Patients-not just Images
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The Referring Physician - A Radiologist's true Friend, Philosopher and Guide
The Referring Physician - A Radiologist's true Friend, Philosopher and Guide
Dr. Virupaksha Joshi, Consulting Radiologist, Ashwini Hospital, Solapur., Maharashtra
Dr. Virupaksha Joshi, Consulting Radiologist, Ashwini Hospital, Solapur., Maharashtra
It was an exceptionally hot and busy Monday afternoon when the intercom on my table rang. That was the era before the mobile phones!
It was an exceptionally hot and busy Monday afternoon when the intercom on my table rang. That was the era before the mobile phones!
“Doctor! Are you sure that Mr.Deshpande’s MRI is normal.” It was the deep, sonorous voice of the senior neurologist of our institute. He was one of the few star physicians of the entire district and I was a cub radiologist who had just started his career in Radiology. That morning, I had read MRI of one of his patients and reported as normal. I sat straight and stiff in my chair when I realized who I was talking to. I didn’t forget to clear my throat before venturing a reply.
“Doctor! Are you sure that Mr.Deshpande’s MRI is normal.” It was the deep, sonorous voice of the senior neurologist of our institute. He was one of the few star physicians of the entire district and I was a cub radiologist who had just started his career in Radiology. That morning, I had read MRI of one of his patients and reported as normal. I sat straight and stiff in my chair when I realized who I was talking to. I didn’t forget to clear my throat before venturing a reply.
“Yes Sir, I didn’t find anything abnormal.” I said.
“Yes Sir, I didn’t find anything abnormal.” I said.
“Did you look at the diffusion images at the skull base?” he wanted to know.
“Did you look at the diffusion images at the skull base?” he wanted to know.
Now, I panicked, gripped by a thick cloud of uncertainty and self-doubt. I was about to mumble something when I heard the same sonorous voice again.
Now, I panicked, gripped by a thick cloud of uncertainty and self-doubt. I was about to mumble something when I heard the same sonorous voice again.
“Look at every image once again and call me, OK?” The line went dead.
“Look at every image once again and call me, OK?” The line went dead.
I sprang to my feet and went over the MRI console to take a re-look. Just a solitary image among the 100-odd images showed a bright area of abnormality of the size of a pin-head in his lower brainstem. My technician had transferred every image except this one on to the films issued to the patient! Without wasting a minute, I dialed this famous neurologist’s phone number. I noticed a subtle tremor in my fingers as I dialed.
I sprang to my feet and went over the MRI console to take a re-look. Just a solitary image among the 100-odd images showed a bright area of abnormality of the size of a pin-head in his lower brainstem. My technician had transferred every image except this one on to the films issued to the patient! Without wasting a minute, I dialed this famous neurologist’s phone number. I noticed a subtle tremor in my fingers as I dialed.
“Sir, I did take a second look. I found a PICA territory infarct on left side” I said, sounding like a three-year-old boy, caught red-handed by his teacher, while stealing a chocolate from his bench-mate’s hind-pocket.
“Sir, I did take a second look. I found a PICA territory infarct on left side” I said, sounding like a three-year-old boy, caught red-handed by his teacher, while stealing a chocolate from his bench-mate’s hind-pocket.
“Of course! He must have a PIC A territory infarct. He has every sign of a Wallenberg’s syndrome. How can his MRI not show that? Be careful next time, OK?” There was silence once again before I could say, “Yes Sir.”
“Of course! He must have a PIC A territory infarct. He has every sign of a Wallenberg’s syndrome. How can his MRI not show that? Be careful next time, OK?” There was silence once again before I could say, “Yes Sir.”
