Re: MDs and radiological sciences

[Al Tschaeche <antatnsu@pacbell.net>]

Excellent discussion.  And I am aware of the tremendous amount of
information medical practitioners must have these days.  However, if I were
a patient and my medical practitioner (doctor) told me to have an x-ray, I'd
want, at least, the comfort of knowing that he knew the effect on me of that
x-ray.  It is the same thing as if he were to prescribe some medicine.  I
would expect him to know the effects, good and bad, of that medicine.  And
so on.  The, to me, excuse that there is too much to know just doesn't
wash.  Any doctor who doesn't know what effect something he does to me has,
must at least tell me that he doesn't know.  I have had extremely difficult
times in getting radiologists and nuclear medicine doctors to tell me my
effective dose when they give me radionuclides or x-rays or other treatments
that expose me to ionizing radiation.  When I ask what effect those
treatments have on me the answer is always, "Don't worry about it" or "There
are no effects."  When my wife underwent breast irradiation of 5000
rads/breast, I asked the doctor what her whole body dose was.  He said, "Oh,
nothing."  When I measured the dose, it was 28 rem effective dose.  That's
not nothing!  I think the medical profession in general has no idea what
doses it is giving the public and, worse, doesn't care.  Now, I know, that
statement is rather strong.  But when I hear that doctors don't get any
training in radiation effects, that there is too much to know so don't try
and get them to know more, and with my own experience with their ignorance,
I don't think it is too strong.  The real question is what, if anything, to
do about it.  Perhaps nothing, but, if so, it should be a reasoned nothing,
not just, "There's too much to know."  Al Tschaeche antatnsu@pacbell.net

"Gibbs, S Julian" wrote:

> Having taught medical students for more than a quarter
> century, I think I may be entitled to enter some comments.
> Are HPs aware that medical education encompasses
> essentially all of modern biology, most of chemistry, a big
> chunk of physics, plus a number of lesser subjects.  It is
> simply not possible to provide expertise in depth in the
> whole gamut.  Enter specialty training, where the breadth
> is greatly diminished but depth is increased.  I teach
> radiobiology to our residents now in specialty training for
> diagnostic radiology.  Some years ago, I had the equivalent
> of a one semester hour course to cover this--modest but
> adequate.  Now, with the advent of more clinical
> procedures (magnetic resonance, computed tomography,
> ultrasound, positron emission tomography, interventional
> angiography, etc.) I have only 5 lecture hours.  I
> understand that this is probably typical of other radiology
> residency programs.
> Most diagnostic imaging procedures deliver very small
> radiation doses to patients.  The upper limit is of the
> order of 10 mGy, for some CT, angiography, etc.  In my
> teaching I try to point out that there is now disagreement
> among competent scientists as to the presence and/or extent
> of risk from these procedures.  We conclude that if there
> is a risk, it must be vanishingly small, and never
> sufficient to warrant cancellation of a medically justified
> procedure.
> Some interventional procedures deliver larger doses.
> Epilation, erythema, and even moist desquamation are not
> unknown.  These involve doses of the order of a few Gy, and
> harmful sequellae might be expected.  However, these
> procedures are generally livesaving and may eliminate
> extensive surgery, the risk of which may be much greater.
>
> I think that the best we can hope for is some in-depth
> knowledge among radiologists but less in other physicians.
> I try to emphasize to my radiology students (and to other
> medical students in my infrequent contacts with them) that
> when faced with a radiation exposure problem they should
> not rely on their memory, but rather should contact their
> friendly academic medical center for current information.
>
> Finally, I wonder why HPs do not relegate these issues to
> radiobiologists, who are really the competent ones to
> evaluate available data.  I know that when I (as a
> radiobiologist) dabble in physics I can easily
> misunderstand some of the sophisticated issues.  My
> physicist friends tell me they experience the same when
> they get into modern biology.
>
> ***********************************************************
> S. Julian Gibbs, DDS, PhD               Voice: 615-322-1477
> Professor, Emeritus                       FAX: 615-322-1474
> Dept. of Radiology & Radiological Sciences
> Vanderbilt University Medical Center
> 209 Oxford House
> Nashville TN 37232-4245        Email:j.gibbs@vanderbilt.edu
> ***********************************************************
> "Under democracy each party always devotes its chief energies
> to trying to prove that the other party is unfit to
> rule -- and both commonly succeed, and are right."
>                 -- H. L. Mencken (1880-1956)
>
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