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Whose Procedure Is It Anyway?By Jim Knaub “A training curriculum, combined with mastery of training and documentation of satisfactory clinical outcomes compared with national benchmarks, will confirm the skill of the ____________ physician. It is time to stop looking from the perspective of an individual specialty.” The blank inserted in the above quote originally contained the phrase “endovascular stroke” but just as easily could have been carotid disease, endoscopy, or any of many other possibilities. The quote came from a Medscape Radiology article about who should treat stroke, written by David Sacks, MD, an interventional radiologist in West Reading, Pennsylvania. I’ve often heard interventional radiologists lament about other specialists who adopt catheter-based treatments developed in interventional radiology and subsequently wrest procedures and patients from interventional radiology. In this case, Sacks was writing about endovascular surgical neuroradiology (ESNR) fellows’ concern about interventional radiologists and cardiologists performing catheter-directed stroke treatments and encroaching on ESNR fellows’ territory. Sacks noted that vascular surgeons, cardiologists, interventional radiologists, interventional neurologists, and neurosurgeons all treat carotid disease. Similarly, gastroenterologists, general surgeons, and colorectal surgeons perform endoscopy. Sacks also wrote that vertebral augmentation procedures are done by interventional radiologists, interventional neuroradiologists, orthopedic surgeons, neurosurgeons, and anesthesiologists. Interventional radiologists have lost patients and procedures to cardiologists and other specialists as those doctors developed skills sometimes pioneered in interventional radiology, but that doesn’t make it wrong—as long as those skills, patients, and procedures can move in both directions. If a doctor develops the knowledge and skill to provide a service, he or she should provide it if they so choose. Physician organizations only need to develop quality training standards and then let those standards serve their purpose. After all, the patient should be the primary beneficiary of any procedure. The idea of patient-focused, coordinated, interdisciplinary may also prove central to healthcare reform and will be a focus of the Charles T. Dotter lecture later this month at the Society of Interventional Radiology’s annual meeting in San Francisco. John A. Kaufman, MD, FSIR, will discuss the many ways interventional radiology is seen by patients, competing disciplines, and policy makers during the plenary session “Integrated Practices and IR: Opportunities for Program Development.” It should be an interesting look at what the future of interventional radiology practice has in store. And while you’re at the conference, stop by booth 704 and say hello. — Jim Knaub is editor of Radiology Today. |
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