like most people on this forum feel that radiology is a 100% perfect match for them. This leads me to wonder my internal conflict is a warning sign that I should not ignore.

 

[cliffhanger]

If you haven't already, I would suggest having a talk with one of your school's student advisers. I was in a similar perdicament and although I don't usually expect counselors to be very useful, it was extremely helpful in this particular case. As someone who was accustomed to dealing with student's eleventh hour jitters, she addressed all of my concerns and basically laid out what she thought based on what she knew about me and what she knew about the hundreds of other students she had talked to and followed up with over the years. Now I didn't want someone to tell me what I should do (although it feels that would have made it so much easier)... but I was surprised at how reassuring it was to have someone tell me that they thought I should go with my original plan... based on X personality traits, Y experiences, and Z personal values... And it helps when it's someone well positioned to make this assessment because she has talked to hundreds of other students and has seen the decisions that eventually made them happy. Of course, not everyone will be this helpful. Pick someone who will be neutral.

 

[sundevil1]

Caffeinated,

That person behind the xray or CT scan may be a drug dealer who was shot or a drunk driver who just killed the passengers of the other vehicle. It could also be a clean cut, professional with abdominal pain and a pancreatic mass on the scan. I haven't worked with a single radiologist who doesn't think about the person whose scan they are reading. On the contrary, I think caring (and the fear of litigation) make one more careful when reading films. Like yourself, I too am more interested in thinking my way through problems and understanding the pathophysiology of disease processes. That is much more interesting than finding a SNF for Mr. IV Drug user who now has MRSA bacteremia. Like the others, I agree that the reason the radiologists did not have more clinical info is because the clinicians tend to give very little/if any clinical info with their request. "Rule out pathology" does not give you much to work with. I was torn between surgery and radiology, three months into my prelim year I am happy I stuck with my gut feelings. Do the specialty that leaves you the happiest and smiling at the end of the day so that you are not an angry SOB at home, where the important things in life are really at.

 

[Apollyon]

unit clerks who consistently give weak histories like "abdominal pain", when the CT abdomen/pelvis shows three drains, a colostomy, free air, and what appears to be a transplanted pelvic kidney

Oh man, this is one of my pet peeves - when I write the salient features with some specifics, and exactly what I'm looking for - and the clerk blows it off. More than once (actually, many times), I have called the resident telling them what my order said (that didn't get to them or or the tech), and what I needed/was looking for.

Garbage in, garbage out. If you don't ask for anything (even if it's +/- "not your fault"), you don't (usually) get anything specific back - and that I can NOT blame on the radiologist.

 

[deciding]

I think it is possible to still have patient contact in Rads, especially IR. I know docs that take 4-5 biopsies a day intermixed with other procedures plus reading the images. The one thing you don't get in Radiology is the in depth and long term interaction with the patient. Nor will you get much of a chance to develop a relationship. I wish there was an IM/Rads track that would allow one to work in both as I think they are both fascinating and essential fields. I took am deciding between a few fields which include IM and Rads. I just like talking with patients, yet love reading images as well.

Have you taken the difference in terms of training time (3yr vs 6yr) into consideration?

Do you care at all about compensation? Both compensate well.

 

[f_w]

When you look at radiology, make sure that you see more than the myopic highly distorted world of academic radiology. Out in the real world, rads is a much more pragmatic pursuit. Also, outside of academia, the egos are a bit smaller which makes the interactions between rads and clinicians a lot more fruitful.

 

[Caffeinated]

I think it is possible to still have patient contact in Rads, especially IR. I know docs that take 4-5 biopsies a day intermixed with other procedures plus reading the images. The one thing you don't get in Radiology is the in depth and long term interaction with the patient. Nor will you get much of a chance to develop a relationship. I wish there was an IM/Rads track that would allow one to work in both as I think they are both fascinating and essential fields. I took am deciding between a few fields which include IM and Rads. I just like talking with patients, yet love reading images as well.

Have you taken the difference in terms of training time (3yr vs 6yr) into consideration?

Do you care at all about compensation? Both compensate well.

