70

CORRESPONDENCE

acute anxiety state in the operator. T h u m p i n g the back, gentle reassurance and encouraging the patients to relax have resolved the matter in every instance. It is nonetheless very upsetting for all concerned. My immediate colleagues report similar experiences. It is now my practice to administer the product as a 'fizzing drink' when confronted with nervous or elderly patients, those with high dysphagia or possible aspiration problems. This has to date not produced any untoward problems. I wonder if this difficulty has been encountered by m a n y other radiologists? J. O. M. M I L L S

Department of Radiology Royal Victoria Hospital Belfast BT12 6BA

W H A T IS A R A D I O L O G I S T ?

SIR - The Editorial 'Should Radiologists Perform Gastrointestinal Endoscopy?' by Dr Bartram (1989), following Dr Simpkins (1988) one, ' W h a t use is Barium?', surely highlights the major predicament which faces radiologists today are we doctors or are we technicians? The question is not applicable solely to gastrointestinal radiology, but perhaps it was necessary for other clinical disciplines to strike at what was regarded as the sole province of the radiologist the gastrointestinal tract - for the words to be assembled, and the question finally asked what are we? W h a t is a radiologist? Perhaps the question could be refined further. W h a t do we do? W h a t do we want to do? W h a t should we be trained to do? Perhaps we should each be allowed to write our own job descriptions, amending them from time to time, as the mood takes us and fashions change, or our abilities alter? The very suggestion would surely give a manager a nightmare and we live in a world of managers, like it or no. At the other extreme is another equally easy and absurd answer - the speciality of radiology was established almost a hundred years ago, and it must never change. We will only do what our predecessors did 50 years ago or more. As we live in a constantly changing world, surely we must change too, if only to keep up, let alone get ahead? For m a x i m u m effect we should change as a group and travel cohesively in a defined, agreed and worthwhile direction 'the promised land'. W h a t will the promised land consist of and will it be worth struggling for? Are we all going to head for the same patch of the greenest grass? Are we agreed on our definition of 'green' and who is going to keep off the rustlers (i.e. the 'clinicians') who might perform some of our examinations while we are grazing. Could we enlist the help of Dr Roebuck's cowboys (College Newsletter, No. 22. Spring 1989 - Page 18) perhaps? Are W E not the clinicians, in that we supply clinical care to patients, and is not the grass green when we directly solve patients' problems? Doctors are people who solve other people's health problems. Technicians mind machines. If we move in the direction of instrumentation and machines we become technicians and the grass pales. If we move towards patients - real people the grass becomes greener, surely a better direction to head in? As Keith Simpson highlighted, the patient is our employer. Radiologists and radiology will flourish when they provide more patient care. If anyone comes into radiology to get away from direct patient care, then it is surely a move in the wrong direction. Radiology becomes respected when it is seen that the radiologist solves the patient's problem - not the machine, or the contrast medium, but the m a n or w o m a n who identifies what the patient's clinical problem is, and who uses his imaging or interventional skill to solve it. So how shall we set off on our journey? Recognition of the highly complicated state of medicine today is one of the first tasks - highlighted by Dr Carty in her Editorial 'Training in Paediatric Radiology' in Clinical Radiology (1989). We cannot possibly be specialists in everything and our training structure and educational provision m u s t recognise this. We must remember the other changes which are taking place in medicine - both in its clinical practice and in its management and be aware that the shape of radiology in the U K today is unique, having been allowed to flourish (is that the correct word?) by 40 years of luxurious National Health Service provision. Recognition that specialisation within radiology m u s t be planned is important; and post F R C R training m u s t be properly organised with a clear goal in mind. The need to concentrate and centralise expensive apparatus within hospitals is elegantly pointed out by Dr Bartram in his Editorial but

the implication that it m a y only be used by 'radiologists' rather than 'clinicians' is a non-sequitor. Expensive apparatus is provided for the solution of patients' problems and it must be used by the people best trained in its use. If these be the 'clinicians' referred to by Dr Bartram, so be it; but, if this happens, radiologists m u s t accept the 'second-class' citizenship which this implies. His point about 'not having time' to do everything is taken - but have we taken a hard look at some of the things that we do, with a view to making time? Have we considered the areas of clinical overlap within medicine where two doctors do work which could easily and properly be done by one o f them if he were fully trained to do so. Cardiology is one classic example - in how m a n y centres is excellent cardiology carried out without any involvement by a radiologist? This could also happen in gastro-enterology and in accident and emergency. The 6 hours certificate wished on us by the EEC m a y enable this to happen in a few years in gastro-enterology, whilst accident and emergency is becoming a recognised specialty in its own right, and in 3-4 years there will be sufficient fully-trained accident and emergency consultants around for it to be argued that the radiologist is redundant. He might miss the interest o f the medico-legal work it brings! Dr Bartram of course radiologists should do endoscopy - that is, some of them, when they've been trained to do so! A. E. H U G H

Department of Radiology North Staffordshire Royal Infirmary Hartshill Stoke-on-Trent ST4 7LN

References

Bartram, CI (1989). Should Radiologists perform gastrointestinal endoscopy Clinical Radiology, 40, 225-226. Carty, H (1989). Training in paediatric radiology. Clinical Radiology, 40, 227 228. Simpkins, K C (1989). W h a t use is barium? Clinical Radiology, 39, 469473.

BREAST S C O R I N G SYSTEM

SIR The Breast G r o u p at the Royal College of Radiologists (1989) attempt to standardise m a m m o g r a p h i c terminology perpetuates a myth about Smallwood et al.'s (1984) 5 point scoring scheme. The second highest point ( ÷ 1 ) should be 'probably malignant', not 'possibly malignant'. This is more than semantics. If a lesion is probably benign ( - 1), surely this means that it is possibly malignant. - -

G. R U B I N

Brighton General Hospital Elm Grove Brighton BN2 3EW

References

Breast G r o u p of the Royal College of Radiologists (1989). Radiological nomenclature in benign breast change. Clinical Radiology, 40, 374379. Smallwood, J, Khong, Y, Boyd, A, Guyer, P, Herbert, A, Cooke, T et al. (1984). Assessment of a scoring scheme for the pre-operative diagnosis of breast lumps. Annals of the Royal College of Surgeons of England, 66, 267 269.

SIR We thank Dr Rubin for his c o m m e n t on the 5 point scoring scheme of Smallwood et al. (1984). We use the words 'possibly' and 'probably' in a flexible m a n n e r to try and indicate to our clinical colleagues a level of certainty about the possibility of malignancy. However, if the score is - 1 this means we see no evidence of malignancy, although we acknowledge (as I am sure you appreciate) that malignancy m a y be present even though there is no positive m a m m o g r a p h i c evidence of this. -

P. B. G U Y E R

Department of Radiology Royal South Hants Hospital Southampton S09 4PE

What is a radiologist?

70 CORRESPONDENCE acute anxiety state in the operator. T h u m p i n g the back, gentle reassurance and encouraging the patients to relax have resol...
142KB Sizes 0 Downloads 0 Views