Open Mouth View: Today the game is different

By David Weiss, MD, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA
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“You arrogant ass. You’ve killed us!” This is the final lament of a Russian submarine commander in the cold war genre film, Hunt for Red October. His ship is about to be destroyed by a torpedo previously fired by his own overaggressive first officer.

PACS and related imaging informatics tools are the crowning achievements of image interpretation of the past decade. PACS has recently become an enabling technology not just for radiologists but also for all who view images—sometimes to our own detriment.

Private radiology practice groups today compete head on with cardiologists, neurologists, surgeons, neonatologists, and others who are all more than happy to collect the seemingly easy pickings. Teleradiology groups, content for a time to read nighttime leftovers, are now competing with private practices for full-service hospital contracts. In order for a practice to maintain its own legitimacy, it must take steps to carefully control this potentially self-destructive force. Gone are the days when we can protect our own turf simply by hiding the keys to the film library. Since nonclinical on-site tasks, such as teaching and research, are often absent or at least not emphasized, private practice groups are more exposed than others.

Nighttime image interpretation has historically been the Achilles’ heel of radiology and has been largely avoided. Even today, we are often viewed by our peers as “9 to 5-ers.” This seems particularly unfair to me when I leave work at 1 a.m. and my car is one of very few in the physician section of the parking garage. PACS is a modern cure for this malady, but not without side effects. After years of increasingly oppressive third-shift coverage, use of PACS by teleradiology services has, in many cases, given us back a semblance of a normal life. This is an arrangement where all benefit. Reports are accurate and timely. Radiologists can now recharge and be ready for a full next day workload. Some, but not all, of these vendors of late have been eyeing the bigger imaging pie with a lean and hungry look. Stories abound of private practice groups losing their contracts to offsite teleradiology. Choose carefully. Make sure your vendor has a strong reputation and demonstrated history of partnership rather than competition. Become involved personally with vendor choice and contract negotiations. This is not a relationship that can be left to hospital administration.

In the eyes of a hospital administrator, what is wrong with Balkanizing image interpretation? Many studies can be read by their respective clinical specialists. The rest can be interpreted off-site by the highly accurate, cost saving, 100% fellowship trained teleradiologists. After all, what administrator does not harbor a subliminal desire to be rid of those tiresome sophists who sit in the dark and can easily bust the hospital budget with just one of their mysterious George Jetson gadgets?

As radiologists, we know that our value transcends mere image interpretation. It is our job to disseminate that message.

  • We must regularly attend clinical conferences and present cases. It is easier to demonstrate our unique knowledge and added value in person than through lifeless textual reports. We may even learn something.
  • Committee service, while time consuming and often oppressively boring, is another way to let colleagues and administrators know we exist.
  • Document everything we do—QI projects; technologist instruction; protocol optimization; management of JCAHO and other agency inspections; and equipment and software evaluation and purchase.

These important on site services will otherwise go unnoticed.

Consider these words from Captain Ramius, another character in The Hunt for Red October: “For … years your fathers before you and your older brothers played this game and played it well. But today the game is different. We have the advantage.” PACS is a live torpedo in the water, one that we ourselves created. It has provided our specialty with benefits and potential pitfalls that were unimaginable a mere 15 years ago. We radiologists must continue to control it with skill and care in order to maintain our relevancy.

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Open Mouth View: Today the game is different.  Appl Radiol. 

February 28, 2012
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