Ask a Queer Interventional Radiologist
At long last, May's interview with Dr. Joshua Scantland
This next interview was a trip to get on my calendar, and it was my fault, Dr. Scantland was nothing but accommodating. This was around the time that I was adopting my dog, Cashew, and trying to get a meeting with him and the rescue was taking up all my free time. Anyway, this interview with Joshua Scantland (he/him) was a pleasure. Joshua is an Integrated Interventional Radiology Resident in his last year of residency practicing in Indiana.
Joshua identifies as a gay man, and we talk about how that identity intersects with his work a little in the interview. We also talk about dogs but I cut that part out for the sake of time. While we talk Joshua is on a walk with his dog who I learn hates skateboards.
It might sound intuitive but this interview taught me what Interventional Radiology is, so I now have a new medical specialty that I’m aware of. I hope you enjoy this one as much as I did!
Dani Janae:
Okay, so when did you first realize you wanted to get into medicine?
Joshua Scantland:
I was actually pretty late in that realization. I was the first in my family to really go to college. And so once I got there, I was not sure what I wanted to do with it. My first declared major was psychology, but that didn't go anywhere. So at some point in time, maybe two or three years into college, I took some, a lot of self-exploration exams are like the personality exams, and they determined that I would like to work in an environment that let me work with people but also was very technical. By that nature, I kind of landed a little bit on medicine and then started shadowing people and that's kind of what further solidified things. So it was kind of a slower realization, and not as like a lifelong dream as some people might have had.
Dani Janae:
Yeah, totally. Yeah, that's cool. So was radiology your first choice? Or was it like a journey to get there as well?
Joshua Scantland:
It was kind of a journey to get there. I mean, it ended up being my first choice in the end. Yes, but I really didn't know what I wanted to do. But initially, I was very interested in neurosurgery for a long time. But then I kind of stumbled into interventional radiology and radiology, and that kind of snared me, in a way. It was the incorporation of technology and equipment. And so that kind of was really appealing to me. And so that's kind of how I got latched.
Dani Janae
Totally. Just because I'm curious, and also I feel like it'd be good for readers to know, what do you mean when you say interventional radiology?
Joshua Scantland
Yeah. So, radiology encompasses multiple different sub-specialties. Whether that's breast imaging, like breast radiology, but specifically, there is a side with sub-specialization. That is where we do additional almost surgical-like training and we perform minimally invasive procedures or surgeries with imaging guidance. So that would be like like ultrasound guided biopsies or CT guided CAT Scans, CT guided placements, or fluoroscopic guided vascular interventions. We use the combination of radiology and interpretation skills and use that to guide our hand when performing certain procedures.
Dani Janae
Yeah, yeah, that sounds cool.
Joshua Scantland
Yeah, it's really fascinating. And I think it utilizes a lot of skill sets. That was really fascinating to me.
Dani Janae
Yeah, totally. So I think like, I've only done a couple of these interviews so far and one thing that I have noticed as I'm moving through them, is that the people that have volunteered to talk to me, have been in very different kinds of fields of medicine that don't get a lot of like shine or attention. So like, I talked to a family medicine doctor, I talked to an emergency medicine doctor, and I'm wondering, what does an average day look like for you? As like an interventional radiologist?
Joshua Scantland
Yeah, so I guess I start off early. Not as early as some, but similarly, I try to get into the hospital, usually around 6:30 in the morning, and I start my day off by kind of running through our tasks. We'll have a list of surgical cases or procedure cases that we're gonna have going for that day and I will, at that time, just review what cases are happening and make sure things are lined up, orders are put in so that we have a smooth start to the day. Sometimes there'll be a conference that I have to attend usually at seven o'clock in the morning. I'll kind of attend that conference, as I'm also continuing to work and then begin cases usually close to eight o'clock. And just keep running through various different cases throughout the day until we get to the end, which hopefully is near five, sometimes six, it has gone as late as 8:00 pm before and then sometimes I might have to do some call coverage, like essentially additional ships and evening or overnight.
Dani Janae
Yeah. Okay. What would you say on average is the number of people or cases that you see a day?
Joshua Scantland
it's really variable on the complexity of the cases. If we see simpler cases maybe 8-10 or more. It doesn't sound like a whole lot, but just given the turnaround time and how much time we're spending on these cases can be a lot. And then, for more complex cases, which could take up to a couple of hours, the number is lower. Now, a lot of it also too, is dealing with consultations. Some people will ask us in the hospital, requesting certain things or, you know, if they need help with something and they're gonna try to figure out if we're going to be able to help them or not. So, throughout the day these will be peppered between cases and I will have to review patient cases and see if there is something that we can offer to help.
Dani Janae
So this question I like to ask but, what do people assume about you when they hear what you do?
Joshua Scantland
So this is actually funny enough. Sometimes I'm cautious about telling people about exactly what I do and I will paint it in a language that is a little vague intentionally because I think it does sometimes change the dynamic of interactions. I, you know, am not really sure exactly what their assumptions are, I think, I always worry that assumptions might be more negative if anything. I think they might assume…I don't know like, maybe arrogance, or something like that, you know, like, if I am opinionated, and I'm a barber, people will just say I'm opinionated, but if I'm opinionated but also a physician, people are gonna think that I’m arrogant. Either that or they assume that I'm judgmental. When I met people and tell them what I do they almost have an immediate sense that they're trying to justify their career decisions to me like I'm judging them. I don't like that feeling. I want people to be comfortable around me so I just downplay it a lot. I will say like, oh yeah, “I work in healthcare in the radiology department.” And if they try to ask for more usually I'll just say like, “Oh, yeah, I you know, I deal with patient care or ensuring patient quality care.” Like just to mitigate that.
