Radiologist's Blog

Of all the things in life, it is the uncertainty of the future that is the most perplexing to the human beings. We try to gauge the future though scientific and non-scientific means and hedge our forecasts using the terms probability or likelihood or some other jargon. Still, it is the wait that gnaws our heart, doesn’t let us sleep peacefully and makes us prone to panic attacks.

 

As Radiologists we are the masters of forecasting. A look at a scan and we decide how much longer a person may live, whether he can be cured or what are his chances of having a normal life. We use our imperfect knowledge and imperfect tests to determine someone’s fate. But imperfect tests are all we have, however might a layperson clamor for simple yes-no answers from us.

 

So often the anticipation of joy turns into fear of unknown, because of our imperfect ways to predict future.

Raju: Wow, look how time flies... Just yesterday we had joined radiology PG and now we are just about to finish the residency. Hey guys, what are your future plans?

Farhan:   Man, I think Radiology future is in the dark … Why did I do radiology in the first place beats me. I was ranked 7^th in PG entrance exam, I could have chosen any medical field… I think I made a big mistake….

Raju: Are you nuts? Radiology is the coolest, the most glamorous branch. Some people pay 2 crores for a radiology PG. Where else would you get to sit in an AC room throughout the day in this hot weather? All we have to do is write a bunch of reports and then we are free. To tell you frankly the reporting isn’t that boring, you do get to see interesting cases once in a while. Like today we saw a case of KLMNO disease…What do you say Rancho?

Rancho: All is well, all is well….

 

 

It starts with a phone call

 

Doc, we want to get a pregnancy scan. Do you do it?

Yes, we do ultrasounds. Its our specialty…

 

Good, but we need to do it fast, cos’ we have a flight to catch.

Let me see what I can do, my schedule is a bit busy right now. You will have to wait a bit. Or you can take another appointment…

 

No it’s URGENT.. we need to get it done right away. You see we are going to America. We need to get these tests done before we leave.

Okay, let’s see… Yes I think I can squeeze you between two of the appointments. But you need to come with in 15 minutes.

No problem…

 

Two hours later, a couple turns up at reception...

The practice of fee-sharing or cut practice is regularly condemned by the medical fraternity and general public.  Patients are waking up to this reality, making it one of the major reasons of declining doctor-patient relationship. Almost every discussion about cut practice results in loud cries of moral indignation. Despite this, such practices flourish and have now enveloped much of the modern medical practice.

Forms of Cut Practice

We radiologists tend to think that we are the most affected by this ‘affliction’ but it is much more diffuse and pervasive in the medical field. It takes many forms (1):

• Giving a share of fees to the referring doctor.
• Referring patients for unnecessary consultations or tests to ensure a kickback from the consultant or laboratory.
• Giving expensive gifts periodically to the referring doctor.
• Appointing junior specialists to a super specialty hospital so that procedural work is always referred by them to you.
• Unnecessary admissions in nursing homes/hospitals.
• Sponsoring of a conference or payment of travel expenses by a company in return for the use of its equipment or prescription of its drugs.

 

“Look at the crowd at the bar” my wife exclaimed.

 

My wife had accompanied me to an outstation academic conference for Radiologists. While I attended the conference hoping to learn any new trick, my wife, who is not a doctor, spent her day time shopping and visiting our relatives in that city. We were attending the post conference dinner that night and she had just witnessed the mad rush to bar counter as soon as it opened.

 

“Er, would you like a drink? I could use one myself.” I said.

“Excuse me Superman, but how are you going to beat that crowd and get us a drink?”

“Madam, could I have your permission to try?”

“Jao, Vijayee bhava ! ”

 

After a long time, I returned victorious with two half glasses of mediocre quality beverages, having spoilt my shirt in the process of elbowing and jostling through the crowd.

Complaints about hard work, long hours, low pay and uncertain tenure are the norm amongst Radiologists. The special role a radiologist plays in patient management is discussed ad nauseum from radiologist’s side, but it is a moot point. The question is how other specialists or hospital management perceive a radiologist’s work? Do they think radiologists are valuable team members or just bright technicians? In a bigger picture, how does general public see the role of radiologist in their welfare?

In a free market, the price of a radiologist’s (or any professional’s) services is– whatever a service seeker is willing to pay, which can be a hospital, diagnostic center or a patient. The price is determined by market forces, mainly supply-demand curve and hardly depends on a person’s skill profile as a group.

For example in a region which demands radiology services but has no radiologist for 200 kms, even a bad radiologist can get a premium price for his services. On the other hand a really good radiologist in a big metro may find job seeking very competitive because of many available candidates. So the way to get a job is to ask for lower wages or take up a job which offers lower wages. Since by and large radiologists have similar skill sets, they earn almost the same amount amongst their peer group in a particular region. Only a few exceptional ones can buck these norms.