What DON'T radiologists know?

[LovingItAll]

I'm a MS I, and so I've put in about 7 weeks under my belt -- so pardon my ignorance.

Going in, I've been thinking radiology as my first choice. So, naturally, as we go through our weekly cases (our school does case-based method), I'm keeping a tally of which cases are diagnosed thanks to a radiology study. So far, its been a huge majority.

So, seems to me radiologists potentially know everything. What I'm interested in finding out from all you residents: what don't radiologist's know? or alternatively, what "general" stuff can't radiologists do well?

For example, I know a radiologist look at a chest x-ray and report "atelectasis" - but does he have the knowledge to associate it with particular diseases given the physical findings made by the clinician? Better yet, could a radiologist go collect the information himself (I know practically speaking this never happens, but theoritically, does a radiologist have the skill set to do that)?

Similarly, am I right to assume that radiologists forget everything they ever learned about pharm the same way orthopods forget everything they ever learned about internal medicine?

Bottom line: of the stuff I'm learning as a lowly first year med student, which does a radiologist forget/not work with? I love it all, which is part of the appeal of radiology, but they can't possibly know it all.... can you guys?

Thanks!

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[Whisker Barrel Cortex]

I'd say pharmacology is lower on the list. Although we still have to know all of the radiologically detectable complications (such as pulmonary fibrosis and some medications) of meds.

Top on the list of things to know is anatomy (of course), pathology, general medical and surgical management of every specialty (not that we do the management but that we need to know how what we call on a film will affect treatment in some cases). We are tested on and and learn OB ultrasound so we need to have a grasp of embryology.

We also need to know physiology (doppler ultrasound, nuclear medicine, some MRI and CT is affected by this) but generally not in as much detail. Biochem is also low on our need to know list.

Radiologists are required to do one clinical year so we get some decent physical exam skills. These skills do atrophy somewhat but we still need to know basic auscultation and palpation for when we do interventional procedures.

So physio and biochem are probably the least important. I think the most attractive part of radiology to me was that we are the true generalists of medical knowledge in that we need to know the radiographic diagnosis and associated findings of every specialty from ortho, to gyn, to nephrology, to pediatrics. Pretty cool (and somewhat intimidating) if you ask me.

 

[RADRULES]

I know everything.

Just kidding, in all seriousness we are expected to have a very large knowledge base. But, it centers around anatomy, pathology, radiographic presentation of disease, some physio, and some physics.

I decided early on in my career that treating the patient was the job of the clinicians. So I do not try to fill my mind with patient management knowledge. I limit it to knowing which findings make a big difference in treatment.

For example, if I see a lung cancer, it is important to me to measure how far it is from the carina because that is important when it comes to clinical treatment. But it is not important to me the various different ways it may be treated.

Some rads get off on thinking they all this wonderous "clinical knoweldge", which I think is somewhat important (more in terms of clinical presentation rather than management), but overrated. We are paid a lot of money to give our opinion on what we are seeing, not to suggest how to manage a patient.