Professor Erika Denton is the National Clinical Director for Diagnostics, NHS England
You will be delivering the BIR Mackenzie Davidson Lecture at our Trainees conference in November 2013. Given that your lecture is called “The impact of changes in the NHS on imaging”, what three pieces of advice would you give to a trainee entering the profession?
Don’t listen to the doom-mongerers. I think the future for radiology is rosy and bright. Imaging is fundamental to so many patient pathways and the difference we make to pathways for patients and patient care means that there is absolutely no doubt we have a really sound future. The continuing advances in interventional radiology and the speed of change in the way that we deliver imaging mean we have one of the most dynamic careers in medicine.
Get the basics right—understand your anatomy and your physics. This will stand you in better stead than you can ever imagine as you get older and longer in the tooth as a radiologist.
Be prepared to be flexible. What you think you will probably end up doing when you are a new trainee radiologist is probably not what you will end up doing once you are ten years into your consultant post. You need to be comfortable letting that happen and this flexibility is what makes a great radiologist. You will not be fixed doing the thing you started out doing. Careers and the subject evolve over time, often rapidly.
What has been the biggest challenge for you in your current role?
I am now National Clinical Director for Diagnostics. I looked after Imaging in the Department of Health and then with the advent of NHS England I was appointed to a new National Clinical Director role which also encompasses the broader spectrum of the rest of diagnostics. I work with the National Clinical Director of Pathology, the National Clinical Director of Gastroenterology and Hepatobiliary disease and the Chief Scientific Officer to look after all of diagnostics. Part of my recent challenge has been getting to grips with and understanding, for example the pathology programme of work and what is needed in terms of service improvement for pathology and also endoscopy with a current focus on services for GI bleeding. Interestingly there is overlap with previous work I have done to improve 24 hour access to radiology services especially interventional radiology. There are similar workforce challenges and similar issues for smaller hospitals across the diagnostic services.
One of the most important things when you are facing something new that you don’t understand is that the first job of work is really fact finding and understanding the subject area and then next understanding the key people involved and organisations to work with and liaise with. For example, I am now working with The Joint Advisory Group for Gastroenterology, The British Society of Gastroenterology and the Royal College of Pathologists. These are groups I have had very little contact with previously but in the new role I work closely with them. And am also working with the bowel cancer screening group—we have had contact through CT colonoscopy but I am now looking at the endoscopy side. So, it is a very different role in some ways and similar in others.
Given the financial pressures on healthcare, will the required investment in the latest imaging technology be affordable?
This is always a real cause for concern. And where I come from is we have to look at value for money. It’s not appropriate for every CT scanner and every magnet to be absolutely top of the range. We need some of those—but not all equipment can be “all singing and all dancing”. I think where we can demonstrate value for money and where we can see we are adding something to patient care there will never be a problem in affording the right equipment. Where it gets difficult is when we are pushing the boundaries. So, for example, PETt MR, which is frighteningly expensive—whilst we are in the phase where we are working out how we use PET/MR, how to use it best and what benefits it will bring and value for money it offers, this is where it becomes much more difficult to work out a business case for its purchase.
Will we ever have a 24-hour radiology service?
I don’t think we are going to be doing everything in radiology 24/7 365 days, but will we be doing a whole lot more across 7 days a week? Yes. The days of us operating a service Monday to Friday from nine to five have gone.
How is the new system of Any Qualified Provider (AQP) impacting on services?
The AQP programme is impacting in a really variable way geographically. In some parts of the county commissioners are using AQP to go out to tender for many services. For example, it had a big impact for some ultrasound services where there may have been a big tendering process with lots of providers. In other parts of the country, it’s made very little difference. This was to be expected. As National Director for Imaging I was very involved in making sure specifications for the contracts where they included imaging were very robust, and we had considerable success in that. So there is an impact—there are natural fears and concerns that when services are split, that the acute hospitals will be destabilized although no evidence of that as yet. I think commissioners are very aware of the issues AQP brings and they do understand the risks that come from splitting service providers.
My proudest achievement is ...
My kids! Undoubtedly, the big challenge of these roles when you are a Mum is balancing your professional and domestic worlds. There may be days, perhaps when you are on holiday or in the evening, when you are not a National Clinical Director or a radiologist but you are certainly never not a Mum!
