Peh, WCG

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Title Radiology and family medicineAuthor(s) Peh, WCGCitation Hong Kong Practitioner, 1997, v. 19 n. 11, p. 569-570Issued Date 1997URL http://hdl.handle.net/10722/44663Rights Creative Commons: Attribution 3.0 Hong Kong LicenseThe Hong Kong College ofFamily Physicians8th Floor, Duke of Windsor Building,15 Hennessy Road, Hong Kong.Tel : 2528 6618 (2 Lines)Fax: 2866 0616Website:http:// medicine.org.hk/hkcfp/journal.htmEDITORDr. Lam Tai PongDEPUTY EDITORSDr. David VK. ChaoDr. Wong Hung WaiBOARD MEMBERSDr. Cynthia S.Y. ChanDr. Chan Wai SunDr. Stephen ChenDr. Nelson K.H. CheungDr. Rudolph WM. ChowDr. Julie CohenDr. Mina GoyalDr. Kwok Kon HungDr. Augustine I. LamDr. Cindy L.K. LamDr. Lam Tai KwanDr. Lam YuenDr. Bernard WK. LauDr. Frederick C.T. LeeDr. Glenn K.L. LeeDr. Peter C.Y. LeeDr. Lawrenee K.C. LeungDr. Ronson C.T. LiDr. John MaekayDr. Charles C.Y. NgDr. Ng Chun BorDr. David OwensDr. Raymond W.M. PauBUSINESS MANAGERDr. Betty K.M. KwanEDITORIAL EXECUTIVEMs. Teresa LeeEDITORIAL ADVISERSProf. Cincly S.T. AunProf. Augustine F. ChengProf. Helen ChiuProf. Tony DixonProf. Wes FabbProf. S.T. FanProf. A. HedleyProf. Walter WK. KingProf. C.R. KumanaProf. C.P LauProf. P.C. LeungDr. Mak Ki YanProf. C.W OgleProf. Wilfred C.G. PehProf. Grace TangProf. Mark TsoProf. C.A. Van HasseltProf. Jean WooProf. C.Y YeungProf. R.T.T. YoungSTATISTICAL CONSULTANTSDr. Joseph LauDr. Ian LauderThe Hong Kong Practitioneris indexed in Excerpta Medica(EMBASE).ISSN 1027-3948Printed & Designed ByPrinthouse Production CenterHong KongEDITORIALRadiology And FamilyMedicineIn the old days when the humble x-rays ruled supreme, the applicationsof diagnostic radiology were more readily appreciable. Many familyphysicians had their own x-ray machines instal led in a backroom of theirpractices. Plain radiographs would be taken and processed on site. Themain roles of imaging were to supplement a meticulously-taken clinicalhistory and a thorough physical examination, and to aid, if not actual lyprovide, the diagnosis to the patient's medical problems. This basic tenetstil l holds true today.The field of diagnostic radiology has now developed far beyond just theusage of x-rays. Various modalities, such as colour Doppler ultrasound,computed tomography and magnetic resonance imaging have emerged in therecent two decades or so. The roles of radiologists have evolved toencompass the treatment of patients by means of needles, catheters and otherdevices inserted percutaneously, through blood vessels and by many differentmeans. There have even been calls to recognize interventional radiology asa separate subspeciality, with its own system of structured t raining andaccreditation.1 In many centres, nuclear medicine imaging has alreadybranched off as a distinct speciality from diagnostic radiology. Manysubspecialities currently exist within the field of diagnostic radiology,i n c l u d i n g m u s c u l o s k e l e t a l , paediatr ic , thoracic , abdominal andneuroradiology.Unfortunately, all these advances in diagnostic radiology have meantthat the actual interpretation of these new forms of imaging are beyond theexpertise of most fami ly physic ians and primary care doctors. Moreimportantly, family physicians will also need to know the most appropriatesequence of investigations for conditions most commonly managed in thesetting of family medicine, an appreciation of the limitations of any giveninvestigation and the nature of newer imaging techniques. Knowledge ofimaging technique is prerequisite to informing and preparing their patientsfor the imaging experience, hence allaying preconceived misconceptions andanxiety.A direct line of communication between the family physician and theradiologist would be of immense value in patient management. In aneditorial, Potchen has suggested that radiologists