That was perhaps the first few of a series of such enlightening encounters I had with many super-specialist physicians during the initial years of my career in Radiology. I emerged chastened at times but wiser always after every such interaction. It was a hands-on experience after all the mugging of theory and parroting the signs and syndromes in Radiology during post-graduation course. I was struck by the fact that these super-specialist physicians had such an enormous and in-depth knowledge about their chosen filed. At times, I was even intimidated by their knowledge. I was struck more by how much they knew about the Radiology pertaining to their field apart from knowing their subject itself. It is not surprising considering the fact that they endure and survive those extra, grueling years during the super-specialization. Thus, a gastroenterologist knows a great deal of Radiology of the GI Tract apart from routinely doing a fine job of extracting even the most difficult stone from the bile duct. A nephrologist, no doubt, treats the most complicated case of renal failure but he knows every bit and nuance of Radiology related to the Urinary tract. Just recently, I could diagnose a case of acute cortical necrosis of the kidneys with generous help from a Nephrologist friend of mine. Sometime back I had an illuminating discussion with a neonatologist about the various lines and tubes we see while reporting chest and abdomen radiographs of the newborn infants. So, the first reaction whenever I meet a super-specialist physician is a sense of deep respect which is at times coupled with a sense of awe. Most of my tete-e-tetes with the physicians have played a significant role in making me a better radiologist and also a better person.
That was perhaps the first few of a series of such enlightening encounters I had with many super-specialist physicians during the initial years of my career in Radiology. I emerged chastened at times but wiser always after every such interaction. It was a hands-on experience after all the mugging of theory and parroting the signs and syndromes in Radiology during post-graduation course. I was struck by the fact that these super-specialist physicians had such an enormous and in-depth knowledge about their chosen filed. At times, I was even intimidated by their knowledge. I was struck more by how much they knew about the Radiology pertaining to their field apart from knowing their subject itself. It is not surprising considering the fact that they endure and survive those extra, grueling years during the super-specialization. Thus, a gastroenterologist knows a great deal of Radiology of the GI Tract apart from routinely doing a fine job of extracting even the most difficult stone from the bile duct. A nephrologist, no doubt, treats the most complicated case of renal failure but he knows every bit and nuance of Radiology related to the Urinary tract. Just recently, I could diagnose a case of acute cortical necrosis of the kidneys with generous help from a Nephrologist friend of mine. Sometime back I had an illuminating discussion with a neonatologist about the various lines and tubes we see while reporting chest and abdomen radiographs of the newborn infants. So, the first reaction whenever I meet a super-specialist physician is a sense of deep respect which is at times coupled with a sense of awe. Most of my tete-e-tetes with the physicians have played a significant role in making me a better radiologist and also a better person.
I guess my relationship with the physicians has been mutually beneficial. At times, physicians – especially the non-specialist ones have sought my help to understand the nuances of the science of radiology so that they could make better sense of a radiology report. Some years back, a physician friend of mine made a distress call to me. He had just read my MRI report of one of his patients.
I guess my relationship with the physicians has been mutually beneficial. At times, physicians – especially the non-specialist ones have sought my help to understand the nuances of the science of radiology so that they could make better sense of a radiology report. Some years back, a physician friend of mine made a distress call to me. He had just read my MRI report of one of his patients.
“Hey, what is the meaning of T1 weighted imaging and T2 weighted imaging you mention so often in your report?” he wanted to know.
“Hey, what is the meaning of T1 weighted imaging and T2 weighted imaging you mention so often in your report?” he wanted to know.
He continued, “Do you mind explaining in short what the meaning of the various terminologies you radiologists use in your reports? What do you mean when you say a lesion is hypo intense or hyper intense, for instance? ”
He continued, “Do you mind explaining in short what the meaning of the various terminologies you radiologists use in your reports? What do you mean when you say a lesion is hypo intense or hyper intense, for instance? ”
“I don’t know anything about T1 or T2 except that it rhymes with ‘me-too’”, he quipped in his usual style.
“I don’t know anything about T1 or T2 except that it rhymes with ‘me-too’”, he quipped in his usual style.
I invited him to my MRI department on a Sunday morning and spent an entire hour explaining whatever he wanted to know. I am glad I did that because now he understands the radiology reports better and he has stopped calling me to know what I mean when I mention in my report that a lesion is hyper intense, hypodense or echo-free.
I invited him to my MRI department on a Sunday morning and spent an entire hour explaining whatever he wanted to know. I am glad I did that because now he understands the radiology reports better and he has stopped calling me to know what I mean when I mention in my report that a lesion is hyper intense, hypodense or echo-free.
