“He looked across the sea and knew how alone he was now. But he could see the prisms in the deep dark water and the line stretching ahead and the strange undulation of the calm.” So wrote Ernest Hemingway in The Old Man and the Sea. And what does this have to do with medical imaging?

More than meets the eye, according to Nathaniel Linna and Richard Gunderman, MD, PhD, of Indiana University School of Medicine.

The pair has penned a think piece reflecting on insights radiologists and their CME teachers can draw from the art and science of fishing. It’s running in the January edition of Academic Radiology.

Linna and Gunderman point out that fishing is a livelihood for some and recreation for others. Those who fish for fun and sport have all sorts of reasons for doing so—experiencing solitude, enjoying camaraderie, getting in tune with nature, simply relaxing—many of which have little to do with bringing home the catch of the day.  

Radiologists would do well to approach their work with similarly positive side aims, they suggest.

“Some are so preoccupied with sustaining high levels of productivity that we rarely if ever experience a sense of joy in our work,” the authors write. “Work represents a burden, a seemingly unrelenting demand on our time. The experience of fishing can help radiologists relearn such habits as relaxation and presence. People who are always hurrying from one thing to another soon find that we live with a constant sense of dislocation.”

Many radiologists could use a reminder that the high-tech, antiseptic setting in which they ply their trade is far removed from the rhythms and sensory stimuli of the natural world.

Then again, “nature” can be a state of mind.

“Out in the wild, the radiologist is not the most powerful, best adapted or handsomest thing around,” they add. “The sky, the water and the fish clearly have different purposes, and everything does not hang or fall on our performance. When participating in this ancient rite, radiologists can glimpse the fact that life was happening long before we got here and will continue long after we are gone.”

Radiology, like fishing, can be “corrupted by commercialism,” the authors note.

“Craft can be replaced by mass production, and pressures to produce at an ever higher rate can turn both fishermen and radiologists into assembly line workers. Over time, each can become completely cut off from what matters most—the fisherman from nature and the radiologist the referring physician and the patient.”

Regaining a sense of balance proportion isn’t easy in today’s money-conscious milieu, but the effort can be its own reward, Linna and Gunderman infer.

“The industrial fisheries worker must get back to the water and the fish, and the industrial radiologist, sequestered away in some high-output imaging facility, must get back to referring physicians and patients,” they write. “Doing so may produce no additional financial return and may even cause productivity to falter, but at their best, both fishing and radiology are more than mere production processes.”

The authors acknowledge that, when the word “fishing” is spoken in radiology departments today, it’s usually with derisive connotations in mind.

“Radiologists might, for example, describe a head/neck/chest/abdomen/pelvis computed tomography scan in a patient with uncertain symptoms and signs of disease as a ‘fishing expedition,’ they write. “Despite its largely pejorative use, however, we believe that many of us could learn a lot from fishing, and that many of these insights have important implications for the continuing education of radiologists.”