I was on vacation recently and bumped into a retired surgeon, who ribbed me about how radiology and radiologists always seemed to be on vacation while he was in practice. I politely chuckled along, as this was not the first time I had heard this joke.
It was on my mind though as I read a study authored by a former colleague in an emergency department. It pointed out the lingering blemish on radiology's public image. While the study seemed positive for radiology — in that radiology services were not a primary cause of crowded ERs — two items stood out.
First, the author hypothesized that radiology would be a primary cause of delays. That tells you a lot about the perception of radiology. We linger under an old school claim of being obstructionist and unavailable. That is contrary to my experience. Radiology is one of the most progressive specialties in adopting the modern mentality everything on-demand with service first, and speed second.
How often can you find office visit notes, operative notes, and pathology reports available the same day as the service is provided? How many other disciplines do you know that have completed written reports available, often more than 90 percent of the time within 24 hours? Or even within two hours for the ER? Even the ERs themselves rarely have notes available the same day as the visit.
So how do we change that impression? Studies like this can help. We should support, endorse and promote others when we see them. It also is totally reasonable to point out our successes to colleagues and administrators. We should also not be afraid to press for others to follow our lead to deliver service both effectively and quickly. Portraying ourselves as leaders in efficiency can eliminate those old perceptions, and establish a new baseline.
Second, the study indicated that imaging use more than doubled during the study. It is interesting to note that although radiologists sometimes complain that ER imaging may be overutilized for many reasons, it doesn’t bog things down significantly. The real effect must be measured in terms of outcomes and cost-effectiveness.
I for one have thought many times that performing so many ER studies must slow the service to many others, and that the art of the clinical exam was underused. But if it isn’t delaying care, or overcrowding the ER, then the increasing use of imaging in the ER (or for inpatients) may prove the efficient method for managing and triaging patients. That is something we can all support. We can participate in development of innovative triage pathways for care delivery that use imaging, and endorse studies that look for most efficient imaging methods for patient management in the ER and beyond.
We should look critically at our beliefs, particularly when they are based on experience or dogma, because they are then only assumptions, not fact. Studies like this are great for dispelling myths — or confirming them. Without them, we have no basis from which to identify problems and to improve. We need to look critically at health care and work to dispel misperceptions about and within our own specialty.
