As a Professor of Clinical Imaging at a major university in New York, I have had the opportunity to learn more than teach. I have learned that hearing is far more important than talking. That listening is far more important than hearing and that without listening, accomplishing my role as an educator/radiologist will be far more difficult, if not impossible. The only way I can accomplish my goals is to realize how fundamentally critical is the need to appreciate the importance of this understanding. “Hearing” how the images, whether they are x-rays, CAT scans or MRIs are an inseparable part of a much larger picture. The single most important component of the imaging is its integral relationship to the clinical presentation. All too often, the imaging is misconstrued as a separate entity, a separate discipline tangentially related to the case. The obvious reality is that imaging is a critical inseparable component of a much larger matrix. My role as a Radiologist, is not only to interpret the imaging but to integrate the findings into a meaningful context. To achieve that mission there are two separate but related components. The first obviously is to offer an objective review of the imaging. That frankly, is the least challenging. The second and more difficult component is visualizing how the pieces fit together. Seeing how the imaging relates to the clinical pattern. For over 35 years which have included hospital, office and academic practice, I have seen how critical is the concept of the overview. The overview is as I define, is that perspective which affords the viewer the opportunity to distance himself/herself from the particular vantage of his discipline and to see the much larger pattern. To realize that the only important concern is the puzzle and not its component pieces. Sometimes the specialist or super-specialist generates unnecessary hubris generating unnecessary pride in a myopic micro-focus on his particular specialty. Such a mis-direction undermines communication and actually limits what otherwise could be a meaningful dialogue.
In summary, the best way to look at the role of the Expert Radiologist is to define what is his role.
His role as I perceive it is:
- To correctly provide an accurate review of the imaging without any retrospective pre-conceived biases
- To integrate these findings in their only relevant context, that is the clinical context.
- Finally, once the first two objectives have been satisfied, the third and most critical task is to effectively communicate to the attorney in the clearest manner the overview from the perspective of the imaging. How does the imaging relate to the client? Does it support the case or does it undermine its value? An early assessment of the impact of the imaging and its relationship to the case whether positive or negative will provide the attorney with the insight needed for effective case management.