Radiology Wisdom: Going Back to Our Roots

Radiologists don’t observe their patients like other clinicians. That’s why radiologists chose this specialty, because the interpretation process isn’t superficial. The diagnosis requires an examination that’s deeper than what’s immediately visible.

Former Harvard University professor of radiology Harry Z. Mellins, MD, understood that the profession goes beyond image analysis. Referred to as “the epitome of the clinician/scholar,” Mellins served as the chief of diagnostic radiology and residency program director at Peter Bent Brigham Hospital, which is now Brigham and Women’s Hospital. He was also a mentor and a  teacher who not only wanted his students to become successful radiologists, but also to develop insight into their practice. He once wrote:

“The diagnostic radiologist is a clinician who has sacrificed one of the greatest glories of the practice of medicine and its greatest responsibility - the daily contact with the ill and their families - in order to concentrate more on the essence of our profession, the pathology of the living. This he sees through the medium of shadows which has left him open to the charge of not quite being a real clinician.

But shadows, after all, are real. What are we to one another and what is the world to any of us but an inverted image on the retina? Seeing is done with the mind. The camera does not see; it records. The radiologist perceived the shadow, sees a lesion, and imagines the man. The bedside physician sees the man, perceives the signs and imagines the lesion. They practice from the outside in and we from the inside out. Both are clinicians, for in truth there is no other kind of doctor worthy of the name. The decisive test for all is finally and always the bedside. This, then, is one concept of the radiologist - with a film on the viewbox but the bedside in his or her mind.”

His words are an important reminder as to why radiologists chose this field. Radiologists perform the reverse of what other clinicians do, they examine “from the inside out.”