In the 20th century, before the pervasive presence of all things digital, an integral part of medical education and practice was daily radiology rounds. Each morning, medical students, interns, residents and attendings ventured into the imaging department, tracked down the film jackets of their patients imaged the previous day and brought them to the view box for review with a radiologist. Final reports often did not arrive on the chart for 24–48 hours and actionable information was needed sooner. What ensued was an incredible bidirectional knowledge flow. Medical students and house staff learned the rudiments of image interpretation, imparted by an expert radiologist. Decisions about appropriate follow up imaging were made cooperatively, in real time. Radiologists were provided more detailed information about each patient than available on the cryptic radiology requisition, allowing more nuanced and relevant interpretation of the imaging studies. The clinicians conveyed the most current concepts on complex diseases to the radiologists including how their findings impacted patient management. Comraderies developed. Life was good (except when the orthopedic surgeon had sequestered the needed film jacket in the trunk of his BMW).
Patient care suffers when clinicians and radiologists do not interact in direct face to face settings.
All of that changed in the new millennium with the advent of Picture Archival and Communications Systems (PACS) and electronic medical records. Physicians can view imaging studies from any computer, smart phone or tablet in the hospital, office or from home along with a nearly instantaneously generated self-edited radiology report. Given the convenience of these PACS, it is the exceptional physician who now makes his/her way to radiology for image review and consultation The technology is so dazzling that the radiologist has become invisible to most physicians, like the man behind the curtain in the Wizard of Oz. This has created an interaction gap between clinicians and radiologists that is detrimental to all; most acutely to the trainees and young physicians who may never in their careers have participated in those old fashioned face to face rounds. Radiologists are often in the dark about what really is going on with their patients and what questions the physician wants answered. Clinicians make decisions about what imaging study is most appropriate in a relative vacuum. Patient care suffers.
In the nearby article, Drs. Patel et al. explore a novel approach to bridging the interaction gap between radiologists and pediatricians by incorporating a radiology resident into the patient care team. They demonstrate significant perceived benefit to having an embedded radiologist in daily rounds. This article should stimulate valuable dialog resulting in other creative solutions to the widening interaction gap between clinicians requesting imaging examinations on patients whom they know best and radiologists who are most expert on appropriate utilization and interpretation of those studies. For the sake our patients and quality of care the interaction between clinicians and radiologists must be improved. Patel and fellow articles are headed in the right direction.
Biography
John H. Niemeyer, MD, MSMA member since 1994 and Missouri Medicine Editorial Board member for Radiology, is an Interventional Radiologist at Midwest Radiological Associates in St. Louis.
Contact: jhn4127@bjc.org
