In an article titled, " Radiologists: Physicians or Expert Image Interpreters?" C. Douglas Maynard, MD poses the question, “Are radiologists physicians or expert image interpreters?” He goes on to ask, “How will radiologists use this technology for the best interest of their patients?” and “Are radiologists using teleradiology technology primarily to provide better patient care or primarily to improve their lives?” and importantly “Will teleradiology lead to radiology becoming a commodity?” The parallels with veterinary medicine are striking and these are questions that have been raised on this website previously.
A main theme that runs through this article is that teleradiolgy isolates the radiologist and may eliminate the opportunity for the radiologist and clinician to form a professional bond. Previously, it was clear that the radiologist was responsible to the referring clinician to offer advice and support. With teleradiology, and the rise of third party teleradiology services, Dr. Maynard asks, is the radiologist ultimately accountable to the referring physician, the patient, or the insurance company. When this question is applied to veterinary medicine, one can ask is the veterinary radiologist ultimately accountable to the referring veterinarian, the patient, or the teleradiology company?
As the avenues for communication between the radiologist and the referring vet are broken and it is no longer clear who we are accountable to, radiologists must ask themselves are they consultants who help with patient management or simply expert image interpreters? In the good old days, radiologists would be present in the building and asked about procedures, cases would be discussed, and radiologists were clearly consultants who assisted with patient care and case management. I share Dr. Maynard’s concern that the improper use of teleradiology technology will move radiologists from the desired role of consultants to expert image interpreters.
Of late, radiologists have allowed themselves to become commoditized and marginalized. This is manifest every time veterinarians shop for teleradiology based on price and turnaround times and jump ship from teleradiology services a the drop of a hat. The following are a two steps we can all take to help ensure that veterinary radiology will remain a respected specialty in the future. These recommendations address the most common concerns veterinarians express to us when they contact us looking to switch teleradiology providers.
Step 1: SLOW DOWN and open the lines of communication
Radiologists are pressured to crank out cases as fast as possible in order to improve turnaround times and increase revenues. Unfortunately, failure address bond with the referring veterinarian will ultimately undermine your goal of speed and efficiency because you will be out of a job. There is a point of diminishing returns with regard to turnaround times. All radiologists are encouraged to set aside a certain amount of time each day just to call referring veterinarians.
Step 2: You are the expert and you have a responsibility to educate and maintain standards of imaging excellence
It is no secret that radiologists are asked by employers to read and interpret cases that are of questionable diagnostic quality. These may be digicam images, poor ultrasound studies, or simply poorly positioned, or sub par primary capture digital images. It is easy to hide behind justifications such as “If I do not read it someone else will,” or “If I do not read it, I will get fired,” or “I only comment on what is on the images,” or “If I make a negative comment, I will lose a client.” We have all heard (and used these justifications.) These justifications are all designed to pad our pockets and they all ignore our responsibility to the profession and the veterinarians know it.
It takes time to educate referring veterinarians in the proper acquisition of images. It takes time to help veterinarians work through image quality problems. It is our responsibility as the bearers of imaging excellence and take the time to do this with our clients.
For those of us who do not live up to this responsibility, the veterinarians are on to us and they are not happy. We have had a string of veterinarians switch teleradiology providers because they felt that radiologists were not helping them be better clinicians and were just interpreting images. “Why didn’t my last group of radiologists tell me about these issues, I am so pissed” one referring veterinarian lamented last week.
Bottom line: The bottom line of all of this is really best stated by Dr. Maynard in his article:
“We must decide what we want to be when we grow up. Are we going to be physician radiologists or are we going to be content with reading high resolution images off the beaten path of health care? One thing remains constant: we all chose medicine as a profession because we are interested in working in health care for the benefit of patients. Despite the fact that…[some teleradiology] is run by “suits” and is seen by all as big business seeking market shares and whose major concern is the bottom line, we must not lose sight of the major reason that we selected our profession: the patient….If we let PACS isolate us from our patients, referring physicians, and colleagues outsource our work to others to ease our lives, income enhancement, and lifestyle issues dominate our thinking and others control our choices, we are apt to become marginalized and commoditized…”