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Ep. 62 Radiology Makeover, with Saurabh Jha

Saurabh Jha, MBBS

Radiology holds a special place in the medical ecosystem.  Radiologists are “the doctors’ doctors” and the treatment of a patient rarely proceeds without a radiologist furnishing an opinion.  But the field of radiology also faces challenges: the crusade against “wasted imaging,” the rise of artificial intelligence, the dependence of radiology on hospital systems, and the de facto barrier that separates  radiologists from patients.

What does the future hold for radiology and what could one wish for it? Returning to the show is Dr. Saurabh Jha, Associate Professor of Radiology at University of Pennsylvania Perelman School of Medicine.  He shares his perspective with his characteristic wit and humor.

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2 Comments

  1. Anthony Sajewicz, MD on 02/14/2019 at 7:04 PM

    Michel,
    Sorry it took me so long to comment. Here are my thoughts.
    I remember as a medical student, a senior resident once told me that if the test you want to order won’t change the diagnosis, prognosis or management, then you shouldn’t order the test. I thought this was excellent advice at the time and remember questioning one of my attendings about getting an MRI for a patient where it didn’t seem like anything would change as far as her treatment or help the patient in any way; and her response was she wanted to get the MRI for completeness. Now if you fast forward to my radiology residency a few years, I clearly remember the radiology department serving as a “gate keeper” of sorts for all higher-level imaging services such as CT or MRI. The medical teams would come to the department and discuss the patient’s condition and ask our advice about what test to order and if it would be helpful. We would have a thoughtful discussion and possibly recommend something or not recommend anything at all. The test wouldn’t get approved by us unless we thought it would be helpful in some way. Many test were denied; some were changed to alternate imaging modalities. We clearly were acting as the patient advocate and the consultant to non-imaging physicians and it seemed like the system worked pretty well. I don’t think any of my radiology attending’s minded serving as gatekeeper, in fact I believe they thought it was their duty to be this gate keeper type physician. Now mind you, this all occurred in an academic setting which is logistically much easier …

  2. Anthony Sajewcz, MD on 02/14/2019 at 7:12 PM

    part2
    whereas in the outpatient setting where multiple different physicians are ordering studies to be performed without having hey particular discussion about the patient, seems like an insurmountable task. Approximately one year later in my residency, the hospital system started order entry/EMR. Providers no longer needed to get approval for studies and the volume of radiologic exams skyrocketed. Who knows if this plethora of imaging actually did any good and we can certainly surmise that we probably did some harm by finding and working up incidentalomas that really didn’t need to happen. So, I do think radiologists can serve as a gatekeeper (I still do at times) and that this would certainly benefit patients and medicine in general, however I’m not sure all radiologists would like to be put in this sort of position.

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