Radiologists Are Doctors Too: It’s OK to Act Like One

The post was contributed by Eric Callaghan, MD.

As a musculoskeletal radiologist, I’m accustomed to working with a variety of referring providers, but have increasingly found that my role as a subspecialized radiologist in the new health care paradigm is evolving. A recent phone call to one of our clinic’s pediatricians went something like this:

Me: “I’m looking at patient ___________’s films, and it looks like they have osteochondritis dissecans of the capitellum.”

Pediatrician:”Osteo-huh? Say that in English.”

Me: “Osteochondritis diseccans of the capitellum; it’s an abnormality at the elbow similar to what we see sometimes see in kids’ knees.”

Pediatrician: “Do they need to see ortho?”

Me: “Not acutely, but in follow-up, yes.”

Pediatrician: “Do they need to be immobilized?”

Me: “Not casted, but a sling should be fine for now until they see the orthopedist.”

I’m obviously not an orthopedic surgeon, and I don’t pretend to be one. But as specialized radiologists, we likely have more familiarity with some of the more uncommon entities than our primary care colleagues do, and we can provide valuable triage information for them. This can lead to less ‘urgent’ consults to our specialized orthopedists and more efficient use of everyone’s time.

That being said, no advice is better than bad advice, but if we are comfortable making accurate generalized recommendations for our primary care providers, it can lead to more efficient patient care and add value in the Imaging 3.0 model of care.

“Getting Personal” at A Patient-Doctor Symposium

This post was submitted by Alireza (Ali) Radmanesh, MD, Neuroradiology Fellow, University of California, San Francisco.

The 53rd annual meeting of the American Society of Neuroradiology (ASNR) experienced a unique emphasis on patient-doctor relationship and “getting personal.” Parallel symposia on brain tumor, head and neck cancer, traumatic brain injury, thyroid cancer, and cognitive decline hosted patients, surgeons, and radiologists among the audience and as speakers.

Laurie Loevner, MD, program chair and president-elect of ASNR, and the mastermind behind the patient-doctor symposia, described her opinion of this unique experience, “Such symposia help patients know what a radiologist does, and help radiologists to see what it is like to be a patient. A good relationship between radiologists and patients will not happen unless there is a great relationship between radiologists and clinicians.”

Greg Cantwell, an 8-year survivor of glioblastoma wished that his radiologist had been more accessible in his care. Beth Daley Ullem, mother to a child with Tetralogy of Fallot who also had a pregnancy complicated by uterine rupture, had noticed the lack of transparent data on safety and quality of physicians and medical centers. Chef Achatz, a successful restaurant owner, and survivor of stage IV tongue cancer, raised the issue of lack of a personalized approach in medicine that accounts for unique situations and priorities of different patients. Presence of patients’ families and support group representatives among the audience made it easy for all to “get personal.”

The ASNR experience, though initially as challenging as “selling an electric car to nonbelievers,” was undoubtedly a major success in the era of Imaging 3.0™ and precision medicine. Professional meetings provide great opportunities to mingle with the society we serve, and with the patients we sincerely care for.

Addressing the Flawed USPSTF Breast Cancer Screening Recommendations

This post was submitted by Murray Rebner, MD, FACR, immediate past-president of the Society of Breast Imaging (SBI).

As a breast imager, former president of SBI, husband of a breast cancer survivor and father of a 28 year-old daughter, the past two weeks have been tough. On April 20 the U.S. Preventive Services Task Force (USPSTF), lacking scientific justification, was at it again recommending less frequent mammograms for American women, even though experts continue to maintain that regular screenings should commence at age 40. It’s déjà vu all over again.

My biggest concerns are the recommendations’ coverage implications. Under the ACA, health insurers are only required to provide coverage for health exams and procedures when a “B” grade is given by the USPSTF. The Task Force gave a “C” to annual screenings for women between the ages of 40 and 49 and a “B” to biennial screenings for women over 50. This grading has serious ramifications.

Say a woman is in her 40s and her physician decides that an annual mammogram is necessary. Under the Task Force recommendations, a woman’s health insurer can deny coverage for her exam. Because of this, she may choose or be forced to forgo the mammogram.

National Cancer Institute data has shown that breast cancer deaths in the United States have dropped by 35 percent since mammography became widespread in the mid-1980s. On top of this, published analyses have shown that if screening frequency is based on the USPSTF recommendations, thousands of additional breast cancer deaths will occur each year.

Frustrated yet? What will frustrate you even more is the lack of a compelling rationale for their recommendation. It is based in large part on highly criticized studies which describe the short-term anxiety women experience when radiologists see something suspicious on their mammogram that ultimately turns out not to be cancer. Research has found that almost all women whose mammograms are not normal want to know their status even if it doesn’t turn out to be cancer.

The bottom line is, the Task Force made a subjective value judgment rather than relying on scientific evidence. This could have been remedied had their process included the participation of breast cancer or cancer screening experts.

Luckily, this health threat doesn’t have to stand. Health and Human Services Secretary Burwell can and should affirm that coverage of annual mammograms should not be affected by the Task Force’s recommendations. Longer term, the bipartisan legislation (H.R. 1151) introduced by Representatives Marsha Blackburn (R-TN) and Bobby Rush (D-IL) should be enacted. It would bring greater transparency, plus stronger expert and patient input to the USPSTF process, helping to safeguard against situations like this.

In all of my above-mentioned roles, being a husband and a father are the most important, and from that lens the issue is clear to me – if a woman chooses to have a mammogram, she should be able to get it at the age and frequency of her choosing, and her insurance should cover it.