Who else works in a system where you’ve become the regional dumping ground for everything? Complicated surgeries, weekend disasters, surgical complications, biopsies and every procedure smaller facilities supposedly can’t do or simply don’t want to do. We’re essentially the pop off valve for the entire region. In radiology that includes MSK ultrasound, lung biopsies, MRI patients with pacemakers and anything else that’s difficult, time consuming or unprofitable. And yes I’m talking to you smaller hospitals that cherry pick your work and private equity radiology groups that read outpatient imaging nonstop while dumping the difficult work on full service radiology groups. And we all know how it works. Your hospital system benefits from these patients and collects the downstream revenue and technical fees while radiology does the grunt work. Meanwhile the outpatient MRI group down the street cherry picks profitable studies right under your nose and laughs at you on Saturday afternoon while you’re taking call and they’re calling you a sucker. This has been going on for decades. I’m sure many know the drill. I’d love to hear how others have successfully pushed back against this and stopped being the default destination for everyone else’s unwanted work.

In my opinion the problem in radiology is often not the uncertainty itself but the failure to clearly lay out the solution in the impression. If there is an evidence-based pathway to greater certainty through time or another imaging modality or ultimately tissue diagnosis that pathway should be clearly stated using a sensible scientific approach. The problem is the sloppy impression that simply says “likely this but cannot exclude that” and stops there. Uncertainty is unavoidable. The key is providing a rational path to resolve it.