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  • Has Technology Ruined the Radiology Profession?

    Posted by drvitalr on December 4, 2020 at 6:24 am

    [link=https://www.kqed.org/futureofyou/256816/how-technology-ruined-the-radiology-profession]https://www.kqed.org/futu…e-radiology-profession[/link]
     
    Some may have read this before.  I was impressed by how poignantly it depicts the demise of radiology.  Sums up the root of a lot of our frustrations as we have become slowly marginalized from the system…and this doesn’t even include the raid of corporates.

    Unknown Member replied 3 years, 7 months ago 13 Members · 33 Replies
  • 33 Replies
  • btomba_77

    Member
    December 4, 2020 at 6:42 am

    Nice to see a reference to Billy Malllon’s “parasite” article.
     
    What an effing douchebag.
     
    (ps – I have the residents I work with read that op-ed… just so they know what people really think about us…… better to have your eyes open)

    • Unknown Member

      Deleted User
      December 4, 2020 at 6:51 am

      Haha yeah that Mallon article was a classic….

      • Unknown Member

        Deleted User
        December 4, 2020 at 7:49 am

        “One day I tried to see if I could go the whole day without speaking to anyone. And thats what happenedI didnt speak to a single person.”
        -A radiologist
         
        quote from article
         
         

        • Unknown Member

          Deleted User
          December 4, 2020 at 8:02 am

          “We entered the chest reading room and were greeted by a wall of radiologists backs, their faces trained like lasers on the computer screens in front of them. Not a single headlocated atop the shoulders of about eight different radiologiststurned to greet us.”
           
          My door is always open to technologists and referring doctors.
           
          Docs rarely come by. If one does he or she is usually older. 
           
          Thank god for a few daily procedures and fluoro cases to remind me of my humanity.

          • Unknown Member

            Deleted User
            December 4, 2020 at 8:04 am

            “The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a waste of time and by radiologists as an interruption, Allison Tillack
             
            I would agree with this- we are all on the RVU treadmill.

          • satyanar

            Member
            December 4, 2020 at 8:10 am

            I honestly got goose bumps reading about UPENN in the 80s. I was in med school at the end of that decade. It was interactions with professors like Dr. Miller. That drew me to the practice of radiology. Im sure most academic centers had one or more people like him. There was an art to what they did.
             
             

            • kankarej

              Member
              December 4, 2020 at 8:33 am

              Billy Mallon stroked out in Oct

              • Unknown Member

                Deleted User
                December 4, 2020 at 8:59 am

                “On Monday morning these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.” -Billy Mallon
                 
                These days are long gone
                 
                I don’t think Mallon is very educated on what docs are making. That stack of ER Plain films does not make a radiologist rich.

                • Unknown Member

                  Deleted User
                  December 4, 2020 at 9:11 am

                  “Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.”
                   
                  Teleneurologists supervising NPs on the ground?
                  Pathologists?
                  IM and IM specialists?
                  Derm? Probably more NP and PAs providing derm services than MDs right now.

                  • Unknown Member

                    Deleted User
                    December 4, 2020 at 9:16 am

                    Boomers in shambles.

                  • ruszja

                    Member
                    December 4, 2020 at 9:45 am

                    Quote from drad123

                    Teleneurologists supervising NPs on the ground?
                    Pathologists?
                    IM and IM specialists?
                    Derm? Probably more NP and PAs providing derm services than MDs right now.

                    We have all those. A friend of mine is a ‘derm NP’. Does all the little office procedures that pay so well while the principal focuses on OR cases and carrying bags of money to the bank.

                    Neurology is getting incredibly busy with the boomers falling apart. Much of the stroke care at our satellite hospitals is done via teleneurology.

                    The days of the 3 man pathology group at a smaller hospital are fading fast. It’s all large path corporations where one pathologist signs hundreds of reports spat out by AI enabled image analysis systems.

                    Good luck seeing an IM in person. If you can’t pull strings, you are going to see a PA or NP for anything routine.

                • jtvanaus

                  Member
                  December 4, 2020 at 9:41 am

                  Quote from drad123

                  On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much. -Billy Mallon

                  These days are long gone

                  “Hey I’m just calling to let you know Dr. Mallon has a hemmorhagic stroke.”
                  “Really? I haven’t seen him yet.”

