Most physicians spend a lot of time improving their medical skills and tend not to know the distinctions between sales, marketing, and promotion within the larger multinational companies that dominate the ultrasound market.
I've met quite a few marketing executives over the years, many of them are admirable as individuals, but none of them has really understood physicians or our needs. A few of the sharper marketeers moving through the ultrasound realm during the last decade know this is true and they have focused much of their attention on technologists, whom they perceive as doing a lot of the exams and influencing purchases, although they are not responsible (legally or ethically) for the content of the exams themselves.
Medicine has been reinventing itself for the last few centuries. We are finally getting to understand the astoundingly complex nature of diseases as genetic pathways that are activated, blocked, subverted, or altered; new therapies are being devised based on the understanding of these pathways, and the relatively recent onset and progressive development of statistical methods are indicating what works diagnostically and how treatment should be started, bridging the divide between populations of people and the individual patient. There are also economic forces that have to be addressed when trying to provide optimal care for the entire population. I would assume that most physicians, like me, would say that middle of the road care for everyone is better than fabulous care for just a few, and that given time and a working system, mediocre will become uniformly excelllent.
Internal medicine may have begun as a specialty around the time and through the teachings of William Osler and his disciples. Osler mainly championed critical, scientific thinking, and a lot of skepticism, applied to the patient evaluation. Perhaps the main goal was to sift out from available information whether one was dealing with a systemic condition (i.e. involving an organ system and having consequences for the entire body) or something localized and hence the classic caricatures of the scholarly internest analyzing data (including drug responses) and the surgeon who fixes something physically and decisively.
Anyway, there is always that question that pervades every diagnostic patient encounter: is there an occult systemic process or is the problem localized. For a long time, there were few lab tests and limited imaging procedures. There was little or no preventive medicine, and common conditions were found late in their courses when little could be done. With the notable exception of screening chest films (once an integral part of every hospital admission for any cause), imaging studies tended to be restricted to limited questions.
We now have lots of very specific blood and body fluid lab tests, and, of course, everyone is tending to rely more and more on newer forms of imaging to do the traditional job of the Internest, determining what is going on inviolate deep inside the body. Ultrasound is often marketed in a disease-centric way, not as a general diagnostic tool. The consequence of this approach is that it emphasizes the older notion ofcofirming suspicions of advanced pathology rather than identifying earlyforms of disease without external signs.
Now here is the real issue: every radiologist no matter what the imaging task, labors under the worry about the basic question of systemic vs local disease. Sometimes, we have to accept the word of the referring physician that problems are just local (like a broken finger in a healthy person), but the basic diagnostic burden is still always there, whether we see the patient directly or work through agents like technologists or nurses. This is not a frivolous matter, because the Radiologist, like all other physicians, knows that if he misses any clue to a systemic or more immediately life endangering process, then that inattention will harm the patient. With experience, this burden becomes greater, and part of maturation as a physician is in coping with this responsibility in daily practice. It tends to make us a little humble to our patients (which doesn't mean loss of confidence, since it is essential to believe that you can help in order to do so), forgiving of each other, and, to be honest, somewhat arrogant towards those who are trying to sell us something who don't know about this aspect of our work.
It's a good idea to think of physicians that you are encountering in a business setting a little like talking to an armed FBI agent. That person demands a lot of respect and an understanding that they are not too far removed from life and death issues and apply a knowledge base and set of experiences that are appropriate to those tasks. You should, of course, try to involve imaging physicians as early in instrument development as possible, instead of at the end when your company is already committed to a specific type of implementation.Alternatively, you should think of the physician you are approaching exactly the way that you interact with your own physician.
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