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Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Constructive Destruction: Radiology’s New Challenge

In order to creatively build a radiology of the future, we have to look critically at everything we do now and be willing to tear some of it down.

Welcome to guest blogger Bernadette Keefe, MD (@nxtstop1), who is very active in medical social media circles and medical conference curation. Her blogpost and this month's upcoming JACR tweet chat are inspired by a provocative November 2015 JACR article.

In "De-Adoption and Un-Diffusion," Richard Gunderman, MD, and David Seidenwurm, MD, offered this challenge to radiologists:

"We need to move from a culture in which established practices tend to be uncritically perpetuated to one in which we subject such practices to critical scrutiny. No device, drug, protocol or practice should be overthrown because it is old but we need to apply as much intellectual horsepower to examining the ideas we take for granted, as to discovery and innovation."

The authors cite the rampant and unconsidered adoption of new radiologic techniques and devices, often fueled by industry and academic pressures, as being counterproductive and wasteful. They describe a host of changes that would need to occur in order to accomplish what they term creative destruction in radiology. They want to see the type of innovative, cutting-edge thinking that typifies the best of radiologic science applied with similar rigorous objectivity to things we do in radiology, much of which many not stand up to such uncompromising scrutiny. No more sacred cows.

"What we are talking about is a change in culture." 

— Gunderman and Seidenwurm

As I see it, many stakeholders will need to be on board to achieve this type of destruction, including academic chairs, journal editors, private practice and academic radiologists, referring clinicians, industry representatives, and trainees. These stakeholders will have to adjust their thinking and habits regarding items like criteria for faculty promotions, impact of declining reimbursement, shifting research priorities, publishing negative research studies, using less costly and more efficient imaging options, finding creative ways to use older equipment, and celebrating critical, even skeptical, thinking.

"We forget that the real contribution is not a particular drug or device but a solution to a clinical problem, one that can be modified or even supplanted over time. Our goal should be not to continue business as usual but to prevent and remedy disease, decrease suffering, and improve quality of life.

— Gunderman and Seidenwurm

The concept of constructive destruction builds on the ideas proffered by Drs. Gunderman and Seidenwurm, adding a deliberate, systematic, creative, unemotional process in identifying outdated, wasteful, and unquestioned elements of our processes. I invite you to discuss the following three questions during the March 24, 2016, JACR tweet chat:

1. Have you ever tried to suggest or implement constructive destruction and received pushback from your department chair, colleagues, or journal editors? 

2. Given your present practice situation or perspective, what circumstances would need to change to create the kind of constructive destruction described? 

3. What are the negatives, if any, of constructive destruction in radiology?

Thanks to Dr. Keefe for this thought-provoking blog contribution! JACR is also delighted that she will be this month's tweet chat moderator on Thursday, March 24, 2016, at noon EDT.

It's easy to participate in JACR tweet chats. You'll just need a (free) Twitter account. Once you're logged in, search for #JACR at the tweet chat start time. Then look for the moderator to welcome tweet chat participants and start posting questions. Remember to include #JACR in your tweet responses so that others in the chat will see them.

Ruth Carlos, MD, deputy editor of JACR, and the rest of the tweet chat team look forward to another great Twitter exchange of ideas with you!

Bernadette Keefe, MD, practiced academic radiology at UNC Hospitals in Chapel Hill, North Carolina from 1987 to 2000, after receiving her MD, internship, and residency training in New York City. Keefe is currently a consultant and blogger. Highly active in health care social media, she has consulted on Twitter outreach campaigns for medical organizations and has curated over 200 medical and healthcare conferences.

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Comments 1

Guest - KitByattLaconic_doc on Saturday, 19 March 2016 23:12

Good challenge to us all, Bernadette. NB if new to tweet chats, suggest using 'tchat.io' in your usual browser. This automates insertion of the hashtag in tweets & shows only tweets relevant to it. Makes tweet chats *much* easier!

Good challenge to us all, Bernadette. NB if new to tweet chats, suggest using 'tchat.io' in your usual browser. This automates insertion of the hashtag in tweets & shows only tweets relevant to it. Makes tweet chats *much* easier!
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