The COVID-19 pandemic has provided many opportunities for medical professionals to share ideas on how to cope with various aspects of patient care during this crisis. However, in the case of IR as a specialty, we have seen a specific and positive phenomenon regarding how we as IR clinicians are involved and valued in our respective institutions. There is nothing like a crisis to expose who and what is most important. The pandemic has highlighted the importance of IRs as respected members of the health care team, which has had a positive impact on mitigating tribalism between IR and other specialties.
The ethical paradigm of tribalism describes an “us vs. them” mentality in which members feel loyalty to a socially constructed group, or tribe, and can result in contempt toward parties outside this group. Tribalism is a naturally occurring phenomenon in communities and has been a recent point of discussion in regard to specialties in medicine. It can be observed between different types of providers (e.g., physicians, nurses and advanced practice providers), between specialties, and even within specialties between residents and attendings. In some scenarios, tribalism can fuel healthy competition, but in the negative sense it can breed conflict, bitterness and isolation between groups. This pandemic brings to question how IRs are classically valued in a medical society that often exhibits dysfunctional and counterproductive competition. The concept of tribalism also extends to the exclusion of IRs from teamwork within true multidisciplinary patient care.
This phenomenon strongly supports what we as IRs have known for a long time—how essential we are to the timely and effective care of our patients.
Due to COVID-19, IRs have increased opportunities to directly interact with practitioners of other specialties. Some of these opportunities have been accomplished by expanding systems to perform selected procedures at the patient’s bedside. These opportunities, and the ongoing pandemic events, have diminished the potentially unfavorable connotations of tribalism and, in exchange, galvanized the spirit of teamwork and collaboration in health care.
When our colleagues in surgery and medicine were experiencing significant reductions in clinic visits and procedures, IR practices were largely busy with essential procedures and patient care, involving patients with cancer, trauma, infection, dialysis and other urgent needs for IR services. Our practice was only down a maximum of 20% of the normal volume and I am told that other practices around the country were seeing similar minimal reductions. This phenomenon strongly supports what we as IRs have known for a long time—how essential we are to the timely and effective care of our patients. Historically, there has been a notion that patients, and even some non-IR physicians, are unaware of the complete breadth of IR services, consequently stunting referrals. When patients are turned away from other specialists, and IRs can take on services traditionally offered by those providers (e.g., gastrostomy), IRs may be inadvertently making their presence known to patients and referring departments alike. Not only do we have an opportunity to promote and market our services to referring departments, but we are demonstrating our value as clinical specialists in hopes of future collaboration and consultation.
Hopefully, IR response during this pandemic will result in other medical specialties understanding just how much IRs can be the conduit to true multidisciplinary care and how we should be respected as colleagues and clinicians. The pandemic offers an opportunity for IRs to increase our voice regarding clinical decisions. New policies such as those concerning COVID-positive patients have granted interventionalists the right of refusal for those cases that do not require imaging guidance or technical skills. We should not accept the performance of procedures, purely due to a positive COVID-19 test. Exercising this right of refusal is a relatively novel concept in our (classically) referral-dependent specialty, thus instilling a sense of appreciation in referring providers for when we accept such cases in the future. Ultimately, this all results in enhancing teamwork between IR and other departments. As IR continues to transition to a more clinically oriented specialty, we continue to find creative ways to demonstrate our value in a team-based setting to strengthen the hospital’s sense of an IR-based multidisciplinary tribe.
This article was drafted in May, 2020, reflecting situations as they stood at that time.
