The Making of a Good Radiologist Today!

This week’s New England Journal of Medicine (NEJM) has an article titled “Holistic Review – Shaping the Medical Profession One Applicant at a Time” that describes how some medical colleges in the US are now assessing medicine applicants more holistically than just on their academic grades. This allows the selection of candidates who will have not only the knowledge required to practice medicine, but the ability to communicate better with patients, to work in teams and to deliver better all-round care.

A similar article by Dr. Pauline Chen in 2010, in the New York Times, describes what the “right stuff” to be a doctor and also the importance and use of personality tests to predict how students will perform as physicians. Recently, she has written another similar article that discusses a medical student who was very good with her knowledge but had poor communication skills and an inability to get along with her colleagues and peers, but couldn’t be “flunked” for these shortcomings.

A comment by Dr. Deniz Ones, in the 2010 article by Dr. Chen is very interesting, ““If a medical school is all about graduating great researchers, then I would tell them not to weigh the results of the personality test that heavily…But if you want doctors who are practitioners, valued members in terms of serving greater public, then you have to pay close attention to these results.”

This also applies to radiologists. If being a radiologist was only about reading images on a workstation or view-boxes without patient interaction, then all that we would require is knowledge and the ability to work fast, accurately and to deliver quick turn-around times.

But that is not what being a radiologist is about. I had addressed this issue partly in an editorial in the Indian Journal of Radiology & Imaging in 2008, where I summarized “All our radiology reports need to answer the ‘why’ question. To do this, we must be thorough with our understanding of the clinical situation and the answers being sought by our clinical colleagues. For this to happen well, we must subspecialize and be able to speak the same language as our clinical colleagues. Subspecialization inherently means that we need to work with other radiology subspecialists in a group practice; both academically and in general, this would automatically lead to a better quality of life.”

A good radiologist has the ability to deliver results accurately and in a timely manner. Dr. Woodcock in a short article distils this into the three “A”s of Affability, Availability and Accuracy. The Royal College of Radiology has specific guidelines. It also means not shying away from leadership positions in hospitals and practices and actual patient consultations.

In the end, as radiologists we must realize that as radiology becomes more and more important to patient management in many disciplines, we have the unique opportunity and ability to be a part of and perhaps in many situations the pivots that can make a difference…this involves moving away from the workstations and view-boxes and interacting more and more with patients, other radiologists and our physician and surgeon colleagues. And apart from knowledge, this also requires us to have good communication skills, bedside manners and empathy.

Comments

  1. So far so good, dreaming of an ideal situation. We all have right to dream, but alas the situation in India is different from that in Europe or USA or other countries. You know well, here we are treated as third grade citizens, even some consider us as not doctors. Who is responsible for these situations ? Radiologists themselves are more responsible than physicians themselves. Many years ago they started the system of incentives for getting more buisness, this generation is reaping the ill effects , and will do so for next several decades. I am still asked this question ( even for an x-ray reporting) : why you need history ? Just write your f…ing findings and send us, we will corelate ! No clinicians are ready to part with history in small and medium level cities. Only a handful of them, that too in institutions , are willing do discuss about clinical findings. How do we come out of all this chaos ?

    • Ariwala. Seriously…the situation is what you make of it. I know many radiologists in small towns who have made a name for themselves with their referring physicians. It doesn’t happen overnight. You have to work hard for many many years until they have confidence in you and your abilities. And then it all completely changes.

    • Dear sir,.
      Things in India are changing at speed 100 mile/hour… Radiology has become business rather than service. All corporate laws being used.. Do we really have many years in our hand ???….
      I wish to start radiology practice .. without CUT… what options Do I have?

      • Lots of options Ram.

        Start and don’t give referrals. It takes a little longer but the quality of your practice will be that much better.

        This does not mean that you are not aggressive in marketing yourself and your practice in terms of your quality, availability, turn around time etc.

  2. Biju Pappachan says:

    Respected Bhavin Sir, I definitely agree with you to some extent. But I have myself encountered situations felt by Dr. Mohammad Ariwala & Dr. Ram not once, but on many occasions. In my 11 years of radiology practice (I am working in a diagnostic centre presently), I have had a good rapport with many clinicians and have gained the trust of many. But today I feel that they are availing my services, for their own (self, not patient’s) diagnostic needs, diagnostic needs of their family members and for patients rejected by their primary referral centres due to complexity or “messed up” cases. That means they accept my credibility in such cases, which happen to be very less in total Radiology practice. They send the majority of the cases to centres which give them better incentives with lesser slices & films on CT study, lesser than basic sequences & films on MRI study etc. These centres also know that “such clinicians are more interested in money-making than in genuinely treating patients”. There’s a talk among marketing executives that once incentive reaches the clinicians – they are not bothered about reports.
    There were many occasions when patients known to me came to the centre where I was working, than going to the centres referred by their clinicians for their scans. When such patients reach the clinicians, they will say – Films are not good, Report is wrong etc. These patients return to me frightened & when I contact the said clinicians asking for clarifications – There is absolutely no issue either with the films or with the reports. Imagine the situation in which the patients are not known to me but come based on feedbacks of their predecessors who had good experience in my centre. When such patients return to their treating clinicians – I am crucified by the clinician in front of ignorant patients for no fault of mine. My credibility is completely gone in front of the patient.
    The primary solution to all these is to ensure “RADIOLOGY PRACTICE IS DONE EXCLUSIVELY BY RADIOLOGISTS & NOT BY NON-RADIOLOGISTS (people not having a valid Radiology degree recognized by MCI, irrespective of whether they are doctors or not). It won’t solve the issue at one stroke, but will be the greatest impact towards a dignified Radiology practice. Many managements employ sonologists (non-radiologists by above definition) at cheap rate & pay the clinicians more, which affects genuinity & sanctity of our practice.
    I always feel that the association (IRIA) can only file a legal suit in the supreme court against unethical practice of Radiology by everyone doing so (including non-radiologist doctors). There should also be severe punishment to the extent of scratching of existing degree & license (registration) & forcing hefty fine to people (including Radiologists), institutions and universities giving such trainings to non-radiologists. Then only, our time, money and efforts spent to become a Radiologist will be meaningful & we Radiologists can walk with head held high.

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