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Oct 04
2010
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I read somewhere –“When in Rome, do as Romans do". If this was true, I would have become redundant as a Radiologist.
Libyan Radiology is a complete disaster.
The hospitals are well-equipped with latest diagnostic machines which are either out of order or not being used for lack of technicians or radiologists.
The surprising fact is that no Libyan radiologist performs Ultrasound examination or reports on conventional radiographs.
Everyone is busy reporting CTs or MRIs. And the reports can send any sane mind into turmoil!
The reports are not structured and very often are off the mark. They discuss about hypothetical diseases and tend to create an unusual disease manifestation. The reports would suggest the gravest disease when there none exists.
None of the Libyan radiologists’ are open to discussion. Flat answer is: “I have written in the report whatever was there to say. There is nothing more to add”.
What surprises me is the general curiosity of all physicians and surgeons to learn how to do Ultrasound. On the other hand, none of the radiologist has approached me to learn Ultrasound. They however come to learn CT scan and MRI reporting but no one shows any interest in Ultrasound. I am still searching for an explanation.
There is no didactic radiology teaching in this country. No structured or unstructured teaching program exists. The students are supposed to write the reports after consulting the radiology textbooks. And their lack of experience and knowledge reflects in the reports. To top it all, the reports written by the students are not even cross-checked for accuracy and language by anyone and delivered directly to the patients.
One can easily imagine the level of treatment delivered to the patients, as it is all based on the imaging results.
Unsurprisingly, often patients end up in a total mess up. Recently a patient was diagnosed as cancer of stomach on imaging and operated hastily by a renowned surgeon, as the label was ‘cancer’. To everyone’s surprise, the excised half of stomach did not show any cancer cells or even dysplasia on histopathology!!
Then the patient was referred to me for a repeat post-operative scan which showed the real cancer in 2nd and 3rd parts of duodenum. (See Figures 1,2,3).
Radiology in Libya is indeed amazing!
Obstetrical Ultrasounds are done by clinicians only. And they are not able to definitely determine the gender of the baby till it is born!!
Many pregnant women come to me asking me to tell them the gender of their baby so that they can think of the best names….and I learn from them that their obstetricians have kept them confused by telling them different gender on different occasions. I have developed kind of reputation (or ‘disreputation’ if we are in India) of sex determination in early second trimester!!
So if this is the case, what to talk about detecting congenital anomalies. And these are also detected post-natally. So there is no application of Fetal MRI or level II ultrasound for anomaly detection, whatsoever.
When none of the radiologists are doing Ultrasound, then one can easily conclude that no guided interventions are done by radiologists.
Such is the sad state of Radiology in Great Libya! Amazing indeed!!
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Reviewed by Anuj Mishra October 05, 2010
Reviewed by Dr. Sridhar V October 04, 2010
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Dr. Sridhar V
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... When I saw the Title I was so sure that You are going to talk of tourist attraction of Libya about Ghadames city,Jamahiriya Museum,Green square,Assai al-hamra,The arch of Marcus Aurelius etc and of your memories linked with these famous spots. Amazingly I grasped the finer aspects of radiology practice and how radiologists in Libya are limiting themselves to just CT and MRI and not bothered about the Great Ultrasound.Thank you for enriching our knowledge of radiology being practiced in Libya. It seems ultrasound is becoming more attractive to non radiologists than to the Radiologists, and radiologists really need not worry since they are famous for sacrifices and surrendering their various branches and sub specialties to others which is Radiologist's birth right. There were two interesting articles about non radiologists doing radiology work Imaging by non-radiologists drives up health care costs http://www.auntminnie.com/index.asp?Sec=nws&sub=rad&pag=dis&ItemId=56760 and Many radiology exams in Germany improperly performed http://www.auntminnie.com/default.asp?Sec=sup&Sub=ult&Pag=dis&ItemId=56602 Your observation that " The surprising fact is that no Libyan radiologist performs Ultrasound examination or reports on conventional radio-graphs." really takes the cake.I have a doubt. What is that Radiologists are taught in their training process in Libya ? Things have come to this level because Radiology is practiced surprisingly in a very funny way in different countries.Do not ask me why such things are allowed to happen. For example, In Germany, about 70% of imaging studies are done by non radiologists. In Austria and Switzerland Radiologists play a very limited role. In Italy, only ultrasound studies are performed by general physicians,( source: Sarah Jersild-Diagnostic Imaging ). In USA,Uk,Scandinavia and Estonia Radiographers perform ultrasound and Radiologists come into the picture only if there is an abnormality. In our own backyard universities are granting Ultrasound certificates to Bsc.graduates after 3 to 6 months of training.( non medicals) Younger generation of Radiologists shying away from ultrasound practice.May be it is question of time We reach Libyan and European standards. Whether it is radiologists doing radiology practice or Non radiologists doing radiology practice....Ultimately who is taking the responsibility of the plight of the patients ? Thanks again for this thought provoking article. |
Alok Varshney
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... Dr. Anuj, are most Libyan Radiologists working for the government? I suspect there isn't much competition amongst them. Is that so? |
Anuj Mishra
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... First and foremost, I must apologise for the delay due to my short vacation. Your knowledge of tourist attractions in Libys surprised me too Dr Sridhar. Have you worked here earlier? If yes, then you must have experienced radiology practice first hand. Its no different from that in most parts of India, or for that matter, rest of the world. In my short stint in Iceland, I learnt, to my surprise, that abdominal ultrasound can be segmented into 'organ' ultrasounds. Example, you can have a patient for liver ultrasound, or for renal ultrasound etc. etc. Does it make any sense? To me, it did'nt. In another example, radiologists in Germany would spend lots and lots of money, resources and time in order to characterize those subcentimeter liver focal lesions in a normal liver. Isn't this absurd? I feel Radiology is being misused to a larger extent than its appropriate use in proper clinical setting. We often come across request for brain CT and MRI in patient presenting with headache in our daily practice. Moreover, requests for abdominal ultrasound for all non-specific reasons are seen everyday. And a common question from patient is - "Do I have problem in my colon?". How should the sonographer answer to this. Maybe, just "I don't know" or "I can't tell" would ask for a grin from the patient as this thought crosses his mind -" Why the hell did he do my ultrasound for? Maybe he is not an expert!" There is an equal proportion of radiologists in private and public sector. Large number of them are expats. There is a tough competition amongst radiologists as patients carry scans for 2nd and sometimes 3rd opinion from different radiologists. there is a huge pressure on those who work with surgeons and trauma centres as the outcome of imaging is known immediately during surgery. I have not come across any radiologist working in a gynecology/obstetrics centre. |
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