Hey everyone, it’s Medicine Mondays and I didn’t really have any particular post in mind today. So today is going to be another “stream of consciousness” type post where I ponder “Why Radiology?”

Stock Photo from: Pixabay

So this is probably going to be a short post. I don’t think I’m going to go into too much depth and introspection here, at least not today.

So then, Why Radiology?

Well, if you may recall, I didn’t originally set out to do Radiology. In fact, when I left for medical school I was pretty set on being a pediatrician. I had shadowed one for a year while in college and I was pretty sure that is what I wanted to do.

However, this changed after I did my core rotations and my peds rotation. After seeing so much more of the world of medicine, I just didn’t want to do pediatrics anymore. Instead what became really interesting to me was Neurology. There was so much to know and understand. The human brain is so interesting:

“If the human brain were so simple that we could understand it, we would be so simple that we couldn’t.” – Emerson M. Pugh (via his son George Edgin Pugh)

I also briefly considered ENT and Anesthesia because for a short time I liked being in the operating room. However, that was short-lived.

“Only do surgery if you can’t see yourself anywhere but the OR and want to devote all your time into getting back into the OR. If you can see yourself doing anything else, then you don’t want to be a surgeon.” – heard during medical school

So then, near the end of 3rd year, I was pretty set on Neurology.

So what happened? what changed?

Here’s the thing. Overall, nothing really changed.

The only thing that changed was my perception of myself. It took an astute Neurology attending to tell me that I “wasn’t a neurologist”. She even went on to declare (quite decisively, I might add), that I was a Radiologist.

Sometimes in order to understand what you really want, you need someone to speak to you objectively. It’s interesting how humans can force themselves to believe they are happy with their decision(s), even when any outside observer can see they aren’t. I think the best way to describe it is “cognitive dissonance“.

For me, the two conflicting beliefs would probably be something like “I want to do Neurology” and “I don’t like Neurology”.

Like I say in my post about Choosing a Specialty, first and foremost you need to be honest with yourself.

So then, back to the original question, “Why Radiology?”

Once I was diverted from my path of Neurology, I looked into Radiology, which I had never even considered before. This was back in 2005 or so, and I never saw any radiologists, like ever. The only time I saw them was when I was on surgery and I needed them to look at a CT for me. I never really saw them as “part of the team”. Of course, I know better now at just how vital radiologists can be to making management decisions.

It’s also weird that as much as I liked looking at the MRIs on my Neurology rotation, it never clicked to me that somewhere, someone, was looking at these images and formulating a report. More so than that, it never occurred to me that the person reading them could be me.

So then, the first thing to do is to get experience. I was able to switch out my first elective rotation into Radiology and sit down with real live radiologists. Seeing the day-to-day work of a radiologist is important. As a medical student, you think you have some idea of all the imaging modalities that exist and what radiologists read. Perhaps you think, CXR, MRI, CT, etc. However, once you actually sit down with a radiologist you really see the depth of knowledge needed and expertise to read all the different modalities.

Take CT for example, and we’ll even narrow it down to a Head CT.

Noncontrast head CT versus Contrast enhanced head CT, what’s the difference?

Why do we do one over the other? What are the limitations of noncontrast and contrast enhanced?

What about a CT Angiogram of the Head? or a CT Venogram of the Head? How are they different? How are they performed differently? Why use one over the other?

When studying for the steps, all I saw was “Ring Enhancing Lesions” on contrast-enhanced CT. This very uncommon to see nowadays because of the advent of MRI. If there is an abnormality on the noncontrast head CT, the next step will be a contrast enhanced MRI (if possible). A contrast enhanced CT will miss so many lesions because of its significantly lower sensitivity.

There was so much to know, and I wanted to know all of it.

At the end of the day, it came down to this:  what about medicine did I really like?

For me, the answer is diagnosis.

What ails the patient? That’s the question I want to devote the majority of my time to answering.

Also, we get to see the most interesting cases and help to guide management and treatment.

Don’t you miss patient contact?

Well, if I was a “normal” private practice radiologist, I would still have some patient contact when doing procedures (lumbar punctures, arthrograms, biopsies, etc.) or when doing mammography. However, since I’m a teleradiologist now, my patient contact is now zero.

I must admit, I do miss it sometimes.

However, I still feel that I make a direct (and significant) contribution to patient care. For example, when there is acute appendicitis and pick up the phone to alert the ordering physician, that is real guidance to patient management and treatment. Even a negative Chest X-ray provides valuable information, as it helps direct management and treatment as well.

Overall, I am very happy with my choice of specialty, and feel fulfilled.

Didn’t you just do it for the money?

Kind of a loaded question, but I’m sure this comes to people’s minds often.

The answer is no, although people may not believe me. While it’s true that radiologists get paid well relative to some specialties, I didn’t do it for the money. In fact, when deciding on a specialty, I advise medical students to ask themselves this very real question:

“If your subspecialty of choice paid the median salary of all subspecialties, would you still do it?”

My answer was (and still is) yes.

I also advise residents to not chase “the highest salary” in my post Choosing Your First Job. Of course, any additional benefits are important, however, I forgot to mention something that is very important: longevity.

If a job pays $250k but has 2x the call as a job that pays $200k, you need to ask yourself whether you can handle that additional stress or not. If you can only do the higher stress, more call, but higher paying job for a short time, then you will have to look for a job again. This may require moving, or accepting a lower paying job later on. You may also lose any pension or other plan you paid into while you were at the higher stress job. Or you may burn-out and be looking for a way to leave medicine.

Just so everyone knows that I’m not full of crap, my current job doesn’t pay nearly as much as other jobs I could have taken. However, I really like my job and I feel I can have a long, fulfiling career with it, even until I’m 70 if wanted. The likelihood is that I won’t work that long, but important thing is that I think I could.

What’s the take home point?

I think almost everyone who goes through medical school can find a specialty that they enjoy and can be fulfilled. However, you really need to be honest with yourself about what you like and what you want out of life. For some, that may mean not doing residency… and I think that’s ok.

I know a lot of people who have changed specialties midway through, and I don’t think any of them regret their final decision.

Would it have been nice to “get it right the first time?” Sure. However, you’ve already devoted so much time to medicine… life is too short to be unhappy.

TL;DR

Sometimes you need the objective opinion of an outsider to help you with your own introspection.

Of all aspects of medicine, I find diagnosis the most interesting, right next to guiding management and treatment.

I didn’t do Radiology for the money. Really, I didn’t.

Be honest with yourself.

Life is too short to be unhappy.

By the way, this wasn’t a short post. Sigh.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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