The Internist and Radiology

Abstract

NATURALLY, it is with a certain trepidation that an internist ventures to address such a scientific body as this, concerned, as it chiefly is, with a specialty far afield from the routine endeavors of the practitioner of medicine. The daily work of the medical man concerns itself much with roentgenology ; in fact, more and more continuously, but this contact between internist and radiologist is hazy and indefinite. It consists largely of the blind acceptance by the internist of the statements of the roentgenologist as to the proper diagnosis of films, and concerns itself not at all with thoughts of technic or details of method. It is for this reason, then, that I hesitate to venture to express to the members of an organization like the Radiological Society of North America my concepts and ideas about a highly specialized branch of medicine. On the other hand, because of this very fact—the high degree of specialization of your branch of medicine, together with the more or less isolation of the roentgenologic specialty, removed from close contact with medicine, as the internist views his profession—it might be well for me to discuss the limitations of roentgenology as they appear to the medical man as a diagnostic method solely, and dismiss from consideration any mention of radiotherapy. Bear in mind that the position of the roentgenologist in the world of medicine is rather anomalous. He is the only diagnostician in medicine who depends upon physical methods alone to gain his objective, in contrast to the man who must employ biologic and chemic, inductive and deductive measures in order to make an anatomic and functional diagnosis—an anatomic diagnosis which never attains the high degree of exactitude of that of the roentgenologist. He is the only diagnostician who depends solely on his eyes and does not have to call upon the auxiliary special senses, notably of touch and hearing. He is primarily a physicist, secondarily a physician, one who is by knowledge fitted to examine and to treat the sick. He is interested in the manifestation of disease as seen on a film and produced by physical methods, but not in the changes incident to disease that are observed and sensed when standing by the autopsy table. These observations are trite and obvious. They are, for the most part, recognized and appreciated by the body roentgenologic, but they are not taken into consideration by the medical profession, which everywhere seems willing to accept the word of the radiologist as dogma and proven fact. It seems to me that the share contributed by the roentgenologist toward furthering the misconception of the all-embracing authority of the roentgen film lies for the most part in his endeavor to make diagnoses, functional in character. The best example that we can mention is that observed in the usual report, such as is submitted after a complete gastrointestinal examination.