What lies behind the image was the topic of Professor Richard Gunderman's Annual Oration in Diagnostic Radiology at the RSNA 2012 Annual Meeting in Chicago. "The role of radiologists is almost oracular", he said, "We bridge the gap between the invisible and the visible. And, if we see what's only on the images, we miss what's behind the images", he said. Gunderman is Professor and Vice-Chair of Radiology, Professor Pediatrics, Professor Medical Education and Professor of Philosophy, Liberal Arts and Philanthropy at Indiana University.
Gunderman illuminated his point by telling the cautionary tale of two medical residents, who both did well, but only one of whom became a radiologist. During their training, they attended a session where a father of a neurologically devastated patient was talking about his experiences. Resident 1 was transfixed the whole time on the father's face as he told of his harrowing experiences, and was moved to tears by what the man said. Resident 2, sitting in the front row, soon decided that this was not going to be in the next exam, so plugged in his headphones and revised for the exam. Guess which one became the radiologist?
Gunderman also told the story behind the image of a patient he scanned, an 89 year old man with a history of dementia and multiple falls, presenting with a new head trauma. Gunderman did his job, described the findings, then moved on to the next case. But he missed something: this gentleman was the Nobel prize winner Dr. Charles Huggins who was awarded the prize for his discoveries concerning hormonal treatment of prostatic cancer.
"How many titles do you have on your business card, what rung on the organisation chart are you, what's the ribbon count on your RSNA badge?" he asked. This is the path to perdition. Radiologists can get the technical aspects right, but miss what matters most. Radiologists have developed a perfect industrial model but have laid waste to the humanity of radiologists and patients.
"We need to focus more time and attention on the human excellence of radiologists", Gunderman said. "Technical wizardry does not equate to human wisdom". He added that radiologists should not forget that they are physicians in a venerable calling.
Stories are everything, Gunderman suggested. Where are the radiology stories about what radiologists do and what they are? Radiologists' excellence should not be de-contextualised but fully contextualised. "We can be only as good as our stories", Gunderman said. "When was the last time you heard or told a great story about what it means to be a radiologists? Tell me a story of your deep delight. It is my profound conviction that the limit on our goodness and excellence as humans and radiologists is set by our stories." He urged radiologists to collect, disseminate and savor better stories. Radiologists should treat every image, every case as possessed of a degree of preciousness."
Gunderman concluded by saying that radiologists cannot put patients first unless they first know their patients. "Be finely attuned to the story that lies behind the image."