Dani Janae
Yeah, totally. Understand that. So along those lines, I'm wondering if there are any misconceptions or myths or anything about your field that you feel like you would want to dispel or things that people think about what you do that aren't true?
Joshua Scantland
Yeah. I think one that I hear sometimes— I don't hear it a lot— but when I do hear it, it's equally disturbing. People have heard that physicians don’t have the patient's best interests in mind. Sometimes they think they're motivated by external factors. And they think that the recommendations are based on external factors like money. In the end, at least all the physicians I know, the decisions they make because they truly do believe in them and they would recommend it to their own mothers the same advice, you know. But I mean, granted, it's because there have been people in the past who have abused the system and ruined it for everybody else. But you know, I think that's kind of a thing that I would like to dispel. There is just this distrust, people assume that physicians are self-motivated, when in reality, it takes a lot of effort and skill. When I talk to other physicians, they're all motivated by the sense of altruistic means of making the world a better place, so it's because that's the center of it all, at the heart.
Dani Janae
yeah, exactly. Yeah. The interviews that I've done already, I feel like a lot of what I've heard and like what I've heard from other people that aren't in medicine, is that people get into medicine because they want to make big money and things like that.
Joshua Scantland
In the end, like even the high-end earning physicians, they delay making money until their late 30s or 40s. Or, like, those who started working a job as an autobody mechanic at the age of 20 will have the same net worth essentially all the way up until maybe the age of 50. You know, it's not really that much of a profit-turning career, not like something like pharmaceutical sales or someone who's an entrepreneur.
Dani Janae
Exactly Okay, so this question is about the ways that queerness or sexuality and gender identity intersect with the work that you do on a regular basis. So, do your sexuality and your role ever meet?
Joshua Scantland
I think so, usually, and it comes up in how I'm able to interpret the experience of someone who is clearly in the community. There are and I think it's no mystery there are a lot of straight white men in medicine. And I think, as you know, diverse representation is important so that these people who are providing care can relate to those individuals’ experiences. And I think that's where I see the play between my field and my identification is usually in my ability to relate, and I think even in the same way, the fact I mentioned before, for people that come from a lower socioeconomic status or low-income settings. That was kind of what I grew up in. And so I think I can also relate and understand struggles and barriers to care a little bit more, maybe more than someone who has not experienced that.
Dani Janae
Totally. Are there other doctors in your hospital that you get to interact with who are also queer or gay?
Joshua Scantland
Yeah, there's a couple. There's one that I consider a friend. I've hung out with him outside of the workplace. He's actually one of my staff, one of my attendings, so there's another of my interventional radiology staff who is also he's gay as well. I've not really hung out with him outside of the workplace. He's a little bit older, but he's also known to be gay. There are a couple of co-residents of ours in my program. They are diagnostic radiology residents interventional, which means that they are just looking more at images and interpreting them. One is a lesbian and the other one is as well, so yeah.
Dani Janae
If we could just go back a little bit. I wanted to talk a little bit more about if it's okay if it's like not to talk about then that's fine. But coming from a low-income background. How do you think it has that affected your approach to care?
Joshua Scantland
Well, and I think this should be comforting too, in the sense that I don't notice differences in my approach to care than others. And I think because so many people still regardless, despite of their upbringing, or the backgrounds of the patients really try their best to do the right thing. So I don't see too strong of differences in how I choose to practice or what kind of care I provide. And then often, I think it can help me interpret some of the more complex social situations, for the most part, but I think, in the end, everybody's heart is still in the right place. If they're able to really put those pieces together the same way. You know, they're always still wanting to do the right thing.
Dani Janae
Totally. Okay, so my last question is, if you could change one thing about how medicine is practiced, what would it be?
Joshua Scantland
I think most of the things that I want to change would be more public health related. And I think it's all centered on the fact of a more corporate capitalistic drive. There's a more corporate capitalistic drive behind medicine in some cases, which inflates healthcare costs, and I think has impacted patient care globally. Or I guess I should say nationally. Regulating patient costs, over-utilization of imaging and diagnostics, and medicine, all in the interest to have quicker turnaround times for things. And so I guess I would like to see better access to care, primary care. Of course, the challenge too is there's a cultural component to it.
A lot of people in my family, I get really frustrated with them because they need to get something taken care of, but they just don't want to pay for it. Don't want to wait for the primary care doctor or they didn't want to go in because they think it’s a waste of their time. And it's because people, strangely enough, if the maintenance of their health is secondary to whatever else. It's a cultural thing. Which really kind of makes it more challenging. So there are ways to receive care and a way to treat something as opposed to preventing it. This causes flooding in the emergency rooms, which causes inflation of costs, but also for people with cancer, who need to make sure they go see a cancer doctor so that it's appropriately managed and that they are followed for the duration of the treatment. They can't really just go in to see their specialist because of this issue, which makes it a really multifaceted problem.
But in the end, I think if we could restructure the system in such a way that people have much better access to primary care. And, of course, there would need to be some legal changes to help protect patients against the increasing expenses, and the cost of certain medications and whatnot. And there's a really good book called American Sickness, which talks about like, inflation of health care costs related to factors like hospital administrations and pharmaceutical companies that are both competing for increasing profits and the patients have little to do with negotiating. You know, they don't really know what's being asked or like, when a lab or whatever is recommended by a physician, patients are always gonna say, “Yeah, sure” without really knowing costs. And so there's just all kinds of issues and I think it's just all centered around this fact that the people who are not being consulted to help in these situations and patients aren’t being given the knowledge to be as involved in their own care.