The Doctor's viewpoint

PACS vobiscum

There are various ward jobs that pick their time.

It wasn’t so long ago that I was a newbie on the wards and moments of head-in-hands peace could only be snatched behind the bolted door of a lavatory or in a badly lit part of the ward.

Without exception it was exactly this time that the bleeper would go off and, eventually struggling to a nearby telephone I would hear my registrar ask: "So, got the x-rays for the x-ray meeting yet?"

There are plenty of daily hospital administrative tasks, but none more so arduous as preparation for the x-ray meeting.

The x-ray department was always found in the basement of any hospital and in amongst the rows of stale x-ray envelopes would be found some anaemic looking student, posted for the summer.

It was his job to look for my long list of x-rays and his job to put up with the groans and tuts when they couldn’t be found. This was inevitable. X-ray packets were empty, the wrong x-rays were in the packet, or only half the films were there.

The long list of imaging for various patients soon dwindled to two or three complete packets, and my arrival at the x-ray meeting would be met by my registrar’s disappointment. Not only had I failed, but of course it was my fault.

This may have seemed like a minor misdemeanour, but the inability to have imaging ready, reported, and properly consulted on only struck me when I started to run clinics. The absence of the crucial x-ray result meant another anxious week's wait for the diagnosis.

That 'mass' in the liver, which could be a cancer would have to wait until I could find the imaging, or the report or both.

And then the dawn of PACS.

It would be easy for me to sound like a trumpeter for government policy, but the truth is that the advent of PACS has had a huge impact on the way hospital medicine is practised.

Hospital medicine, especially for inpatients, needs to move away from diagnosis to treatment. Diagnostic tests are improving steadily in accuracy and speed and, as such, the diagnosis should make up only a fraction of the patient’s time with the doctor.

If I have a problem, I want to know the cause quickly, and then start treatment. Getting a diagnosis is not just about doing tests, but also about the availability of information.

I want to know exactly when this liver cyst was found and where it was — has it grown from a previous scan; does this tally with the blood results? As such, good information needs to be available quickly. This is what PACS provides — the universal availability about a patient’s radiology so intelligent decisions can be made.

I now can tell what scans were performed when on every patient, from anywhere in the hospital. This makes the art of diagnosis a much easier and more precise one. I can also educate myself about aspects of imaging, as well as show the patient zoomed-in images and allow them to visualise their problem.

And of course medical students can learn more about these important diagnostic tests (or just change the image's contrast so it look like the head CT just shows an empty cranium amongst hoots of laughter - an accomplishment of our last medical student).

Of course, the celebration needs to be guarded. There are problems. I can't see the CT scan of a patient who had the test at another hospital without getting hard copies (and with Choose and Book, a patient's care is increasingly likely to be disseminated).

Worse still, if a patient has a severe head injury, I have to courier the scans to the regional neurosurgical centre with the possible delay of hours for emergency surgery.

Now that the technology exists to distribute imaging, this problem will need to be solved. I have faith that these largely networking problems can be overcome, and the sooner the better. These are the dots that need to be joined to provide a genuinely complete and useful imaging system.

For the moment, however, I'm impressed by the impact of PACS at a local level, but never so impressed as the junior doctor who's information gathering burden is made ever lighter.

Dr Sebastian Zeki is a Gastroenterologist at Ealing Hospital.