Professionalism talks start meeting off right

I'm not sure why, but I think this year had the best opening day of any RSNA meeting I can remember. Maybe it's because the weather in Chicago was beautiful. Maybe getting lucky and picking up several nice Christmas presents for my family, in just a couple of hours of shopping, is the reason. Maybe the fact that I didn't party the night before is responsible.

But, probably, because the issues dealt with in Sunday morning's opening session are just really important to me, and they should be for all of us.

The session started with the customary dedication and awards, which are nice for the recipients and well deserved but not really worth the three-quarters of a tall coffee I had to throw away to walk into the auditorium. The annual RSNA business meeting concluded the session, attended primarily by members who had fallen asleep during the main talks.

The real meat of the program was a series of three talks on professionalism and quality, and they were excellent.

RSNA president Dr. Robert Hattery gave an insightful talk on professionalism. Dr. Stephen Swensen and Dr. Brent James then each gave a talk on quality. Swensen emphasized the practical business case for quality. James gave a wonderful talk on the new model of clinical medicine and the emerging definition of quality with a historical perspective. I, in very typical fashion, forgot my pen. Without notes, the three distinct talks are rapidly blending in my mind, like arterial and venous structures on a chest CT with respiratory motion.

I believe these talks are often reprinted in a subsequent issue of Radiology. If so, I recommend them to all radiologists.

Hattery emphasized the debt we owe to society for the privilege of practicing medicine. This is an age-old concept but one I've been wrestling with recently. For years, my group has run our nonprofit community hospital's radiology department for free. And, like every doctor on the staff, we serve on a variety of administrative committees, also for free. I have always seen this as part of our contribution to the community, our role as physicians.

I began to rethink this when I heard that our hospital board gave over a million dollars in bonuses to administrators based on their performance, much the way corporate America lavishly rewards itself for doing what it was hired to do in the first place. I agree with Hattery, we must act professionally, put our patients' needs first, and remember how lucky we are to be practicing radiology. But I'm not sure where the administrative duties fall.

Am I giving to the community, or am I doing work that puts bonus dollars in our hospital administrators' pockets? I like the concept of giving back to society. Donating my time so someone else can make a bigger paycheck does not appeal to me.

James discussed the evolving nature of medicine, moving from a cottage industry of individual practitioners doing the best they can for each of their patients to a team approach driven more by protocols. As one who entered medicine in the era of autonomy and individualism, I find it very hard and frustrating to give these things up. But, as Swensen clearly showed, if we are putting our patients first, we must move in this direction.

Radiology is too complex for any one person to master. At this level of complexity, human beings will make a predictable number of mistakes, and that number is too high. We must establish protocols and systems to raise the baseline level of our outcomes and then customize them for individual patients. This is easier said than done.

Last year, my group decided that our reports were too variable. We needed a more consistent format for our clinicians. We established a subcommittee, which spent a long time coming up with an optimal format. In the end, the majority of the group refused to accept the changes, out of fear that they would fail to recognize when someone else's report had been incorrectly typed over their signature. We're still working on this dilemma.

In the same vein, we have been working on standardized CT protocols for about two centuries. Everyone thinks their way is just a little better. Other industries have proven this wrong. Commercial airline pilots go by the book, or they don't fly. Saying "Sorry, but I did the best I could" is probably not going to work in medicine much longer.

Radiology and medicine are changing, which is always difficult. But today sure was a nice day to be in Chicago.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.