InterviewsMedicalPhysician Q&A

Q&A with Dr. Graham Lloyd-Jones, Founder of Radiology Masterclass

Dr. Graham Lloyd-Jones (BA, MBBS, MRCP, FRCR) is the founder and director of Radiology Masterclass, a leading provider of online medical imaging educational resources. Through the site Dr. Lloyd-Jones has reached millions of medical students, doctors, and other health care professionals, teaching the art of medical imaging interpretation.

Initially training in graphic design at the University of the West of England (1991), Dr. Lloyd-Jones then studied medicine at Imperial College London (2001), and completed his post-graduate training in radiology in Southampton (2009). He now specializes in musculoskeletal and thoracic imaging at Salisbury NHS Foundation Trust, Wiltshire, UK, where he is head of the Radiology Department, and he is also the Lead Radiologist for the Duke of Cornwall Spinal Treatment Centre based at Salisbury.

Dr. Lloyd-Jones is the co-author and illustrator of ‘Radiology at a Glance‘ (Wiley-Blackwell – 2nd Ed. 2017)

When did you first decide to become a doctor? Why?

On June 1st, 1994!

Three years previously I had completed a degree in Graphic Design specialising in animation. There was no work around due to a big recession at the time, so I took up a job keeping records of trials at Bristol Crown court. While I was waiting to go into a court room that day, I picked up a copy of Gray’s Anatomy which was used for reference, and I started to read. I found it fascinating and at lunch time I bought my own copy, so I could continue reading at home.

I wondered if medicine might be for me and so that summer I studied science text books and enrolled in evening classes to study A-levels in biology and chemistry over the next year. The day I discovered I didn’t need to study physics to be a doctor is still one of the best days of my life!

In my interview for medicine I think they found it difficult to believe, but it really was reading Gray’s Anatomy that first triggered my interest in medicine.

I entered medical school at the age of 27 shortly after getting married. My daughter arrived one week before my first-year exams started.

How/why did you choose the medical school you attended?

When I spoke with my local University, Bristol, they were perplexed as to why someone with a degree in Graphic Design would want to study medicine. When I spoke with St. Mary’s in London, they were much more accepting of the idea. It was the only Medical School I knew anything about as it had been featured in a BBC documentary, ‘Doctors To Be’, about life as a medical student, and being in the West of London was convenient for getting back to visit friends in Bristol, so I applied to St. Mary’s along with Bristol and some other London medical schools. Even though St. Mary’s, now Imperial College, was the most competitive medical school to apply to at the time, they were the only one to offer me an interview. I still owe a debt of gratitude to Dr. George Tait who was the admissions tutor at the time for his welcoming attitude to mature students with interesting backgrounds.

What surprised you the most about your medical studies?

It sometimes surprised me how difficult my colleagues found things I found easy and how difficult I found things they seemed to find easy. I only needed to learn anatomy once and it would stick, but this was not the case for many of the very bright people around me. I had to work a lot harder at other stuff like physiology and pharmacology. Any mention of the Krebs cycle or the Henderson-Hasselbalch equation made me sweat.

The truth is that there is something in medicine for everyone. I still think it is the best degree and the best training for life that any qualification can offer. If you think about it, medicine can be used in any walk of life, not just in medicine itself. Conversely, almost any experience gained prior to medicine can be useful within medicine, which is something frequently forgotten by medical schools.

What information/advice do you wish you had known when you were beginning your medical studies?

Not to take it too seriously.

I was very conscientious. Sometimes too conscientious. There was one time when we were told it was compulsory to attend a physiology practical because the results would not be statistically valid if there weren’t enough people. It coincided with my wife’s 20-week pregnancy scan for our first child. I should have asked to be excused but decided I should be at the practical. This was the wrong decision!

I guess this is true of any career, but I think medics have a particular tendency to get the work-life balance wrong at times.

Why did you decide to specialize in radiology?

In my first year at St. Mary’s, our anatomy professor told us that interventional radiology would take over the role of surgery. Although this isn’t entirely true, at the time it caught my attention. Later I remember finding out that GPs don’t get to look at X-rays, which to me was the fun bit of medicine. I seemed to have an eye for anatomical structures and was always the first to volunteer to present an X-ray on a ward round. The process of image interpretation appealed to my sense of spatial awareness and made use of my developing knowledge and interest in anatomy.

At medical school I enjoyed most things – perhaps not so much gynecology or psychiatry – and so I wanted to do something general. I also considered general practice and pediatrics.

I spent some time in a radiology department during my final-year elective and found the work very varied, and I enjoyed the vibe of a team of radiologists working together and consulting with other doctors a lot of the time.

Has being a radiologist met your expectations? Why?

Radiology is a great career. I thought I would enjoy it, and I definitely do. I can’t really see myself being happy doing any other speciality in medicine.

Many non-radiologists have the impression that it is a very technical and impersonal specialty. Although I don’t have as much clinic time as many doctors, I do spend 6 to 8 hours a week in direct contact with patients, for example doing ultrasound clinics or imaging-guided biopsies. You could argue that having good communication skills is even more important for radiologists as we only have short encounters with patients, often involving scarily large needles, and so it is important to be able to gain their trust quickly.

What do you like most about being a radiologist? Explain.

Radiology makes use of my interest in anatomy, and I find the variety of ways in which pathological processes alter anatomy fascinating.

There are many challenges in radiology, most of which relate to working in a limited health care system, but each day brings new intellectual problems to be solved. I enjoy the clinical detective aspect of the work. I spend a lot of my time in discussion with clinical colleagues, many of whom are friends, which is much less stressful than dealing with patients and their families on the wards. It’s rewarding to be able to offer an opinion which is valued by your colleagues.