Since then my respect for a physician especially the one who is not a specialist has increased. In fact, in my opinion, the non-specialist physician is the real hero in medical practice. He acquires such a vast body of knowledge in various fields just by hard work and willing to learn continuously and remain a life-long student.
Since then my respect for a physician especially the one who is not a specialist has increased. In fact, in my opinion, the non-specialist physician is the real hero in medical practice. He acquires such a vast body of knowledge in various fields just by hard work and willing to learn continuously and remain a life-long student.
A grouse heard often by the patients against the super specialist physician is that he does not spend enough time with them when they visit him with a complaint and that he is too busy and preoccupied. I guess what constitutes ‘enough time’ perhaps differs across a patient population. If there were to be an equipment to measure ‘satisfaction quotient’ as and when a patient emerges from the consulting room of a specialist, I am sure it will record a wide spectrum. Some patients are never satisfied while some others are easily satisfied. Majority fall in between. As a fellow doctor I can understand why it happens. Considering the sheer number of patients visiting a super specialty hospital catering to tertiary level care, it is not surprising if some of them are dissatisfied. It is not to say that the specialist physician is blameless. Some of them are perhaps the best in their field when it comes to professional skills but they are not necessarily effective communicators. We hear often these days that a course on communication skills should be introduced in the medical school and that such skills must be taught along with structure, function and pathology of the human body. However, there is nothing like learning by observing a fellow physician who is good in the areas where one is not. I recall one such instance quite early in my career. I was once called to the hospital at 3 ‘o’ clock in the night for what was expected to be an emergency ultrasound. The anxious relatives had called the senior physician too. It turned out to be, as it often happens, a false alarm. The 19-year-old girl, apparently pampered, had come with a vague pain and expectedly the ultrasound examination was negative. However, I observed with amazement the senior physician answering their mostly frivolous queries with patience and grace. I wondered how on earth this doctor was capable of such patience and that too in the middle of night after a grueling day of work. That night, I learnt a lesson that continues to inspire me even to this day.
A grouse heard often by the patients against the super specialist physician is that he does not spend enough time with them when they visit him with a complaint and that he is too busy and preoccupied. I guess what constitutes ‘enough time’ perhaps differs across a patient population. If there were to be an equipment to measure ‘satisfaction quotient’ as and when a patient emerges from the consulting room of a specialist, I am sure it will record a wide spectrum. Some patients are never satisfied while some others are easily satisfied. Majority fall in between. As a fellow doctor I can understand why it happens. Considering the sheer number of patients visiting a super specialty hospital catering to tertiary level care, it is not surprising if some of them are dissatisfied. It is not to say that the specialist physician is blameless. Some of them are perhaps the best in their field when it comes to professional skills but they are not necessarily effective communicators. We hear often these days that a course on communication skills should be introduced in the medical school and that such skills must be taught along with structure, function and pathology of the human body. However, there is nothing like learning by observing a fellow physician who is good in the areas where one is not. I recall one such instance quite early in my career. I was once called to the hospital at 3 ‘o’ clock in the night for what was expected to be an emergency ultrasound. The anxious relatives had called the senior physician too. It turned out to be, as it often happens, a false alarm. The 19-year-old girl, apparently pampered, had come with a vague pain and expectedly the ultrasound examination was negative. However, I observed with amazement the senior physician answering their mostly frivolous queries with patience and grace. I wondered how on earth this doctor was capable of such patience and that too in the middle of night after a grueling day of work. That night, I learnt a lesson that continues to inspire me even to this day.
I hope my short account of a shared journey with physicians explains why I consider him not just a true friend but also a philosopher and guide. Since the radiologists and physicians are fellow travelers in this wonderful journey of caring for the sick, let us hope that our relationship continues to nurture each other. We are in it together and therefore let us make it a journey worth traveling and in the end a fulfilling experience.
I hope my short account of a shared journey with physicians explains why I consider him not just a true friend but also a philosopher and guide. Since the radiologists and physicians are fellow travelers in this wonderful journey of caring for the sick, let us hope that our relationship continues to nurture each other. We are in it together and therefore let us make it a journey worth traveling and in the end a fulfilling experience.