The extraordinary growth of imaging technology has dramatically affected all aspects of the practice of clinical medicine. As imaging comes to play a larger role in patient care, it is critical to consider the role and professional obligations of the physician-specialists who work in and lead this expanding field—radiologists. Are radiologists responsible for insuring that patients receive the optimal exam for a particular indication with minimal risk and cost? Do radiologists' obligations to referring physicians extend beyond clear and timely communication of results? Do radiologists have duties directly to patients? In short, what does it mean to be a radiologist?
This issue of Virtual Mentor directly tackles these and other questions that contemporary diagnostic radiologists face. The first clinical case discusses the role of radiologists in the era of telemedicine: can radiologists in a different state or country be as effective as those who practice in the same community as the patient? The second clinical case raises one of the field's most frequently encountered ethical concerns—the discovery of a missed lesion. The commentary describes the guidelines for determining whether not reporting the lesion was in fact an error and if so, whether it must be disclosed. The third clinical case examines an essential aspect of the practice of radiology—cooperation with the referring physician—that can be a source of professional and ethical tension. In the medical education article, a former residency program director describes the challenges to residency training posed by recent developments in radiology and the growing interest in the field among medical students. Since new imaging modalities have not displaced the standard X-ray for static views of the skeleton and dense tissue, the journal discussion addresses a perennial question: has the accuracy of X-ray interpretation improved over the decades? The clinical pearl introduces one of the newer technologies in cancer diagnosis—breast magnetic resonance imaging.
The issue then moves from the bedside to a broader view of diagnostic radiology, with a policy forum that examines the effect that the 1992 Mammography Quality Standards Act (MQSA) has had on mammography and women's access to that form of screening. The success of this federal legislation remains an open question. The health law section reviews two other federal statutes—the Medicare and Medicaid Antikickback Act and the Stark Law—both designed to prevent physicians from profiting by referring patients for unwarranted services. In the medicine and society section, the author addresses the diagnostic radiologist's professional obligations to his or her patients, colleagues, the community, and society. And finally, the author of the medical narrative article describes one of the masterpieces of Western literature—Thomas Mann's Magic Mountain—as a fictional example of the power of images, the truth that seeing is believing.
By considering these topics and scenarios carefully, we may be better able to recognize and confront the ethical—and not just the clinical—challenges faced in our daily practice as we develop into morally conscious physicians and physicians-in-training.