Deconstructing divisiveness: the collaboration of radiology and cardiology

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Although turf wars sometimes abound among cardiologists and radiologists, the collaboration of the specialties holds the promise of creating a mutually beneficial relationship, according to Peter L. Zwerner, MD.

“We tend to demonize one another to make ourselves feel more valuable in order to justify why we should be the people reading the studies,” he noted.

Zwerner, a cardiologist, who works in the departments of medicine and radiology at the Medical University of South Carolina in Charleston, shared his thoughts on collaboration at the 2008 North American Society for Cardiovascular Imaging (NASCI) annual meeting in Phoenix.

Supreme among the roadblocks to establishing a collegial, cooperative relationship among the two specialties are what he termed “tribal attitudes.”

Zwerner noted that radiologists may cling to some partisan notions about cardiologists, such as “radiologists develop the technology and cardiologists steal it. Cardiologists are only in it for the money and will over utilize studies to make their boat payments. Cardiologists will miss major non-cardiac pathology, and cardiologists know nothing about the technology.”

However, Zwerner also observed that cardiologists are not without their own set of pre-conceived biases against radiology.

“Radiologists aren’t real doctors because they do not take care of patients,” he said. “Radiologists know nothing about coronary anatomy. The radiology reports are clinically useless. Radiologists go home at 3:30 in the afternoon.”

These “tribal attitudes” are antithetical to the integration of diagnostic imaging and therapy and only serve to blind clinicians to the advantages of collaboration.

According to Zwerner, there are many practical reasons for radiology and cardiology to lay down the gloves and work toward better collaborative efforts among the specialties.

These include the capability to grow one another’s service lines; provide marketing advantages through joint efforts; the efficient use of expensive imaging equipment; the better utilization of a skilled pool of technologists; better outcomes reporting; cross-specialty training pathways and the ability to counter out-sourcing; and a unified front in reimbursement efforts.

One example of successful collaborative efforts at the professional societal level, Zwerner pointed to recent work by the American College of Cardiology (ACC) and the American College of Radiology (ACR) on CPT codes for cardiac and vascular CT angiograms (CTAs).

“The ACC and ACR are also working together to create a model coverage policy related to CTA for Medicare carriers,” he noted.

For clinicians entrenched on their side of the cultural divide between the specialties, a change in perspective is needed, Zwerner said.

“Cardiologists have a unique knowledge of cardiac anatomy and physiology; they have a clinical perspective and semantic; and they control what imaging modality is ordered,” he said. “Radiologists have a unique knowledge of the physics and technology of imaging modalities; they are familiar with tomographic image acquisition and interpretation; and they are knowledgeable about non-cardiac chest structures.”

The keys to collaboration, Zwerner noted, are mutual respect, the avoidance of old wounds, the ability not to let other turf battles get in the way, the recognition of common enemies and the development of what competencies and credentialing criteria will be put in place among the partners.

“If you want to be incrementally better, be competitive,” he said. “But if you want to be exponentially better, be cooperative.”