              • Unknown Member

                Deleted User
                December 4, 2020 at 9:33 am

                Quote from Cowy1

                Billy Mallon stroked out in Oct

                He is 61. Too young! Looking at his lectures from 2016. He didn’t look too healthy. But then again I have seen corpulent rads live like this into their 80s.
                 
                Hit those gyms fellow rads!

          • ruszja

            Member
            December 4, 2020 at 10:04 am

            Quote from drad123

            My door is always open to technologists and referring doctors.

            Docs rarely come by. If one does he or she is usually older. 

            Thank god for a few daily procedures and fluoro cases to remind me of my humanity.

             
            Last week I counted. I had 35 separate instances of someone walking into my office in a single day of mammo/CT/US.
             
            That’s when I locked the door. We are in the middle of a covid wave. I am all ‘open door’ warm and fuzzy with the techs, but I dont want to get the ‘coof’ or end up having to isolate because one of our techs gets it. When we are back to a ‘not insane’ level of covid circulating in the community, I’ll be open to in-person interaction. Techs can call me to clarify some CT order or check some diagnostic mammos.

            • afazio.uk_887

              Member
              December 4, 2020 at 11:00 am

              The article is totally on point. I recall thinking about how PACS could easily commodities radiology when I started my training and thats basics what is happening.

              • Unknown Member

                Deleted User
                December 4, 2020 at 11:55 am

                I just skimmed that article, and agree with what I read.  We like to think that technology is neutral (“guns don’t kill people, people kill people”) and its impact, positive or negative, is completely up to the one who wields it. (P.S. I am an NRA certified handgun instructor, not anti-gun.) Marshal McLuhan, and later, Neil Postman, said that “the Medium is the Message.” Technology (the medium) is not neutral, it influences the content (the message). In their time, people would not have recognized Lincoln if he walked past them in the street or spoke to them, but they would have recognized the cadence of his prose. They voted not on the basis of his appearance, tall, or short, fair, or dark. The first televised Presidential debate (I think) had Nixon losing to Kennedy in part due to the appearance of his five o’clock shadow, i.e. his stubble, and the effect it had on his appearance. The medium of transmission – one’s visual image on TV or sound bite vs. reading his penned words – make a difference in how people perceive a candidate and how they vote. 
                 
                The effect of PACS is that it facilitates us all becoming image readers, less so consultants. How many radiologists wear a tie these days?  How many can carry on a pleasant conversation with a clinician?  In residency in the late 2000s (not that long ago), one of our very senior attendings in pediatric radiology required the guys to wear dress shirts and ties, and taught us the appropriate speech and body language to exhibit when a clinician entered the reading room. How not to talk over them. How to discuss a case. Things that – even at that time (for you young’uns) – was totally a lost art, a glimpse into the past, and a reminder of how different our field had become. In another section, the attendings were as5holes to the clinicians and made it very clear they were disturbing our morning readout; from those attendings, we learned a very different lesson: that our job is to pump out reports, and that which interferes with our generating good reports is a problem. 
                 
                So far we have come. 

                • julie.young_645

                  Member
                  December 4, 2020 at 12:10 pm

                  Radiological chivalry isn’t dead, but it’s in a coma. It can be revived. 
                   
                  As usual, what Flounce says rings totally true. We are physicians, not little tin robots pumping out reports. The latter can be replaced by AI; the former cannot. 
                   
                  My main posting these days is at a clinic where most of the clinicians want to see most of the imaging on most of their patients. I seriously think that this scenario allows all of us, radiologists AND clinicians, to practice the best possible medicine and serve our patients to the best of our ability. My one complaint is that some of them will stroll into my office and want the scan on THEIR patient read NOW, even if I’m in the middle of reading something else. An instant read will often have omissions, and more often than I’d like to admit, I’ve had to text them with an addendum. That is problematic, but I’ve had to learn to tolerate this as the way they insist on doing things. 

                  • drvitalr

                    Member
                    December 4, 2020 at 2:26 pm

                    This is true, we are in all aspects physician consultants, but not treated as such.  My main take home was not that people don’t hit up the reading room anymore, that is mostly irrelevant.  Many of us are on boards/committees and very engaging with colleagues.  Fact is, in any large practice, you will mostly read from sites where you are not physically located and may not “know” or ever interact with the docs.
                     
