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10 Questions with Mark E. Klein, MD, MBA

June 1, 2016

Article

For this "10 Questions" series, we spoke with Mark. E. Klein, MD, MBA, about his work and the future of radiology.

1. Please state your name, title, and the organization you work for.

Mark E. Klein, MD, MBA, FACR. For the past 31 years I have worked at Washington Radiology Associates (WRA) in Washington, DC. That’s on K St., home of lawyers and lobbyists, a short jog to the White House. For even longer, I have held a clinical faculty position at The George Washington University Medical Center.

2. How did you get where you are today?

I have been fortunate to be part of a group of radiologists who take great pride in the quality of their work and who have always been forward thinking. We encourage each other to learn and bring new skills, procedures, and technologies to our practice. In the late 1980s, I became interested in the use of ultrasound to diagnose prostate cancer. My colleagues and I created a joint effort with local urologists, affording me the opportunity to scan over 25,000 men, perform ultrasound-guided biopsies on thousands, and diagnose hundreds of invasive prostate cancers, all before urologists adopted this technique into their own practices.

Beginning in 1999, I attended the International Symposium on Virtual Colonoscopy. In the early years of that conference I was the sole private-practice radiologist in attendance; all the rest were academic researchers. In 2002, I once again asked my colleagues at WRA to support my effort in a new diagnostic technique, and once again they did so. Over the past 13 years, I have performed many thousands of these studies, and have been fortunate to be a regular faculty member at the ACR Virtual Colonoscopy course offered three times annually at the ACR Education Center in Reston, VA.

3. Why did you choose your profession?

By serendipity, really. I began in Internal Medicine. One day, exhausted, following a not uncommon brutal night of admitting sick patients to my queue, I found myself literally in tears. My resident noticed, put his arm around my shoulder, and assured me it would all be all right. The following week, my arm was around his shoulder, catching his tears and assuring him of what he had assured me only days ago. Truth is, it really wasn’t all right for either of us. Let’s just say my mind was suggestible.

Part of intern data-gathering involved numerous trips down to radiology to view X-rays. I would have said images but in those days they were mostly just plain films, barium studies, IVPs; studies now scoffed at as anachronistic. While we Internal Medicine types were mostly killing ourselves with busy days and sleepless every-third-night call schedules, I couldn’t help but notice that those in the radiology department were all smiles. Plus they had some incredibly new cool toys, like ultrasound and CAT scanners (the more elegant and succinct “CT” acronym came later). I became friendly with those residents, and they actively encouraged me to consider switching to their team. Over a three-day period - as Dave Barry would say, I am not making this up - I applied, interviewed, and was accepted. That was March; three months later I was a radiologist-in-training.

4. What is your biggest day-to-day challenge?

Just like every other radiologist, or really any physician in just about any specialty, the great challenges are getting all of the work done and not screwing up. One benefit of being around a long time is that your name tends to become well-known (hopefully for the right reason). The flip side is that yours may be the only name a referring physician knows off the top of his or her head, so when the phone calls come it is often you being paged to answer a question. I also believe that, as physicians, we really can’t say no to requests to add urgent cases, the net effect of which is that a day that seems benign at daybreak is not infrequently chaotic only hours later.

As for the screwing up part, well it’s unavoidable. Dim the lights low, exclude ambient noise, banish thoughts of lunch and weekend plans from your mind: you will still screw up. I don’t care who you are, how careful you are, how dedicated and caring you are. You will screw up. Regularly. And for most of us type-A-high-achieving types, that is painful. Honestly, that’s the part of the job I dislike most. The rest is pretty darn good.

5. What worries, if any, do you have about the future of radiology? If none, where do you think the field is going?[[{"type":"media","view_mode":"media_crop","fid":"49062","attributes":{"alt":"Mark E. Klein, MD, MBA","class":"media-image media-image-right","id":"media_crop_6248084938692","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5903","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Mark E. Klein, MD, MBA","typeof":"foaf:Image"}}]]

If you have no concerns about the future of radiology, then either you have no worries about anything-good for you!-or you live in Colorado where weed is legal. Radiology as a specialty has only been around for about one hundred years. The earth, now 3.7 billion years old, got along just fine without our specialty for almost all of that time, and likely will again someday. It’s not that our skills and technology will vanish. It is far more likely that as we see increasing specialization due to new advances in molecular biology and yet unseen technologies, radiology could be largely subsumed by other specialties. The neuroradiologist is indispensable to neurologists and neurosurgeons. The breast imager is kin with the oncologist and breast surgeon. Body imagers share a lexicon with gastroenterologists and so on. As we witness the metamorphosis of medical care and its delivery, it only makes sense that our particular skills might one day more appropriately fit within other medical specialties. We will just have to see.

6. What one thing would make your job better?

I guess it would be finding just the right pace. I very much enjoy my daily routine. I love working with the staff, interacting with patients, and sharing cases and life with my colleagues. Unfortunately, as the pace accelerates all of those suffer. There is just too little time for each. But that sounds like whining, and really I feel super fortunate every day. I’m good.

7. What is your favorite thing about radiology?

I belong to a rather unique practice. On any given day, I might examine, in person, thirty patients. In our practice, we see all diagnostic mammography and breast ultrasound patients, every single general ultrasound patient - old school, I know - and even some CT, MRI, and X-ray patients. That patient interaction is what continues to motivate me. Of course, the imaging remains fascinating. It is rare to have more than a day between very interesting cases. That’s not true for many of our clinical colleagues.

8. What is your least favorite thing about radiology?

What I call the “5^th wheel” phenomenon. Let’s face it, for all of our bravado about how important we are to patient care, we have all experienced that sense of feeling unnecessary. While there is no doubt that we often contribute valuable information and insights into patient care, there are innumerable times we dictate the irrelevant report. The antidote to this problem is of course to become super specialized. See number 5 above.

9. What is the field’s biggest obstacle?

I don’t like the word “obstacle.” It implies that radiology should continue to exist and grow simply because it does and has. Really what we want to preserve and grow are the knowledge and skills that enhance patient care. Maybe one day the radiology department will consist only of equipment and technical staff. The “radiologist” may have a different name, or likely many different names as we scatter to new homes in the medical institutions of the future. I won’t be sad, and I suggest none of you should be either. Associations are formed because of a need. Too often over time the association takes on a life of its own; its reason to exist and persist is simply to exist and persist. If what you do improves the care and lives of others, your title and the name of the group under which you operate are really not important.

10. If you could give the radiology specialty one piece of advice, what would it be?

It’s the same advice I would give every other physician. View your work as a gift. Patients still see physicians as trusted confidants. Open your eyes and ears to your patients. Hear them, spend time with them, let them know that you care. Don’t hide behind a computer screen. Not only will you become a better physician, but those interactions will open new worlds to you and enrich your life in ways you cannot even imagine. That is the magic of medicine.

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