In many North American medical schools, students take no dedicated radiology courses. In some of these, students still receive instruction from radiologists, who serve as guest instructors in courses offered by other disciplines and multidisciplinary courses. In other schools, radiologists play little or no role in required coursework, and whatever instruction in radiology students receive is provided by physicians in other fields. As a result, many students have little opportunity to learn what radiologists do and, in particular, to gain an understanding of the many ways radiologists contribute to patient care. This is a problem for radiology, the students, and the patients for whom they will care.
In thinking about what radiologists contribute to patient care, it is important to distinguish between two fundamentally different categories of contribution: inputs and outputs. The facts that there are more than 30,000 practicing US radiologists and that the average US radiologist performs and interprets more than 15,000 exams per year represent inputs. They tell us that health professionals rely to a great extent on radiology in the care of their patients, but they do not tell us what sort of impact radiologists are actually having on the care of those patients. What really matters most is not the resources being put into radiology but the outputs of radiology in improving care.
The most readily apparent contribution radiologists make to the care of patients is found in the area of diagnosis. In many cases, health professionals refer patients for imaging exams with particular diagnostic hypotheses in mind, such as “right upper quadrant pain—assess for gallstones” or “thunderclap headache—rule out subarachnoid hemorrhage.” Under these circumstances, one of the radiologist’s principal missions is to confirm or disconfirm the hypothesis, by determining whether there is evidence of gallstones or subarachnoid hemorrhage. In many cases, such as suspected fracture, the images are completely diagnostic.
In many other cases, however, the referring health professional may not have a specific hypothesis in mind. For example, a patient with an acute abdomen could have any one of a few dozen different disorders, and history, physical examination, and laboratory findings may not permit the development of a single hypothesis. In this case, the radiologist’s mission is to inspect the images and determine if any anatomic lesions are present. In fact, even in cases in which the referring physician is able to formulate a specific hypothesis, the radiologist still probes the images carefully in search of abnormalities.
In some cases, the radiologist finds completely unsuspected pathology. In one case, a woman was referred for an abdominal computed tomographic scan to rule out appendicitis, but the radiologist who interpreted the images identified a swollen, cystic-appearing right ovary, indicating ovarian torsion. In another case, the chest radiograph of an infant referred for cough and irritability revealed multiple rib fractures indicative of child abuse. Although the radiologist should always attempt to answer any specific questions posed by the referring health professional, the ultimate mission is to arrive at the correct diagnosis, whether foreseen or not.
Radiologists’ assessments often have huge implications for treatment. A computed tomographic scan reading often determines whether a patient undergoes urgent surgery or is sent home. It may also determine what kind of surgery the patient undergoes and by whom it is performed. For example, should the patient be seen by a general surgeon, a urologist, or a gynecologist? Similar considerations apply in medical therapy. Should the patient be referred to an infectious disease specialist for antibiotics or an oncologist for chemotherapy? The radiologist’s interpretation often represents a fork in the clinical road, powerfully altering the course of a patient’s care.
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