The title of this essay on its face seems contradictory. Of course we know what business we are in. Don’t we? Well how should we answer that? You and I are experts in the interpretation of images of the human body generated by a variety of energy sources. We are also experts in the implications of the abnormalities we recognize and in the appearances of the spectrum of normality. And increasingly in both of these manifestations of illness and lack of illness, we gain perception of both its static and dynamic configurations.

Well, that is the substance of our intellectual labor but our main business is consultation and communication. Such a distinction is important for how we comport ourselves, how we make ourselves and our expertise available, how we relate to referrers and patients, all of which are dimensions of our job as important as and separable from our capabilities as diagnosticians. Fundamentally, the distinction between our craft and our business is akin to that of animated movie makers who possess special knowledge to create alluring images but whose salable product is wonder and diversion.

So how do we perform in a very specific environment; a large hospital. Do we tend to our business as I have defined it?

Radiologists tend to decry the incursions of other medical practitioners into the territories we consider our own. We all hear the litany from many of our leaders about how much (some say even more than half of imaging) is done by physicians in other specialties who purchase and use their own machines for their enrichment. True enough but radiologists presentiments and the exigencies of our partially regulated market place do not necessarily have to coincide. We also rightfully complain about intra-hospital competition by others such as E.R. physicians who after a few days of attending at a course claim competence in ultrasonography and by vascular surgeons who want a piece of the angiography pie.

Yet, by and large, in major hospitals and in their associated outpatient clinics and imaging centers, radiology remains a monopoly. No one else is allowed to do breast imaging. The CT and MR machines are ours by ownership or usufruct. PET/CT is almost always a province of radiology and so forth. Yet, too often as a monopoly we adopt and maintain the business ideology of one who has no competition, especially when it involves our core functions of communication and consultation.