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Chairman's Corner
Chairman's Corner
Patients first !
Patients first !
Ravi Ramakantan
Ravi Ramakantan
Two enlightening events from completely different backgrounds—and involving different people—occurred over the last six months or so.
Two enlightening events from completely different backgrounds—and involving different people—occurred over the last six months or so.
As many of you know, I usually conduct at least one teaching session a week on conventional radiology. This has been going on for a very long time—perhaps since the 1980s. In the early days, these sessions were generally well-attended and eagerly sought after; radiology students from all over Mumbai wanted to attend. However, that gradually changed over the last two decades or so with the predominance of cross-sectional imaging. Since I taught only conventional radiology, these sessions became less and less popular.
As many of you know, I usually conduct at least one teaching session a week on conventional radiology. This has been going on for a very long time—perhaps since the 1980s. In the early days, these sessions were generally well-attended and eagerly sought after; radiology students from all over Mumbai wanted to attend. However, that gradually changed over the last two decades or so with the predominance of cross-sectional imaging. Since I taught only conventional radiology, these sessions became less and less popular.
This is understandable. After all, residents are interested in what benefits them from the perspective of their examinations and their future practice, as well as what seems attractive to them. There is no glamour in conventional radiology; these are simple X-rays, and reporting them yields very little income. On the other hand, CT and MRI are glamorous, and each examination fetches a lot more money. One could even say there is a certain excitement in reporting these advanced images, whereas interpreting conventional images is viewed as mundane. Yet, a few months ago, for the first time in my career, I was told that the students scheduled to attend my weekly session chose not to come, claiming they could just learn the material from books. To say that this did not surprise and hurt me would be untrue. In these sessions, I teach not just radiological interpretation, but everything radiology has to do with patient care. For decades, I have stressed the fact that radiology is about patients, not just images.
This is understandable. After all, residents are interested in what benefits them from the perspective of their examinations and their future practice, as well as what seems attractive to them. There is no glamour in conventional radiology; these are simple X-rays, and reporting them yields very little income. On the other hand, CT and MRI are glamorous, and each examination fetches a lot more money. One could even say there is a certain excitement in reporting these advanced images, whereas interpreting conventional images is viewed as mundane. Yet, a few months ago, for the first time in my career, I was told that the students scheduled to attend my weekly session chose not to come, claiming they could just learn the material from books. To say that this did not surprise and hurt me would be untrue. In these sessions, I teach not just radiological interpretation, but everything radiology has to do with patient care. For decades, I have stressed the fact that radiology is about patients, not just images.
At another level, a colleague of mine was writing an article for a radiology journal, proposing a change in the curriculum and the format of radiology examinations. I was asked to be one of the co-authors. The article went through two revisions, but I still could not bring myself to agree with its core premise: essentially, that conventional radiology is no longer important because it does not occupy a significant proportion of the time a radiologist spends interpreting images, and therefore, the examination syllabus for it should be watered down. I had major reservations about these statements. I argued that even today, at least 60% of all patients who visit a radiology department do so for conventional radiography. It does not matter how much time a radiologist spends reporting them; what matters is the sheer number of patients whose lives are affected by conventional radiology.
At another level, a colleague of mine was writing an article for a radiology journal, proposing a change in the curriculum and the format of radiology examinations. I was asked to be one of the co-authors. The article went through two revisions, but I still could not bring myself to agree with its core premise: essentially, that conventional radiology is no longer important because it does not occupy a significant proportion of the time a radiologist spends interpreting images, and therefore, the examination syllabus for it should be watered down. I had major reservations about these statements. I argued that even today, at least 60% of all patients who visit a radiology department do so for conventional radiography. It does not matter how much time a radiologist spends reporting them; what matters is the sheer number of patients whose lives are affected by conventional radiology.
As it stands, contemporary radiologists often possess very poor skills in conventional radiology. If this trend continues and conventional radiology dies, the consequences will be disastrous. If a clinician or radiologist cannot interpret a basic chest radiograph, a CT scan will be ordered instead. Consequently, costs will escalate, patient inconvenience will increase, and radiation doses will rise. I argued with one of my co-authors on the paper, asking: "If your own son or daughter needed an evaluation for chest symptoms, would you opt for a chest radiograph first, or a CT scan—especially if the child had to be examined under anesthesia?" Yet, a routine CT is exactly what will happen if we lose our skills in conventional radiology.
As it stands, contemporary radiologists often possess very poor skills in conventional radiology. If this trend continues and conventional radiology dies, the consequences will be disastrous. If a clinician or radiologist cannot interpret a basic chest radiograph, a CT scan will be ordered instead. Consequently, costs will escalate, patient inconvenience will increase, and radiation doses will rise. I argued with one of my co-authors on the paper, asking: "If your own son or daughter needed an evaluation for chest symptoms, would you opt for a chest radiograph first, or a CT scan—especially if the child had to be examined under anesthesia?" Yet, a routine CT is exactly what will happen if we lose our skills in conventional radiology.
Our fascination with technology is not necessarily a good thing. We might spend eight hours using sophisticated technology to determine whether a lesion on a brain MRI is radiation sclerosis or a recurrent tumor. But how much does that distinction truly matter to a 70-year-old man in terms of his quality of life and life expectancy? On the other hand, if you lack the skills to diagnose an infiltrate on a chest radiograph or an enlarged hilar lymph node, and consequently miss a diagnosis of tuberculosis, it can have devastating, long-term effects on the life of a child or a young adult.
Our fascination with technology is not necessarily a good thing. We might spend eight hours using sophisticated technology to determine whether a lesion on a brain MRI is radiation sclerosis or a recurrent tumor. But how much does that distinction truly matter to a 70-year-old man in terms of his quality of life and life expectancy? On the other hand, if you lack the skills to diagnose an infiltrate on a chest radiograph or an enlarged hilar lymph node, and consequently miss a diagnosis of tuberculosis, it can have devastating, long-term effects on the life of a child or a young adult.
We must realize that every conventional radiographic examination is just as important as the most sophisticated MRI, because both deal with the exact same entity: a human being. We cannot allow ourselves to be carried away by what gives us personal pleasure and professional fulfillment over what the patient actually needs. We need to place ourselves second, and the patient first. If we wanted our own desires to be the top priority in our daily work, we should not have become doctors, whose primary duty is to care for patients.
We must realize that every conventional radiographic examination is just as important as the most sophisticated MRI, because both deal with the exact same entity: a human being. We cannot allow ourselves to be carried away by what gives us personal pleasure and professional fulfillment over what the patient actually needs. We need to place ourselves second, and the patient first. If we wanted our own desires to be the top priority in our daily work, we should not have become doctors, whose primary duty is to care for patients.
This is fundamentally about faith—the implicit faith patients place in doctors, trusting that they will be taken care of, well beyond any personal prejudices or preferences of the physician. Medicine is not about us; it is about the patients. Patients always come first.
This is fundamentally about faith—the implicit faith patients place in doctors, trusting that they will be taken care of, well beyond any personal prejudices or preferences of the physician. Medicine is not about us; it is about the patients. Patients always come first.
Furthermore, artificial intelligence will very soon take over most of the interpretative skills of radiologists. When that happens, what remains will be the radiologist-patient relationship and the radiologist-referring physician relationship.
Furthermore, artificial intelligence will very soon take over most of the interpretative skills of radiologists. When that happens, what remains will be the radiologist-patient relationship and the radiologist-referring physician relationship.
June 2026
June 2026
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