Just recently I was discussing a particularly complex
case with a colleague from a nearby hospital. It was a gratifying telephone
call: full of friendly banter with a wide-ranging medical conversation.
Fortunately, I was able to offer help in the diagnostic chase. At the end of
the conversation he laughed and said, “You really are a renaissance radiologist”.
I took this as a compliment; I think it was
intended as such. Whatever his intention, it got me thinking. It is flattering
to be thought of as a radiological Renaissance Man. I’m not a polymath or even anything
close. But, like many others, I take pride in being a decent general
radiologist with varied subspecialist interests.
However, general radiologists have a bad rap these
days. Perhaps it is because, historically, mediocre radiologists simply called
themselves generalists. And it is true that, statistically speaking, 50% of
general radiologists are below average.
The age of sub-specialist radiology is in
ascendancy. Radiology is becoming more complex; it is difficult to be good at
everything. In fact, it is difficult not to sub-specialise to some degree.
Furthermore, endless journal articles tell us that sub-specialists outperform
generalists every time. In this age of credentialing and accreditation, you aren’t
cutting it unless you have an armful of sub-specialist badges. The generalists are
clearly the bumbling country bumpkins to the city-slicker sub-specialists. The
message is clear: generalist, bad; sub-specialist, good.
I’ve long had a problem with this. In fact, several
problems.
First and foremost, sub-specialists can be pretty
useless colleagues. The more sub-specialist they are, the more useless they
become. When a clinician asks for help, unless it concerns their particular
body part, they hold their hands up and claim ignorance. They aren’t any good
at clinical problem solving or thinking laterally. When a multi-system disorder
crops up, they are all at sea.
I once met an interventional radiologist who “didn’t
do CXRs anymore”. When a colleague starts down this road, the rot has truly set
in. When work is being distributed, they dodge their share of the grunt work,
claiming they are too specialized +/- deskilled. For similar reasons, they soon
‘have’ to stop doing general on-call and duck out of ‘duty radiologist’
sessions. Such behaviour is insidiously poisonous as it foments resentment.
Sub-specialists also tend to be either grumpy or
boring. Often both. They spend years honing their skills to exclusion of all
else, including abandoning all remaining social graces. When you hear of a notoriously
cantankerous radiologist, it is almost guaranteed that they are highly
sub-specialist. Sub-specialist radiologists are therefore like undescended
testicles; hard to find and when you do find them, they don’t work properly and
are often malignant.
This is even worse with groups of sub-specialists -
the problem is synergistically multiplied. Pure mono-specialist groups can set
new standards in irascibility; particularly in their downright rudeness to junior
doctors. This is probably why radiology departments of large teaching hospitals
tend to have a toxic reputation.
It isn’t just the individual radiologists. Sub-specialist
radiology itself is boring. Spending hours and hours looking at endless normal scans
of the same organ is skull-crunchingly dull. I can only look at 4-5 consecutive
CT colons before my frontal lobes melt and drain through my cribriform plate. I
look forward to my weekly ultrasound list, mainly for light relief away from a
PACS station, breaking up the working week. I also look forward to on-call where
at least some of the scans are abnormal.
I think this explains the career path of many radiologists.
They often weave through several sub-specialties, changing every 5-10 years due
to boredom. After a decade, you’ve been there, seen it all, done it all and
bought the t-shirt. You need to move on.
If you meet a subspecialist who has done the same
thing for 30 years, they are either an insufferable monomaniac bore or pretty
rubbish at what they do. The former tends to have a degree of autism; they may
be a good radiologist but people steer clear of them. The latter category has
become a subspecialist in name only; they’ve never really understood it well
but it is their least weak area.
I now unflinchingly describe myself as a ‘renaissance
radiologist’ – I love the concept. It fuses some of the detailed skills and
knowledge of a subspecialist with the breadth and flexibility of a generalist. You
have great clinical utility and none of the stigma. The variety is endlessly fascinating
and intellectually challenging. And if, like me, you are mid-career then you
need work that continues to inspire you. At the very least this gives you a
good reason to get out of bed in the morning, other than to pay the mortgage.
