Radiology Needs to Come Out of the Dark

Prior to starting residency, I was so enveloped in learning the scientific knowledge and book facts that I did not notice how much of medicine is social skill. As an intern in internal medicine, some days over 50% of my work seems like social work and the other 50% talking to consultants. Over the past few months, I’ve recognized how important it is to have a good relationship with specialists. I’ve also recognized the importance of developing trust with the patient and their family by engaging them, and how physical surroundings factor into both kinds of relationships.

The key to successful social spaces is a thoughtful structure that maximizes convenience, provides physical proximity, and channels emotional connection. Restaurants, cafes, malls, airports, and hotels all incorporate some component of social architecture in their design. These principles can also apply to hospitals in which we need spaces for family waiting areas, staff lounges, consultation rooms, cafeterias, etc. These are all places that people come together to discuss wellness and disease, and sometimes the most important conversations may occur outside the patient’s room.

One factor in particular that has disconnected radiologists from their clinical colleagues has been PACS. Electronic medical records and imaging have been a tremendous asset but also a double-edged sword. In the days when radiology consisted of physical films, the reading room was a hub of activity. It was a space for socializing, where general medicine doctors and doctors of all specialties would come visit radiologists and chat about patient cases; a physician’s lounge of sorts, alive with buzz and discussion.[[{"type":"media","view_mode":"media_crop","fid":"45702","attributes":{"alt":"radiology, come out of the dark","class":"media-image media-image-right","id":"media_crop_5555348526073","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5252","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":"height: 225px; width: 250px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"By Junzi Shi, MD","typeof":"foaf:Image"}}]]

Nowadays, the atmosphere of the reading room has completely changed. The use of filmless radiography has allowed much broader implications including digital enhancement, real-time distribution, and sending the image anywhere in the world. Better imaging has also contributed to increased utilization. For example, between 1998 and 2001, utilization per Medicare enrollee increased 16% per year for MR imaging and 7%–15% per year for CT, US, interventional radiology, and nuclear medicine. The pressures of sheer volume have pushed radiologists to work faster and read more images in the same amount of time have competed directly with face-to-face time spent with consultants and patients.

Overall, image-capturing technology has advanced by leaps and bounds. But the way we practice medicine - the way the patient interacts with the technology, and the way that we interact with patients - has fallen on the back burner. Physically, radiology has also been displaced into the far reaches of the hospital structure, shifted to the basement or consigned to a corner that is difficult to access. Part of this has been for practical reasons - shielding of radiation and magnets and access to power source. However, radiology has done itself a great disservice by opting out of the social engagement of medicine.

Radiology gets more consults than all of the other specialty services combined and is integral to many clinical activities, yet radiologists have allowed themselves to retreat into the darkness. I believe that there are many clinical, operational, informatics, and architectural remedies as we move forward in the 21^st century. I will be writing more about this topic in my next article.