While interventional radiology is experiencing a strong dynamic of innovation and an increasing number of applications, it remains largely unknown. How to explain this lack of visibility? How could we create more awareness for IR?
As a sociologist, the first time I was introduced to interventional radiology (IR) was when I was asked to work on the subject. Like many, I had never heard of it and had no idea what it was. I didn't remember any mention of it in the media, on medical TV shows or in popular culture. Subsequently, I was quite surprised when I re-watched House MD, and realized that IR-related procedures were performed in many episodes. But the name is never mentioned and it is difficult to relate this activity to that of a radiologist. Looking at history and the social organization of the specialty, how can one explain this lack of visibility? How could we create more awareness for IR?
A lack of visibility
During my research, when I had to explain my subject of study, the first reaction I got from people was an interrogation, coupled with a form of concern: “radiologists who perform interventions on people? but do they have the right to do that?” More worryingly, some of the patients I met, who have been treated by IR techniques, also had difficulty identifying the role of the radiologist in the process. Referring to the radiologist who operated on her, one of the patients told me, “Oh, I thought he was a surgeon!”
While it is clear that IR is not well known and not easily understood by the general public, this lack of identification is sometimes found within the health sector itself. This may be the case for some medical correspondents and other physicians who may not be familiar with the full range of techniques offered by IR. Additionally, this may also be true for health agencies that do not necessarily identify the specialty very well.
The burden of history?
In fact, these issues have much to do with the history of the specialty. Quite quickly, the radiologist was associated with the role of a “simple” image-maker. As early as 1897, when Béclère created the first radiology department in France, his colleagues told him that “he was dishonoring the hospital staff by becoming a photographer.”
The legacy of diagnostic radiology has exacerbated structural and organizational problems that may have contributed to the lack of visibility of the interventional radiologist as a care provider. The difficulty of developing a proper consultation time and space and the lack of hospital beds dedicated to IR clearly did not help it to be easily identifiable by patients. This is all the more valid since the problems of competition between specialties (especially surgery) have led to a difficult valuation of the place of IR in the care pathway. For a long time, the competence and legitimacy of IR to intervene on patients was denied.
Obviously, things have changed since Dotter was confronted with the famous "Visualize but do not try to fix" message. IR is now more established in the medical landscape, it has a positive impact on the patient experience and, together with other specialties, offers a wider range of care. Nevertheless, it remains largely unknown, and one can therefore ask how to improve public awareness.
Improving public awareness
Within the health sector, a first area of improvement is the visibility of interventional radiology in medical curriculum. Introducing it earlier and longer would improve recruitment as well as make it possible to inform other future doctors of the possibilities offered by IR, so that they would think of it as a potential solution in the offer of care presented to their patients.
Another key element is the relationship with medical correspondents and the role of the interaction between interventional radiologists and other practitioners. It is through the nurturing of these relationships that strong links with other specialists can be established and that the skills of IRs can be better recognized.
Finally, politicians and health agencies are another target audience. Here, it is a question of strengthening lobbying actions, which can be a dirty word. Nonetheless, there is a need for action by professional organizations in order to defend the specialty, its recognition and its financing.
The effort must also be directed at the “civilian” world: the patients and the general public. The first element is the medical consultation, which has a strong effect in terms of visibility of the specialty. If patient information can be facilitated through brochures and fact sheets, direct interaction remains the way to go if you want to be identified as a care provider. Regarding the general public, many of the interviewees I met quipped that it would be necessary to operate a star to make the specialty more visible. Beyond the joke, this phenomenon is known as the “Angelina Jolie” effect: following her double mastectomy, an effect has been observed on screening awareness. After all, Dotter had also operated on VIP patients by traveling to them, which generated more visibility as well as donations to his service.
In a more realistic way, media and public communication should be developed. Unless you have an in with someone in the TV industry to influence the next medical shows, the best solution will probably be to reach the general public through digital communication. This can be done with the creation of videos presenting what interventional radiology is, by making texts to communicate to non-scientific audiences to have intelligible and accessible online information, which is not always the case. If initiatives have been taken in this direction, they are relatively recent, too few in number and with little media coverage to compensate for the initial deficit of visibility of the specialty.
Being a clinician
These different challenges related to the visibility of the specialty can only be met by keeping in mind the importance of the role of interventional radiologist as a provider of care. An organizational change concerning the place of the radiologist is underway, and the reinforcement of their true role as clinician. It is by putting the relationship with the patient at the heart of the profession that the specialty will be more easily identifiable by the patient, and at the end of the day, by the general public. Conversely, the interventional radiologist who refuses to engage with the patient will be no more than a skillful plumber. As Dotter pointed out: « The angiographer who enters into the treatment of arterial obstructive disease can now play a key role, if he is prepared and willing to serve as a true clinician, not just as a skilled catheter mechanic. He must accept the responsibility for the direct care of patients before and after the procedure; now see them as patients, not just as blocked arteries. »