Docs don't know what IR does...

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[Gvataken]

Excellent point. This is extremely important. You have to educate the primary care physicians and other doctors of what all that you can do. In fact very successful IR groups have one of their IR docs giving a grand rounds or talk on some of the more common interventions on a weekly basis.

ie
fibroid therapy
vertebroplasty/kyphoplasty
peripheral arterial disease
carotid disease

Also, if interpreting imaging (CT/MRI) our radiologists are very good about recommending an IR consult for evaluation. It was very important to educate the diagnostic radiologists who were unaware of all that we do and after giving them conferences on what we do, our referrals from them went up.

 

[NappingGuppy]

So I kinda have a question/comment and wanted to get your guys's imput.

My question pertains to IR/NIR's role in patient care. How involved are they? I mean do they dx an issue (using scans and physical exam) and then suggest a treatment like surgery might do? Is there a diff in this regard between IR and NIR?

I had a great conversation with a mix of "old school" and "new school" IR's the other day where I basically asked them the same question. The short answer is that the game is very different now and there is a bit of a generational difference between "old school" and "new school". I'll try to summarize and I'm sure other posters can probably give their thoughts on what I've said.

Old school - Back in the day, IRs didn't get very involved in patient care. Other docs would send their patients to IR, IR would do a procedure, and shoot them back to the referring docs, complications/problems be damned. They would then proceed to cash a really fat check, while the referring doc slaved away into the night managing a sick patient for much less money. Understandably, once they saw how IR rolls, other specialists have definitely tried to jump into the pool as well.

New school - general recognition that the competition is fiercer now, and that IR's need to be known to the patients, and be responsible for the workup and dx like you said. IR's especially in private practice, might manage both the diagnostic imaging, then after discussing treatment possibilities with the patient and performing a phys ex workup - perform the procedure, then perform diagnostic imaging follow up for the patient. There have also been several pushes on a national level to educate PCP's on what IR's can do for their patients, and to be involved in making life "easier" for the PCP's that refer their patients to IR.

Hope this helps.

 

[IRneuroIR]

I think that's a pretty good summary of the differences in most places/instances although we should give credit to the "old school" guys who were pioneers and explorers of uncharted territory and also those who have adapted with the change to a more clinical model. The "new school" VIRs are definitely more of a clinical specialist and the modern training reinforces this.

I agree with Dr. V's post that we must actively educate clinicians and patients on what we can offer and our areas of expertise. Grand Rounds, teaching/noon conferences for residents, and visits to clinicians' offices are just a few ways we can better reach out to our colleagues and gives us an opportunity to showcase our knowledge of various disease states but also the tools and procedures we can employ to help but in a way that reinforces the fact that we will not "dump" the patient back into their laps following our procedure -- we take care of patients!

 

[NappingGuppy]

Yeah, that may not have come out very well. I didn't mean to make the old school sound like they were the root of all IR's problems. Credit where it's due - many of these folks are also the ones that saw that IR training needs to change and are at the helm of promoting these new training pathways, education, developing new procedures, etc.