                    What hit home for me is how counterproductive our PACS efficiency and TAT milestones have become in that rather than wait to see what the radiologist “consultant” has to say in good time, it is more see how fast the radiologist can examine our patient for us and put words to a study with a history of fall or AMS or my personal favorite, “P” (which is believe is pneumonia or else a quick tremor of the finger??”)
                     
                    Can you imagine a cardiology or gi or surgery consult being this way?  Even the lowly pathologist isn’t held to TAT requirements….

                • ruszja

                  Member
                  December 4, 2020 at 12:16 pm

                  Quote from Flounce

                  In residency in the late 2000s (not that long ago), one of our very senior attendings in pediatric radiology required the guys to wear dress shirts and ties, and taught us the appropriate speech and body language to exhibit when a clinician entered the reading room. How not to talk over them. How to discuss a case. Things that – even at that time (for you young’uns) – was totally a lost art, a glimpse into the past, and a reminder of how different our field had become. 

                   
                  It is a lost art. The flipside of that is also that the ER doc or the surgeon would come to your office to look at a case with you rather than having the secretary call you if there is no written and signed report 31 minutes after the study was completed.
                   
                  If we think we are commoditized, we need to look at our hospitalist colleagues. Hospitals switch those contracts at the drop of a hat. Another fast talking MBA from a new staffing company shows up and promises them how they will be ‘aligned with the hospital’ and 3 months later there is a whole new crew of young internal medicine graduates and PAs wandering the halls aimlessly (often enough, some of the existing crew gets re-hired by the new company at a lower salary and with crappier benefits).

                  • Unknown Member

                    Deleted User
                    December 4, 2020 at 1:06 pm

                    The whole healthcare system is about making more money with shortcuts.  From the physician assisant who sees you and discharges you from the ER to your primary care dr that spent only 5 minutes on your visit – he can only deal with 1 of your problems on each visit, you need a separate appointment for the other visits.  Your GI dr gives you an appointment prior to your routine colonoscopy just to get everything set up, then you do your colonoscopy, then you have another visit going over your negative results – Billed as 3 separate visits.  No need to single out radiology here, the whole medical profession is the same game.  Corporates have done a lot of the damage and they call their changes “Efficient.”  True efficiency however does not compromise quality.  

                    • drvitalr

                      Member
                      December 4, 2020 at 2:35 pm

                      Also, comparing a hospitalist to a rad is a little much.  We are, after all, specialists.  A hospitalist is virtually a primary care/im who basically rounds and orders a specified panel of studies that a mid level could do

                    • afazio.uk_887

                      Member
                      December 4, 2020 at 3:13 pm

                      Rads is setup perfectly to become commoditized and corporatized…. sad situation for the future of the field. The field itself is cool and interesting but unfortunately low hanging fruit for the vultures

                    • Unknown Member

                      Deleted User
                      December 5, 2020 at 8:51 am

                      Very good discussion.
                      Great article too.
                      I remember the days of the ballroom with alternators; fun. Then there were the 40# jackets, lost films, chaotic file room; not fun.
                       
                      I had one attending preach what he called “politic.” Turn to the clinician, stand up, look him/her in the eye, offer your hand [elbow today], start a conversation, be welcoming. I still do it. Basic civility; it goes a long way. Used to teach the same to residents when in academics, so many were socially awkward. 

                • Unknown Member

                  Deleted User
                  December 7, 2020 at 9:23 am

                  Quote from Flounce

                  I just skimmed that article, and agree with what I read.  We like to think that technology is neutral (“guns don’t kill people, people kill people”) and its impact, positive or negative, is completely up to the one who wields it. (P.S. I am an NRA certified handgun instructor, not anti-gun.) Marshal McLuhan, and later, Neil Postman, said that “the Medium is the Message.” Technology (the medium) is not neutral, it influences the content (the message). In their time, people would not have recognized Lincoln if he walked past them in the street or spoke to them, but they would have recognized the cadence of his prose. They voted not on the basis of his appearance, tall, or short, fair, or dark. The first televised Presidential debate (I think) had Nixon losing to Kennedy in part due to the appearance of his five o’clock shadow, i.e. his stubble, and the effect it had on his appearance. The medium of transmission – one’s visual image on TV or sound bite vs. reading his penned words – make a difference in how people perceive a candidate and how they vote. 

