Tried, Judged, and Condemned

On another medical website I frequent, a clinician raised the subject of preliminary radiology reads. Specifically, allegations of a situation in which a hospital (maybe more than one) would have studies interpreted overseas, with final reports being generated by local, on-staff radiologists the next morning. The overseas individuals were described as having no local license, and maybe lacking other credentials of import.

As you might imagine, something of a firestorm ensued. Physicians from multiple specialties (including radiology, of course) asked questions, offered their personal experiences with offsite reads (preliminary and final), and made conjecture about what might be going on in the alleged circumstances.

It didn't take long to see that the majority of those contributing had their minds made up, and not just about the specific allegation - which remained conspicuously nebulous, as the clinician who originally brought it up refused to specify things like the hospital in question, the offshoring radiological entity, etc. Even some of those asking questions seemed to be doing so in pursuit of conclusions they had already reached.

You've surely heard some of these before:

Radiologists who farm out their night and/or weekend work are lazy and deserve to be supplanted.

Doesn't matter if the radiologists in question are a small group covering hectic medical centers, especially in undesirable locations where you couldn't entice a new hire if your life depended on it. Doesn't matter if they have been covering q3 for decades and actually want to have lives outside of their workplaces.

Radiologists enjoy cushy 9-to-5 schedules and fail to provide 24-7-365 coverage like “real” physicians.

Doesn't matter that full-time rads haven't routinely had such limited hours for years, at least not if they've wanted to keep their jobs and/or minimize annual hits to their compensation. Doesn't matter that covering call for a radiologist means working a full shift - rather than call coverage for most clinicians, which means carrying a pager or cell phone and hoping it doesn't ring.

Doctors are paid too much, and they are why our health care system is so expensive.

Doesn't matter that physician compensation accounts for less than 10 percent of our health care costs (Check out this item if you'd like to see how we stack up against other countries). Doesn't matter that physician payment is the only element that gets targeted every year while the rest of our bloated system trucks right along.

Notice what these have in common? They are oft-repeated stories that resonate well with people outside of and unfamiliar with the situations in question. That is, uninformed (or at least, incompletely-informed) people telling other (often equally uninformed) people their view of the world. To say nothing of those who are actually informed, yet have an axe to grind by selling their stories.

As frustrating as it is to try educating these folks (often your best possible outcome is agreeing to disagree with them), it's downright baffling when you find yourself locking horns with one who's personally fought such battles over his/her own turf, and should know better. For instance, a radiologist who will gravely commiserate about how other physicians mischaracterize your shared specialty, but proceed to malign your group's business model. Or a pulmonologist who shares your frustration about medicine's mistreatment by the federal government but then goes on to tell you why your specialty needs to be further defunded to prevent cuts to his own.

If you want to debate the veracity of these tales with their tellers, you've got a major uphill battle, akin to scaling a sheer cliff. Sometimes you'll even catch them proudly telling you that they know what they know and nothing you can say will change their mind - which at least saves you the time and effort of trying. More frequently, you slog through the pretense of dispelling each of their fictions, and watch them gradually get more frustrated until their logical ammunition is used up. Personal attacks are often their next recourse.