Recapturing the Centerrecapturing the center

Over the past 115 years, radiologists have been blessed by the technological advances of our specialty. In each new era of health-care delivery, some new technology has captured the hearts and minds of physicians and patients.

Our reliance on that technical propagation has, in part, contributed to a sense that radiology and radiologists are in such a central position because that is the natural order of health-care evolution. In today's world, no one would argue that excellence health care could be delivered without imaging.

However, storm clouds that were on the horizon are now directly overhead. Health-care expenditures have reached an unsustainable percentage of the national gross domestic product; new payment systems are being implemented; the National Cancer Institute is proposing a consolidation of collaborative research programs; and proof of competence, proof of outcomes, and value-oriented medicine are being demanded across the board by society.

Despite this seemingly unfavorable climate, there is little debate that imaging will maintain a central and indispensable role in future health-care delivery. Scientific progress will not abate, and future generations will experience personalized medicine, genomic molecular imaging, and personal biomarkers to predict risk of disease and response to treatment. The future of radiology will be secured by scientific and technological progress. The future of radiologists, however, will not be secure unless true added value is generated and proven.

Lest radiologists become marginalized, we must think in new terms about our place in health-care delivery systems. I would advocate we create the concept of "radiology-centric medicine" as a means of recapturing and securing the center of the enterprise. A necessary component of radiology-centric medicine is "radiologist-centric medicine."

The future of radiology will be secured by scientific and technological progress. The future of radiologists, however, will not be secure unless true added value is generated and proven. 

If we continue to perpetuate behavior and practice patterns through which we are perceived as ancillary, we will never achieve our goal. Leaders in radiology have told us for decades that we need to emerge from our darkened reading rooms. That advice has never been more important than it is now.

With a grass-roots commitment to recapture the center, our collective, creative storehouse will be able to produce a broad array of concepts that can be applied to the development of radiologist-centric medicine. The spectrum of these concepts should include practical applications of a renewed commitment to service, good citizenship, professionalism, introspection, and innovation. Longstanding models of practice business and staffing will need to be re-evaluated and revised to accommodate the process of recapturing the center.

In this issue of the ACR Bulletin, three such concepts are described. For decades, the traditional radiology reporting system involved a radiologist dictating a report, a report being transcribed, the radiologist checking the report for errors, and finally, a printed copy of the report being sent to the medical record and the referring physician. This process was progressively streamlined to the point where it became an extremely efficient component of the radiologist's workflow. However, depending on clerical resources, report distribution could be unduly delayed. The article on page 17, "Loud and Clear," discusses the advantages and challenges of voice-recognition reporting systems — a tool that clearly can facilitate the enhancement of radiologist-centric medicine by proclaiming that the interests of the patient, through immediate report availability, are of primary concern to the radiologists central to their care.

The article on page 11, "Right to Speak?" reinforces the radiologist-centric concept by exploring the process of radiologists delivering imaging results directly to patients. This would have been unacceptable to referring physicians 40 years ago, but their appreciation of radiologists' ability to interact directly with patients has evolved through the efforts of mammographers and interventional radiologists. Direct reporting to patients is another opportunity to create radiologist-centric medicine.

Imaging is also central and critical to the diagnosis and management of trauma. The article on page 14, "Tackling Trauma," discusses the need to effectively manage trauma through streamlined care. Here is another area in which the personal involvement of radiologists can solidify our role in radiologist-centric medicine. Stepping up in our role as true consultants and not mere followers of orders will enhance our stature in the minds of our medical colleagues and our patients.

The opportunities to create a brighter future for radiologists are there. It's up to each of us to use them.

BOC headshotBy John A. Patti, M.D., FACR
Chair, Board of Chancellors

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