THE MEDICAL PHYSICS CONSULT

MAHADEVAPPA MAHESH, MS, PhD RICHARD L. MORIN, PhD

Medical Physics and Communication: Cool Hand Luke? Richard L. Morin, PhD Question: Why can’t my medical physicist just answer my bloody question? Answer: It’s complicated. Although it might seem that a medical physicist responds with a great deal of detailed information when all you want is a single number, or a yes or a no, there are reasons why this occurs. First of all, the training backgrounds for physicians and medical physicists are quite different. Medical physicists come from an academic structure and training, centered on details and quantitative responses. However, those details are often not memorized but calculated or estimated on the fly as they are needed to respond to questions. This is quite different from the training background that requires detailed memorization of anatomy or syndromes or differential diagnoses. This difference in training does not become apparent for medical physicists who are solely in scientific teaching environments or research environments. It becomes apparent, however, in clinical environments. In this setting, clinicians, both radiologists and nonradiologists, often wish for a single, concise, quick answer to a question that could be very complicated, such as the risk for cancer from a CT examination. Within the medical-physics community, it became quite apparent to examiners at the oral boards that this communication challenge was

very often due to a lack of clinical experience. It is not uncommon that communication ability is developed early in a career, as a junior medical physicist. Interestingly, the discussions that followed led to the creation of medical physics residency programs. Physicists, during their residencies, acquire the skills necessary to communicate with colleagues, similar to what occurs in other medical residencies. This was felt to be so important that at the urging of the Board of Directors of the American Association of Physicists in Medicine, the Board of Trustees of the ABR has now implemented a policy that a medical physicist must complete a medical physics residency program to be eligible for the oral examination in medical physics (ie, therapeutic medical physics, diagnostic medical physics, or nuclear medical physics). This distinction between explanations in detail and bottom-line, several-word answers is not a situation found just in radiology. Medical physicists in clinical environments see the same interactions occur with physicians outside radiology and radiation oncology, as well as with the press and the general public. As an example, a few years ago, a medical physicist addressed a major cardiology meeting, discussing the risks involved in medical imaging. The strongest point of the lecture was that there is no one number that answers this question of risk and

that the process is complicated. At best, particularly for an individual, the only solid recommendation is the relative comparison with other risks found in everyday living. The happy medical physicist descended the podium after a panel discussion and immediately was joined by 4 cardiologists. After a couple of questions regarding the lecture, a cardiologist took the medical physicist aside and asked silently, almost whispering, “Really, what is the effective dose for CT cardiac angiography, and what is the risk?” This is not a situation that is limited to radiology or medicine. In fact, to a certain extent, it can be described as cultural. International businesses have faced these kinds of communication issues for decades. Very often, Americans are viewed as aggressive, bottomline oriented, wanting the final answer, and wanting it now. Some other cultures are often viewed as more accommodating, willing to listen to the variety of possibilities, and wanting the opportunity to make their own decisions. With the advent of a residency becoming necessary to attain board certification in medical physics, there is hope that the future will not have as many failures to communicate as the past has had. So this begs the question: When will this problem be solved? The answer may well be 2024eor perhaps never.

Richard L. Morin, PhD, Mayo Clinic, Department of Radiology, 4500 San Pablo Rd, Jacksonville, FL 32224.; e-mail: morin@ mayo.edu.

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ª 2014 American College of Radiology 1546-1440/14/$36.00  http://dx.doi.org/10.1016/j.jacr.2014.07.016

Medical physics and communication: Cool Hand Luke?

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