An Open Letter to Radiologists

Abstract

The cornerstone of modern medical care is correct diagnosis, and the keystone of correct diagnosis is competent radiology. Competent radiology requires that there be adequate numbers of trained radiologists available both for patients outside hospitals and patients inside hospitals. As far as outside patients are concerned, there are fortunately hundreds of well trained conscientious radiologists in private practice who are doing good work and, as far as can now be told, will continue to do good independent American medical work in the future. When we turn to the hospital situation the picture is somewhat different. There are hundreds of competent radiologists in American hospitals today, but many of them are not conducting their own practices. They have not the right to decide who shall be appointed as technicians and nurses in their departments, they cannot always decide the kind of equipment with which they must operate, and often they cannot decide the extent of the services which they believe they should render to patients, or the fees they should charge for those services. In other words, the departments of radiology are no longer under the direction of the radiologist in many hospitals—they are under the direction of the hospital superintendent. If this were just a matter of fees or financial reward it might, with the altruistic traditions of the medical profession, well be overlooked. Obviously, however, it goes beyond that. He who pays the piper calls the tune. Precedents created today, especially in connection with group hospitalization insurance, may be frozen into our medical picture tomorrow. What then should we do? The first and foremost obligation of every hospital radiologist is to do good medical work and to see that in every manner possible he keeps radiology identified as a medical specialty, as a branch of medicine and not as a branch of hospital work. He should pay as much attention to the organization side of his department as he does to the scientific side. If he is indifferent, or too busy, or too lazy to attend to the organization side, he will find that in the eyes of the average layman, the average hospital superintendent, yes and even in the eyes of doctors, he is not in charge of his own department. More and more laymen and physicians are coming to regard radiology as a part of hospital service and not medical care. This is largely our own fault. (We are referring not to one or two large research or diagnostic clinics, but the average private hospital throughout the land.) Again we ask what should be done about it? We would suggest that, for the sake of the scientific future of radiology in hospitals, as well as for the sake of the rights of the rest of our profession, we should not consent to the inclusion of our services in any formally organized hospital insurance scheme. This will require courageous action and constant vigilance.