Radiology has suffered the consequencesand enjoyed the benefitsof limited patient contact for many years. Interfaces take place almost entirely with the virtual patient (the images and accompanying medical data), and any attempts at relationship-building occur with the referrers. No resident entering the profession expects otherwise, and, as far as I have observed, most radiologists are relatively content with this arrangement.

The consequences of this construct, however, are worth mentioning. The very act of operating as consultants to other physicians has left the radiologist dependent on the good will of those physicians and the administration in matters of hospital politics. While the shortage of radiologists has temporarily lent radiology some additional clout with administration, radiologists cannot, in the thick of negotiations, announce: "I'll take my patients elsewhere."

Limited patient contact has also rendered the radiologists almost totally anonymous to the patient population: "What are radiologists? Are they doctors?" While I suspect that this is unimportant to most radiologists (because the more ego-driven physicians have selected other specialties), it has real consequences in the marketplace. Significantly, it leaves radiology without a venue for patient communications on important radiological issues (such as whether to have a mammogram, the benefits and drawbacks of uterine fibroid embolization, and the effects of ionizing radiation). In an effort to connect with  the public, radiology's professional societies have launched consumer education sites on the Web: the American College of Radiology and the Radiological Society of North America collaborated on www.radiologyinfo.org, and every time I type an interventional procedure into a search engine, the Society of Interventional Radiology's web site, www.sirweb.org, pops up.

Why bother putting a face on radiology? George Wiley writes tellingly of the growing trend in self-referral for imaging beginning on page 23 ("Self-Referral: The New Gold Rush?"). This troubling trend has resulted in the establishment of many imaging offices by single and multi-specialty groups for the sole purpose of capturing technical and sometimes professional imaging fees. Our guest editorialist, Richard Townley (see page 8), a man who has helped hammer out many joint ventures between hospitals and radiology groups in recent years, suggests that the best hope for radiologists to even stay in the outpatient imaging game is to include some of these super-referrers in the deal.

Public relations and other marketing efforts can take radiology only so far. One of the most effective ways to put a face on radiology is to open an interventional clinic with admitting privileges. Riverside Radiology Associates established a clinic in 1998 (see cover story) with grave reservations and today it thrives. In a time when interventional radiologists are very hard to find, the 40-member group now has a total of seven. They are respected members of the hospital community and have added important new services that benefit the inpatient population, including treatment for aneurysm and stroke.

The value of interventional radiology to diagnostic radiology goes well beyond the number of ancillary imaging examinations produced: the benefit of having a branch of the practice doing rounds, out on the floor dealing with patients and colleagues, cannot be overestimated. It is a relationship that cuts both ways, as interventional radiology needs diagnostic radiology's strength in numbers. Why, then, are not more radiology groups  establishing interventional clinics in hospitals everywhere?

Cheryl Proval

cproval@medpubs.com