                  The effect of PACS is that it facilitates us all becoming image readers, less so consultants. How many radiologists wear a tie these days?  How many can carry on a pleasant conversation with a clinician?  In residency in the late 2000s (not that long ago), one of our very senior attendings in pediatric radiology required the guys to wear dress shirts and ties, and taught us the appropriate speech and body language to exhibit when a clinician entered the reading room. How not to talk over them. How to discuss a case. Things that – even at that time (for you young’uns) – was totally a lost art, a glimpse into the past, and a reminder of how different our field had become. In another section, the attendings were as5holes to the clinicians and made it very clear they were disturbing our morning readout; from those attendings, we learned a very different lesson: that our job is to pump out reports, and that which interferes with our generating good reports is a problem. 

                  So far we have come. 

                  I wear a suit and tie and captoe leather dress shoes. Don a surgical gown when doing procedures. 

                  • Unknown Member

                    Deleted User
                    December 7, 2020 at 9:27 am

                    Nice!

                    I wear REI and 5.11 Tactical. If a clinician knocks or procedure calls, Ill change into scrubs for the rest of the day.

                    • Unknown Member

                      Deleted User
                      December 7, 2020 at 10:44 am

                      Quote from Flounce

                      Nice!

                      I wear REI and 5.11 Tactical. If a clinician knocks or procedure calls, Ill change into scrubs for the rest of the day.

                      I’m trying to resurrect the radiology profession in the small town where I work.
                       
                      No, there is nothing to do in this small town- I have to entertain myself with clothing.  One can spend hours just perusing ties online.
                      Standard, Skinny, Dotted, Floral, Geometric, Metallic, Paisley, Plaid, Solid, Striped…..
                       
                      And then there are pocket squares. LOL
                       
                      As long as I avoid the OR I don’t have to change into scrubs.

                    • Unknown Member

                      Deleted User
                      December 7, 2020 at 11:01 am

                      I can see how choosing attire can be really fun and not too expensive for a radiologist.
                       
                      I don’t like to think about my wardrobe and prefer to simplify. All pants/shirts/jackets combined, I have 5 items, each with a duplicate when one is in the wash; and soft body armor and a yellow vest for volunteer work. And drawer of socks, underwear and undershirts. Could all fit in a suitcase.  

                    • ruszja

                      Member
                      December 7, 2020 at 11:35 am

                      Quote from Flounce

                       and soft body armor and a yellow vest for volunteer work. 

                       
                      You should wear that to work one day. 
                       
                      I have consented a patient/family wearing a wetsuit once.  But that was on backup-call.

                    • suman

                      Member
                      December 7, 2020 at 11:45 am

                      [image]https://static.wikia.nocookie.net/memepediadankmemes/images/0/01/297.jpg[/image]

                    • lisbef3_453

                      Member
                      December 8, 2020 at 6:26 am

                      It’s not just Radiology that has been affected.   If you can digest the rambling screed, Ted K’s ‘Industrial Society and It’s Future’ was eerily prescient for its time.   If not for the whole mailing bombs things, he might have been more widely read.

                    • Unknown Member

                      Deleted User
                      December 8, 2020 at 8:52 am

                      RESTRICTION OF FREEDOM IS UNAVOIDABLE IN INDUSTRIAL SOCIETY
                      “modern man is strapped down by a network of rules and regulations, and his fate depends on the actions of persons remote from him whose decisions he cannot influence. This is not accidental or a result of the arbitrariness of arrogant bureaucrats. It is necessary and inevitable in any technologically advanced society. The system HAS TO regulate human behavior closely in order to function. At work people have to do what they are told to do, otherwise production would be thrown into chaos.” Unabomber
                       
                      Should we go back to auscultation, palpation, and percussion?
                       
                      Then we would be free?

        • Unknown Member

          Deleted User
          December 5, 2020 at 1:43 pm

          Quote from drad123

          “One day I tried to see if I could go the whole day without speaking to anyone. And thats what happenedI didnt speak to a single person.”
          -A radiologist

          quote from article

          My phone never stops ringing. A few weeks ago I was surprised that I didn’t receive a phone call for about 2 hours and eventually found out that the phone was dead.  

          • 22002469

            Member
            December 5, 2020 at 2:28 pm

            Good article.
             
            Don’t have much to add other than the author (I assume its the same Bob Wachter) has been a really good twitter follow through the pandemic. Chair of UCSF Dept of Medicine.
             
            Unless you are a Trumper… Does not like Trump.