The first proposition is pretty direct for image forming rather than its inseparable companion, image interpretation. I'm never surprised at how many of the people I know in the various disciplines of medical imaging identify their hobby as photography. And, to be sure, the mandatory exposure of residents in Diagnostic Radiology exposes them to a graduate level education in the tech of photography that goes far beyond what the vast majority of professional photographers see or get. Is there really a difference between sunlight or gamma ray photon and phonon photography at a conceptual level?
I hope you will all visit my light photography website and enjoy the various topic galleries at Visual Jason Photography.
I believe the second notion was one that my good friend Dr George Flinn in Tennessee expressed when I started in private practice at the end of 1988 after 20 years in big hospital/academia, where, also, patients tend to have no (or not offered any alternatives) in where they have their imaging studies.The main Harvard associated hospitals never send patients for imaging studies to each other, and there is no phrase in the local language for even expressing the idea of having imaging studies at any of the Tufts or Boston University locations. Perhaps that failure to share resources has something to do local pride of excellence. The situation is much worse in Chicago, where for many years the larger hospitals have formed hospital networks that don't recognize each other's existence, which, from my personal opinion is motivated by economic factors primarily.
From the standpoint of the free standing clinic, what the referring physician gets is a report of the patient's visit. That needs to be coherent, complete, and accurate as well as prepared and sent promptly. We can assume that when there is an urgent issue, the physician involved with an individual exam will contact the referring physician directly. Most of the time the report is e-mailed, faxed, or sent by conventional mail. The referring physician typically has none of the options for reviewing images directly with a Radiologist when everyone is rounding in the same location. For the time being, we will concentrate on the way things have been done for the last 50 years and reserve discussion of some of the free web based PACS systems that are available to private practice Radiologists for a later posting.
What George realized and had been doing in his own practice was a novel way of placing images directly on the reports. What the referring physician needs is to know the interpretation of the Radiologist for the exam, does it answer the clinical question, if not, what should be done next. Placing images on the report is a way of validating the interpretation and expressing visually how an interpretation was made. It also illustrates that the interpretation was made from technically satisfactory images (which has always been a major issue in ultrasound). It is not the images themselves that are important, but what they represent. A report with great images conveys the professionalism of the center doing the study, which is a marketing function when there are multiple locations that appear to provide the same service for patients.
Our own little contribution to this was the thought that when a referring physician sits down to go through all the reports filtering in for their patients, especially those with lesser problems, it may be a little tricky to remember who's who. So, what we do and have done for most of the time we have been in private practice is to photo-identify all of our reports with a closeup of the patient in the upper right hand corner of the report, near the patient's name and identifiers.
21st March, 2011. T, Moon (11-2146)
Formatting is trivial with a word processor, but you get the idea. About 1 in 12,500 patients will decline the photo-op, which is their privilege. Everyone else likes it, especially my referring physicians, and I find that it helps me to get back into a case whenever a patient returns for more scanning. Like most Radiologists, I'm primarily visual. The picture above, was made with the same camera that we use for patient photos with some contrast enhancement for impact. Any digital point and click will work well for this application, especially since there is no need for enlargements.Of course no one gets to see those photos who is not designated to receive the report.
I think I saw a short paper in a recent JACR about some clinic at the Massachusetts General Hospital photo-identifying patient reports. Nice innovation, MGH, although about 20 years behind the curve.
THIS IS AN E-MAIL I RECEIVED FROM MY DEAR, OLD FRIEND PROF.DR RAINER OTTO IN ZURICH, SWITZERLAND. HE IS ONE OF THE BEST AND MOST RESPECTED RADIOLOGISTS IN EUROPE, A WORLD AUTHORITY ON ULTRASOUND GUIDED NEEDLE PROCEDURES, AND VERY WELL KNOWN FOR HIS MANY YEARS OF RESEARCH, PRACTICE, AND TEACHING IN BREAST IMAGING.
ReplyDeleteDear Jason,
thank you very much for your e-mail letter and the long and very interesting paper. Many ideas I share with you. For me here in Switzerland the most important ultrasound problem is education. Surgeons do sonography themselves "only for emergency cases" after having done 100 examinations under survey of some expert, general practitioners do 200 patients under control and then they are permitted to continue on their own, radiologists have to do 1 000 patients before their certification. But in reality experience grows after the first 10 000 patients, as you and I know. Your case of sickle cell anemia is typically a situation, where one needs quite a good knowledge of internal medicine.
In Europe normally a physician performes ultrasound, which surprisingly was not the case ealier in the USA. Technicians, however, sometimes can be very good, at least when they become aware during the ultrasound examination, that something is wrong and they have to call their medical senior.
And you are right, sonography permits us to check the whole patient, as we are able to discuss his problems during the procedure. Moreover, in 70 - 90% of the cases it is the patient himself, who tells us already his diagnosis, respectively the essential details, which brings us on the right track. In our hospital in Baden ultrasound often is the first examination on admission of the patient, which is due to the fact that an experienced senior colleague first of all looks at the patient while doing the sonography at the same time. And how do we explain the adequate sequence of (more expensive) examinations to our clinical staff ? Prof. Donner, ancient head of the x-ray department at Johns Hopkins, originally from Saxonia/Germany - you might remember the name -, he always sent a senior radiologist of his team to follow the wardrounds; so this experienced radiologist was able to propose his colleagues the fastest and most efficient way to find the diagnosis.
What ultrasound suffers from since its very beginning is the fact, that this imaging revolution appeared slowly, calme - no Nobel Prize ever, no big bang, visible for the public and - longtime - no serious control of the qualitiy of users (and technique?), at least for many years. What did we glorify CT or MRI instead ! And sonography was and is still too cheap ("not worth while", people say sometimes. On the contrary, when we perform interventions like drainages of abscesses, sometimes, quite of sudden, we are "heroes" in the eyes of our patients.
And even our private radiologists prefer to order different MRI knee or brain examinations by their technicians instead of one ultrasound examination, which they would be urged to work out themselves, at least so in Europe).
Concerning the question of portraits this would be a very good idea. However, in our country people are skeptical concerning data privacy protection. I think we would need a long period of positive propaganda, before this action could start.
Last not least advertising an institution or a personality in medicine. This deplorable custom takes hold more and more in Europe as well. However, the more important advertisement is pushed by somebody or institution, the more second thoughts we have.....
These are some ideas, which just came over me, when reading your paper. What did Cicero say : "...o tempora, o mores !.."- no dramatic change since ancient Rome ?
Kind regards
Rainer