RSNA: Gunderman pushes rads to find the stories behind the images

CHICAGO—During the Nov. 27 annual oration in diagnostic imaging, Richard B. Gunderman, MD, PhD, in a tremendously passionate address, urged his fellow radiologists to learn more about the patient behind the images that they are reading, and also challenged radiologists to share their personal stories as well.

“Our degree of engagement and inspiration in the practice of radiology—as in medicine at large—hinges on our ability to dig deeply and see beyond the superficial aspects of the image,” he stressed.

Providing a humbling example, Gunderman shared a story when he “missed something,” by failing to recognize the person behind a head CT scan of an 89-year-old man who had a history of dementia and had suffered multiple falls.

The man behind the CT image turned out to be Charles B. Huggins, MD, who was awarded the 1966 Nobel Prize in Medicine for discovering that hormones could be used to control the spread of some cancers. He was the first person to demonstrate that cancer could be controlled by chemicals.

His identity unknown, Gunderman diagnosed him with bilateral acute on-chronic subdural hematomas. “I did my job,” he said. “I described those findings, the diameter of the hematomas, the degree of mass effect and mid-line shift. Then, I moved onto the next case.”

Gunderman conveyed this story because “I missed something. I don’t want you to make the same mistake. You and I, in the interest of efficiency and throughput, fail to pause and fail to marvel about what’s before our eyes. And in this case, I failed to shed a tear and failed to say a prayer for the story that lay behind these head CT images.”

When Huggins made his initial discovery, he was quoted as saying that he couldn’t walk home because his heart was pounding too hard. At 89-years-old, he couldn’t walk across the room without falling. “We as radiologists can see patients’ state of health or disease quite clearly, but those images tell us nothing or precious little about their lives,” Gunderman said.

“At meetings, like the RSNA, we spend a lot of time thinking about equipment, bemoaning cuts in our budgets, worried about what’s going to happen to the compensation of radiologists and nervous about job security,” Gunderman said. “We may be measuring our success in terms of publications or awards we received. We are in danger of spending too much time counting our money and not enough time on what really makes us tick.”

While acknowledging that these metrics contain some importance, he noted that “if these are the signposts by which we navigate our careers and our lives, then we will soon find ourselves on the path to perdition."

"Radiology, like all the human endeavors, makes it possible to get the technical aspects correct—we can be extraordinarily precise and utterly inaccurate,” he added. “To understand the image, it is insufficient to see only the image. There is no radiology without a radiologist. We need to focus more time and attention on the human excellence of radiologists.”

Again, he acknowledged that the technical parameters of job performance for radiologists are important, but “the human being behind the performance makes it all happen.”

He went to say that the character of the radiologist accounts for a great deal of his or her success in practice and life. If these personal aspects are neglected, then the field of radiology will suffer in turn, according to Gunderman, who added that if radiologists only focus on throughput, it’s a recipe for alienation and burnout. Both syndromes are all too common among radiologists.  

“We are not just technicians or revenue generators; we are in fact physicians and human beings who entered a venerable human calling,” he said. “Stories are everything—the context in which we work and live is everything. There is no great practice of radiology devoid of context. We need to re-contextualize what radiologists do and who radiologists are.”

He asked the audience: What is the nature of the story that you tell your colleagues, your patients and yourself about being a radiologist? “The story we tell ourselves about our future has the ability to shape our future,” Gunderman concluded. “When was the last time you told a really great story about being a radiologist? We can be only as good as the stories we tell.”