Why radiologists need to care

Abstract

In his 2012 book, ‘What Money Can’t Buy: the Moral Limits of Markets’, Michael Sandel argues that we are shifting from a market economy to a market society, in which the market is seen as the best way to understand every facet of human life [1]. Everything we think, say and do can be viewed in monetary terms, assigned a price, and bought and sold. We have progressed so far down the path to becoming a market society that many radiologists might take it more or less for granted that the time and attention of a radiologist is a fungible – and expensive – commodity that should not be squandered. This market view of radiology is reflected in many aspects of contemporary radiology practice. For example, the productivity of radiologists is measured in economic units (relative value units) that favor procedures over so-called ‘cognitive’ activities such as speaking with patients [101]; reading rooms are designed to minimize ‘interruptions’, such as face-to-face interactions with referring physicians [102]; and radiologists are kept at more than arm’s length from patients, whose concerns and questions might significantly compromise the efficiency with which they work. Sandel describes such economic hegemony as a form of ‘corruption’, by which he means that some aspects of human life are distorted and debased by being treated as commodities. An obvious example would be children; how much would we take for our firstborn? The problem with such a question is that it asks an economic question about an inherently noneconomic reality, something whose worth cannot be expressed in dollars and cents. If medicine is not really a profession, but just another way of exchanging money for service in a market economy, in which free and rational people should be willing to provide and purchase whatever they choose so long as they can agree on a price, then Sandel’s perspective offers little in the way of insight. But if, on the contrary, there are aspects of excellence in medicine that cannot be described, accounted for and prioritized in economic terms, then medicine, and by extension radiology, must continue to be regarded as a profession whose purpose is not merely economic. We believe that medicine is an inherently professional – as opposed to merely economic – endeavor, and that all physicians, especially radiologists, must continue to serve as advocates for the importance of noneconomic purposes in their work. Patients are not merely healthcare payers, but suffering human beings who need to be able to trust that their doctor is doing what is best for them, even when it redounds to the economic detriment of the medical practice and hospital. Likewise, physicians are professionals, who put the needs of patients ahead of money making. Consider the following example. An elderly gentleman with a history of prior therapy for prostate carcinoma presents for retroperitoneal lymph node biopsy. A radiology resident is tasked with interviewing the patient, explaining the procedure and obtaining the patient’s informed consent. From an economic point of view, informed consent is important, partly because failing to obtain it could subject the resident and attending physician to penalties such as loss of hospital privileges, and partly because it provides important protection from a lawsuit in the event of an adverse outcome [103]. There is another important economic consideration. A radiologist’s time is precious. Every Why radiologists need to care