Ian Brett
Consultant Diagnostic Radiologist
Tameside General Hospital
How did you train for Diagnostic Radiology?
I started off at the University of Dundee in 1976, and then spent one year as House Officer in Leeds and Shrewsbury. I studied orthopaedics and surgery in Wakefield and took further surgical training in Liverpool as a SHO in surgical specialties. At this time radiology was developing into more than radiology used to be. I took careers advice, which was there although it wasn't formalised. Surgery is a competitive specialty and I realised that it wouldn't suit me. I enjoyed being a clinician and with radiology I could become involved in nuclear medicine. In 1982 I became Registrar and Senior Registrar in Liverpool and the surrounding areas of Chester, Warrington and Whiston. I obtained my DMRD ( Liverpool) and my FRCR in 1987.
Has it lived up to your expectations?
Radiology is about digitalised imagery now. My role is to supervise and support. It is all about reviewing, reporting and diagnosing clinical information. We are diagnosticians. Team working is important, especially in cancer care units. We help clinicians decide what treatment to give and are clinically focused in our involvement with patients.
It is a specialty driven by work load issues and technology. The continuing challenge for this specialty is the workload issue. There is a shortage of consultants in post nationally. It is also an international problem. Developing countries have a great need for radiologists. There is a greater clinical workload in those countries.
The specialty has developed exponentially due to new methods and technology. New technology, the development of ultrasound - CT, magnetic resonance scanning, nuclear medicine - enables clinicians to look at bodies in new and different ways which are complementary to the old methods. It is common now for a lot of patients in hospitals to have at least one of these four types of screening. Clinicians require greater detail and quicker results and, therefore, radiologists have more clinical contact than used to be the case. We are now an integral part of the clinical team. Because of this it is also possible to sub-specialise. The specialist radiologist understands different techniques used in, for example, gastrointestinal or neurological imaging. We are, therefore, now working in specialist teams.
Due to the changes in equipment, there are opportunities to go in directions not there 10-15 years ago. Imaging is critical to much medical work.
How will the technology be developed in the region?
Each hospital will have a technical rollout. In four years time everything will be available by computer - MR and CT scans, digital imaging, will all move to the LAN or WAN. It has to be thought through carefully because there needs to be electronic protocols as well as medical protocols. For example, in future, if there is a neurosurgery emergency in one hospital in the region, the images can be sent to Hope and a Neurosurgery consultant can look at them to advise on the situation. It will also have an effect on on-call when CT scans can be viewed at home. Then anyone in the team will be able to see it online and join in the diagnosis.
Radiology has been focussed in primary care because these are the fund holders. Again, imaging in primary care needs agreed protocols to go with the evidence sent to doctors. The biggest driver in the UK is cancer care which is providing the impetus to focus the process: how we go about things, what is relevant in this new order. On-call is growing at the moment: it is now one to three a day. If there was no link to home it would be demotivating. But the growth in the workload should be offset by the technology and result in homeostasis.
Why the Clinical Tutorship?
At Dundee (who now has a virtual medical school) I was the undergraduate medical education representative. I'd always been interested in education and took the opportunity to become involved when it presented itself. I've done it for 13 years now but am giving it up in September to take on the lead clinician job. This will involve accountability issues and clinical governance. There is a responsibility for tomorrows’ doctors and it is necessary to be accountable in future. There is a need for mentorship and formal induction. If there are poor doctors, it reflects on who trained and supervised them. It is very obvious, for example, regarding surgeons in training, whether the training was good or bad, because it provides high profile cases. Like anyone else, medical staff can be demotivated by outrageous politically motivated generalisations and statements. There are pressures in training and support is needed. The best is being done in often difficult circumstances and problems arise because of the situation and the reaction to it.
What personal qualities and skills do you think are needed for the work?
Being a good communicator is necessary. One needs to communicate easily with colleagues for patient management. Many clinicians need to understand imaging technology and techniques and have become more reliant on radiologists.
It is advisable to have a period of clinical experience. Most Radiologists go in at Registrar level and take exams for Fellowship of the Royal College. Experience in A&E always stands Radiologists in good stead. Medical and surgical skills are combined in A&E: there is the time element, management skills, working as a team and a wide based clinical work load. Radiologists are not as remote from patients as they used to be.
Specialist interests are good to offer at interview. Initially one specialises and gains in-depth knowledge, then, as a consultant, one broadens out again to manage the department, the workload, education, training, audit, etc. As a developing specialty with its own interests or sub specialties one can become swamped with paper work and writing lists, so it is important to have good management skills.
Radiology is an exciting and developing specialty making an impact on modern hospital care.