Defining—and dealing with—radiology’s personality problem

Cultivating physician character in an increasingly tech-centered environment can be difficult for radiologists who are often isolated in their work, but in a medical landscape where quality patient care is key, imagers may need to venture outside of their comfort zone, a trio of Emory University radiologists wrote in Academic Radiology this May.

“In the contemporary environment of patient- and value-centered care, it is no longer sufficient to limit the definition of an ‘excellent radiologist’ to someone who is skilled at image interpretation,” first author Keith D. Herr, MD, and co-authors wrote. “As the field of diagnostic radiology struggles to understand what this new mandate requires of its practitioners, it represents not only a challenge but also an opportunity to refine the role of the diagnostic radiologist as a physician primarily in the business of caring for patients.”

It’s an identity radiologists continue to move farther away from with the rise of advanced medical technology, Herr et al. said, since those digital capabilities have allowed physicians to work more efficiently, more productively and, often, more remotely. Diagnostic radiology has made leaps in establishing itself as a legitimate specialty—but since radiologists are concerned primarily with image interpretation, they’ve stepped away from the front lines of patient interaction.

“In other words, the mechanized and increasingly siloed nature of the job makes diagnostic radiologists prone to physician character erosion through missed opportunities for virtuous caring and professionalism with other care providers,” Herr and colleagues said.

Basing their work around the moral intuitionist paradigm of physician character development—or the idea that a doctor’s character can be built through experiences that amplify and trigger their caring instincts—Herr and his team at Emory outlined several ways radiologists can step out of the reading room and into a patient-centered environment.

One of the greatest barriers to creating high-quality patient care in radiology is the fact that radiologists are often “invisible,” the authors wrote, both to their patients and to referring providers. Radiologists lost their shot at fostering a personal relationship with a patient when they removed themselves from the actual imaging process, and systems like PACS have made communicating study results to referring providers almost robotic.

“Relative isolation from patients is a reality in diagnostic radiology, and without faces to see and bodies to touch, opportunities for providing virtuous caring are few and come with the price of time away from the work list,” Herr et al. wrote. “The more disconnected diagnostic radiologists become from their patients, the greater the capacity is to dehumanize them.”

And the more disconnected they are from their medical colleagues, the authors said, the more they foster interdisciplinary xenophobia. That might not fall solely on radiologists’ shoulders, though, since productivity is emphasized in radiology to the point where patient and colleague interaction comes second to completing work in a timely manner.

Herr and colleagues said even small alterations in a radiologist’s day-to-day routine could make them more visible in the hospital setting. The team suggested taking opportunities like IV placement or the informed consent process to sit down, connect and empathize with patients, and said something as minor as changing their path to the reading room to cut through a waiting area could increase their visibility.

Scheduling strategic, in-depth meetings with colleagues at their care center could also help, the authors wrote, as could calling a referring provider with results rather than communicating them digitally. Role-modeling caring, professional, human behavior for younger physicians can have a profound impact, too, they said, as could easing up on tight standards and admitting to inevitable mistakes.

“In diagnostic radiology, errors are laid out in black and white for all to see,” Herr and co-authors wrote. “Occasions to acknowledge the limitations in our own knowledge are plentiful in the reading room. Every day we can turn to a trainee, a colleague or even ourselves and humbly, but unapologetically, announce, ‘I don’t know.’”

At the core, the authors said, it’s important for radiologists to humanize and define themselves as physicians separate from their intricate, technological work.

“Ongoing technological and healthcare policy factors have had the effect of isolating diagnostic radiologists from both patients and clinician-providers,” they wrote. “This siloing effect deprives diagnostic radiologists of opportunities to cultivate character and, therefore, adversely affects radiologists’ potential to provide virtuous care, demonstrate collaborative professional behavior and actualize the broader definition of an excellent physician.”