Politics and Judgment

If you have to smile, it isn't a sport. That is what I am thinking about as I watch the Olympics in Salt Lake. Is skating really a sport? Is snowboarding the ``half-pipe'' really a sport? Is anything where ``judgment'' is involved really a sport? Did you watch the Norway vs. Italy biathlon or the Canada vs. Russia hockey game? These are real sports. There is great competition, heart-stopping excitement, and real action decided by skills, not judgment issues. Did the Canadian pairs really beat the Russian pairs skaters, or was this event decided by the press? I never really have liked these types of events. Gymnastics, ice skating, snowboarding, ballroom dancing are not and have never really been sports to my eye.

Yet, as ``antijudgment'' as I am, about deciding these things, I and you are affected a lot by ``judges'' of what we do. Do we really do many objective things in interventional radiology? Yes and no. We certainly have to be successful in our work, and that is very objective. Multiple complications would lead to fewer referrals. On the other hand, there is a lot of ``marketing,'' smiling and being available at the right times for the referring physician, which makes us more attractive as a referral service. These ``high smile scores'' are present in all areas of medicine. It is rare that a gastroenterologist will refer patients to a surgeon if he or she is a real jerk. Certainly, in academics, the acceptance of a paper is one of the most ``subjective'' things we see in medicine. Many times, it is not the science but the presentation or even the subjective response of the reviewer that can determine whether a paper is accepted in a prestigious journal. Is this any different from the French judge who decided that someone should win the gold medal in pairs skating over another team because of nonskating reasons? Is this any different from someone not referring a case to you because you told someone at lunch that he was a jerk?

Politics and judgment are in everything we do; many years ago we wrote a paper on the value of clinical rounds on patients who were on the ``ward'' and who had interventional catheters in place. We stated that about 20% of patients had findings that we noted and acted on, which changed the clinical course of the patient. Now, 20 years later, we still make rounds, but it seems clear that more important than clinical findings is the fact that referring physicians actually ``see us'' on the ward and interact with us. It matters less that we see the patient than that we are there. Our version of smiling at the judges? Subjective, not objective findings. In reality, we are being judged by our referring physicians not only by our objective results of a successful biliary dilation in a postlaparoscopic patient but also by the rather subjective observation that we are actually on clinical rounds seeing patients. We all know that interventionists in the United States are talking about having a clinic, seeing patients without referrals, and so forth to gain more vascular patients. Sure, we are doing this to gain more control of these types of patients. But, also, we are trying to show the nonradiologists that we are ``really taking care of patients,'' like them.

Subjective. Judgmental. You bet it is. You know what, maybe we should smile and we will get the ``gold medal'' like the figure skaters. Maybe the subjectivity and judgmental ideas are more part of our fabric than we thought!