Right now I am between 2 fields - ophtho and rads. My interests in both fields would likely lead me to pursue fellowship training. For ophtho, my interest is retina (4 yrs residency + 2 yrs fellowship = 6 yrs). For rads, my interest is IR, nuclear med, or neuro (5 yrs residency + 1-2 yrs fellowship = 6-7 yrs). So length of training does not factor so much into my decision.

Again, thanks for letting me vent my thoughts on this forum. I am hoping that talking it out like this will be "diagnostic and therapeutic." I appreciate everyone's feedback.

 

[factoid]

well i feel like we look up the clinical history on practically every patient. it was odd for me in the beginning when i started residency because i never looked up the history and during check out time, the attending would ask "well what did this patient have done? why were they admitted? what's their WBC?" now i'm more used to looking things up and calling clinicians if i need further clarification. it's actually a pain the ass sometimes. i thought radiology was supposed to save me from all that delving in the history business 🙂 well, as you can imagine though, the history is very helpful! more helpful then, say, an indication for "r/o cancer" i love that one.

 

[bosky]

What we need is like a PACS system for requests - eliminate the clerk with the GED.

As a prelim, I often write specific information for the request, but then they distill it down to what is billable. It can be a waste of mine and the radiologist's time to page them explaining every request - better if I could just type it out much like this message.

 

[banner]

Caffeinated,

What you are describing is not a typical radiologist. You are describing a lazy radiologist.

Radiologists should be interested in how their interpretations imapact patient care and should work as a "detective". Radiologists who are too detached tend to not provide useful information to the clinicians. Clinical information like age and sex of the patient are usually important in generating appropriate differential diagnoses.

Every field has their lazy MDs - and there's no shortage. They just manifest differently, depending on what their particular field allows them to get away with. As you probably are now aware, many lazy clinicians order frivolous tests like automatons rather than do their "detective" work and thinking.

Your desire to add clinical information to the situation and awareness that imaging is part of a bigger picture of care of the patient is an asset to you if you become a radiologist.

Don't be scared away by the duds. You'll practice how you want to practice.



Banner

 

[Wallachia]

What we need is like a PACS system for requests - eliminate the clerk with the GED.

As a prelim, I often write specific information for the request, but then they distill it down to what is billable. It can be a waste of mine and the radiologist's time to page them explaining every request - better if I could just type it out much like this message.

if i was the patient, i hope the billing code is inputed properly so i am not stuck with unreimbursed item . . . it is the current system . . . everything must fit into a CPT code

 

[mig2k]

We are so used to getting a piss poor clinical history that we just get used to reading the studies "blind".

you guys get history? we get "pain" for everything...EVERYTHING

 

[116408]

When you look at radiology, make sure that you see more than the myopic highly distorted world of academic radiology. Out in the real world, rads is a much more pragmatic pursuit. Also, outside of academia, the egos are a bit smaller which makes the interactions between rads and clinicians a lot more fruitful.

Bit offtopic, but this is recently giving me the jitters. I'm one month to be a full doctor (europe) and i'm in the process of choosing between (phd + academia residency) and a more or less non-academic residency.

I'm pretty confident that i'll somehow get a place, but you never know and i'll probably have to make a choice between paths soon. I really would like to do some real research, but i'm afraid of the above mentioned distortion.

 

[f_w]

My comment refers to US academic radiology. Often, people in academia have no understanding of the business aspects of radiology, and their comments on that subject are typically irrelevant. When deciding on a residency, I would go where you get exposure to the widest spectrum of disease and the most teaching. And in the US, this tends to be at academic (university hospital) medical centers. There are a couple of excellent community radiology residencies, but for the most part it is preferable to be at a university place for residency.

 

[Dr.RosenRosen]

I dont have time to read all this blather...so maybe this was mentioned and i'm redundant supid.

A good radiologist will clinically correlate their findings with some of the history they read from the ordering physicians' note. There's no way around that....if you're reading blind there's not point. Ordering physicians dont want to hear "could be this, rule out that" etc. They want to know what IS and IS NOT there considering what they are looking for.