What advice would you pass on to your successor?
When something feels difficult, step back and think about it from all angles and all other peoples’ perspectives. This is particularly important if you feel that a one to one relationship is more challenging than you are comfortable with. Usually if you look at it from the other person’s perspective and work through that before reacting, you can often work through it more successfully. Things become less daunting if you face them from every angle.
Why did you originally become a radiologist?
I was fascinated by the diagnostic challenges—the process of getting the answer. I found the follow up process, particularly in general medicine, less interesting. I was gripped by the diagnostic conundrum. Radiology is the key to so many bits of what we do. And I love the pictures—I’m a pictures person. I like looking at things. I think in images—if you are into that kind of thing then radiology really appeals.
What do you say to people who say those who choose radiology are doctors who realised they didn’t want to be in the profession or because they don’t like interacting with patients?
People say that about histo-pathologists—who just look down microscopes. That’s a naivety and lack of understanding about what other people do. It’s like saying a surgeon is a butcher. Clearly that’s utterly ludicrous. There are masses of misunderstandings about any profession and you only know it and understand it when you are in it. Every different branch of medicine has something to bring to different aspects of patient care. If you are a radiologist and you particularly like the diagnostic side or interventional side or both and you like looking at images—otherwise you won’t be very good at it. Other people won’t want to do that.
As for interaction with the patient—I’m a breast radiologist. I do two days clinical work now and I do predominantly – breast work and gynaecological ultrasound. All of my clinical practice, apart from some plain film and mammogram reporting, is interacting with patients. This work is often with patients at their most anxious or frightened in their journey through health care. A person who has breast cancer or ovarian cancer, when they see the radiologist you are the most important person they will see at that time and they will remember the dialogue with you, especially if you have to break bad news to them more. So, I profoundly disagree with those that say radiology is for those who don’t want patient contact unless your career choice is to work only as a teleradiologist sitting at a work station for a teleradiology company—well that’s a different job and to date I don’t think anyone does this type of work full time as the colleague and patient interaction are so important.
Why would you encourage someone to join the BIR?
I joined the BIR primarily so I could access the journal. It’s a really good journal because it covers a broader spectrum than just clinical radiology—it gives you a feel for physics and the different aspects of imaging.
The BIR is multi-professional, so it covers industry, the physics behind imaging and the wider clinical teams who are involved in imaging—not just the doctors. Radiology is the most multi disciplinary subject— we work really closely with all our colleagues. You can’t run an MRI scanner without your physicist. You can’t run nuclear medicine without really good science back up. We are too often siloed, as doctors, into a world where only doctors communicate with doctors. In the last 20 years we have moved progressively away from that. And the BIR symbolizes for me multi-disciplinary working—and I think it does it really well.
What is the best part of your job?
There’s many—I’m not sure I can answer that! The feeling that I’ve made a difference, whether that’s working to reduce waiting times for imaging or improving access to imaging so all patients can access 24/7 inteventional radiology or the access for a patient with a GI bleed that everybody would be able to access an endoscopy service. But also making a difference one to one. If I can make a patient, individually, feel comfortable and not frightened when having a procedure done or attending a frightening appointment for investigation, I’ve made a difference. That’s probably the most important thing about my job.
What is the worst part of your job?
Juggling and travelling. I live north of Norwich in the middle of the Broads—it’s the most fabulous place to live but it’s a long way from anywhere. The travelling’s not great, and I can spend an awful lot of time on the train. Making sure I deliver to the best of my ability on everything I am dealing with means quite often I have a lot of balls in the air to juggle.
If you could go back 20 years and meet your former self, what advice would you give to yourself?
Be nicer to yourself and don’t push yourself quite so hard. Don’t be scared. Life tends to be alright. Be true to yourself and do what you feel is right.
What might we be surprised to know about you?
I am a sailor—we have dinghies, kayaks, a sailing boat and a motor boat. We grow most of our own vegetables and I love my garden!
Which actress would play you in the film about your life?
Liza Minnelli—I can’t sing like her but I’d like to. She’s fun loving and a bit quirky and people say I used to look like her when I was younger – when I had dark hair. She also has the reputation for getting what she wants—and I am quite a stickler for getting things right.