should function more asextenders of primary care. Radiologists can aid primary care doctors, suchas family physicians, by defining the patient 's problems soon after569EditorialEDITORIALidentification at initial consultation. This approachwould be less costly than a referral to a specialist, whothen requests a diagnostic procedure to define theproblem.2 Armed wi th the information provided byimaging, the family physician can then decide whetherto manage the patient himself, or to refer the patient tothe appropriate specialist. Other means by whichradiologists could t ransmi t information to fami lyphysicians include giving continued medical educationlectures with question-and-answer sessions, wri t ingreview and education articles in local journals such asThe Hong Kong Practitioner, and making availablepamphlets l i s t ing detai ls of va r ious radiologicalexaminations.Another way of ensur ing that f ami ly physiciansrefer patients appropriately for imaging is the use ofproblem-based guidelines. Such guidelines have beenpub l i shed by organizat ions such as the AmericanCollege of Radiology, Royal Australasian College ofRadiologists and the Royal College of Radiologists ofthe United Kingdom.3-5 Studies on the influence ofthese guidelines on family medicine have shown thatthey are useful in reducing the rate of radiographicalexaminations and thus patients' exposure to radiation.6-7Presently, a jo int Working Group of the HospitalAuthority and the Hong Kong College of Radiologists isdeveloping a set of clinical guidelines in diagnosticradiology, which when completed, should be ofsignif icant benefit to local physicians.Diagnostic radiology is very much technology-dependent and there is no doubt that previouslyunattainable clinical information and diagnoses can nowbe obtained rapidly and with a high degree of accuracy.Interventional radiology wil l continue to promote lessinvas ive pat ient care, obviating the need for majorsurgery in many clinical conditions. The suggestion insome quarters that "high technology is largelyresponsible for the skyrocketing cost of medical care" isunfounded . Properly selected inves t iga t ions andm i n i m a l l y invas ive procedures that are rout inelyperformed by radiologists save money, improveoutcomes, and minimize patient discomfort. These newtechnologies and techniques have enabled avoidance ofexpensive hospital admissions in the diagnosis andmanagement of many cases.8Family physicians should cooperate more closelyand consu l t wi th thei r radiological colleagues.Radiologists should be more aware of the needs offami ly phys ic ians and the i r patients, and respondaccordingly. Such an approach will be beneficial topatients, and the society at large. •Wilfred C G Peh, FRCR, FHKCR,FHKAM(Radiology), FAMSProfessorDepartment of Diagnostic RadiologyThe University of Hong KongReferences1. Adam A. The fu ture of interventional radiology - does it have one?Clin Radiol 1993:48:160-162.2. Potchen EJ. Future of diagnostic radiology. RadioGraphics 1994; 14:936-938.3. American College of Radiology. Appropriateness Criteria. 1995.4. Royal Australasian College of Radiologists. Imaging Guidelines. 2nded. 1993.5. Royal College of Radiologists. Making the Best Use of a Departmentof Clinical Radiology. 3rd Ed. 1995.6. Royal College of Radiologists Working Party. In f luence of RoyalCollege of Radiologists' guidelines on referral from general practice. BrMed J 1993:306:110-111.7. Oakeshott P, Kerry SM, Williams JE. Randomized controlled trial ofthe effect of the Royal College of Radiologists' guidelines on generalpractitioners' referrals for radiographic examination. Br J Gen Pract1994;44:197-200.8. Heilman RS. High tech equals high cost in medicine: does it really?RadioGraphics 1994; 14:1004.570

Radiology and family medicine

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