What do you like least about being a radiologist? Explain.

There’s not much I don’t like about being a radiologist. I guess one thing you need to get used to is people taking you for granted or even taking credit for things you do. It used to annoy me when clinicians say, ‘I did a scan and I found…’, but now it just makes me chuckle. Some clinicians, usually the not so good ones, will say this sort of thing and show no appreciation for what radiologists do. Fortunately, most clinicians are appreciative.

Wasteful imaging can also be an annoyance. It seems that medicine is increasingly dependent on imaging before clinical decisions are made. This is good for radiologists, or so you would think, but really it reflects a lack of confidence in clinical skills. You may think it heresy for a radiologist to say this, but I am a firm believer that, ‘clinical medicine works!’ This is particularly true if patients are assessed by the right clinician. As a radiologist, you need to be prepared to have wrangles with clinicians if it seems that patients are not being properly assessed. Being a patient advocate in this way doesn’t always make you popular, but it is important to stand your ground if the patient could come to harm without your input.

What’s your typical work-week like?

I work full time in the NHS and I’m currently head of the Radiology Department, so things are very busy. When I’m not making tea or coffee, or deleting emails, I have a varied week of clinical activity. I spend 6-8 hours each week seeing patients directly in ultrasound or fluoroscopy, or when performing biopsies and imaging guided injections. At other times, I am reporting X-rays, CTs or MRIs, preparing and attending multi-disciplinary meetings, offering advice to hospital clinicians or GPs, or administrative work such as vetting referrals for investigations.

I also give time to teaching our junior medical staff and radiology trainees from the local training scheme and facilitating radiographer education.

On top of the usual jobs of a head of department I am currently also leading a team in planning a new building to house another MRI scanner.

Tell me more about how you started Radiology Masterclass.

Believe it or not, there was a time when it looked as though it would be difficult to get a job as a consultant radiologist in the UK… how times have changed! As a radiology trainee, I needed to find something that would set me apart from others. I decided to learn HTML coding in order to bring my degree in Graphic Design up to date; I had qualified about a month before Tim Berners-Lee posted the first web page. I also had an interest in education, so an educational website seemed like a good idea.

In my final year at medical school, I had carried out a survey into the use of radiology teaching websites available at that time. There were some reasonable projects out there, but I was surprised how little people actually used them.

I spent about a year learning coding and tried putting together pages without publishing to the internet. At first, I made all the mistakes that other sites had made: too much information, random content, and no clear audience in mind.

It was on reading the book, ‘Don’t Make Me Think’, by Steve Krug – an absolute must for anyone putting together websites – that I became happier with the direction the site was taking. The site was first published in 2007 with a single tutorial on chest X-ray anatomy, and things have gone from strength to strength from then on.

How has it informed your clinical practice?

Einstein was right when he said, ‘if you can’t explain it simply, you don’t understand it well enough.’ I frequently set out to explain something, only to find that I don’t fully understand it myself. Going through the process of making it understandable to another person via a web page definitely makes you learn what is important about a subject, and what is not.

There is no question that teaching something makes you better at what you do.

What do you like most about running Radiology Masterclass?

I like the creative process. Presenting high quality educational material draws on a wide range of skills in planning, preparing illustrations, and writing and editing text content.

Getting messages of thanks from many people is very encouraging and seeing the number of visitors to the site is staggering.

I used to do all the coding myself, but now the site is too complex. I enjoy working with some very clever people who help me keep things up to date.

Although there are several very good radiology teaching websites available now, there is no other site that has the same approach. Until someone else does it better, I guess I’ll keep going.

What do you like least about running Radiology Masterclass?

I find that publishing content to high standards can be a very slow business. Most of the time I work alone, which can be difficult. I have tried to involve others in the creative process of putting things together, but few people understand how to write for the internet and so it is often quicker to do things myself. Coding is the only thing that others are involved in. It was much easier in the early days, but now keeping up with changes in technology would be impossible without considerable help from my web developers.

On average: How many hours a week do you work? How many weeks of vacation do you take?

I am full time in the NHS. I do 1 or 2 on-calls a month and 4-5 weekends on call a year. I do a few hours private work each week.

Work for Radiology Masterclass is variable. I usually do about 8-10 hours work per week on the site, more if there is a project on.

I now get 34 days off a year in the NHS, plus a few days of study leave.

How do you balance work and life outside of work?

I live in a rural village not far from my hospital, and so it is easy to feel relaxed quickly on arriving home. I enjoy playing various musical instruments, I keep bees, and I’m an active member of my local church. Oh, and I spend far too much time playing Clash Royale and Clash of Clans on my phone.

I am good at not taking work home with me, which I think is easier in radiology than it is in some specialities. It is good to have a wife who is a doctor. We often talk through different scenarios the day has presented and it is good to have someone to talk to who understands the pressures of working in healthcare.

What types of outreach/volunteer work do you do, if any?

I see my work with Radiology Masterclass as my biggest outreach project. I’ve been very privileged to have had the excellent education I’ve had, and it is great to feel as though I can give something back. The educational material is free to access and has been read by millions of people across the world.

Closer to home, each year our village has a huge fair. Thousands visit from all over the UK. It’s difficult to live here without getting roped in to a fund-raising activity each year.

I’m often invited to local events to educate people about beekeeping which has been a hobby since I was a teenager.

I also do various community activities with my local church.

From your perspective, what is the biggest problem in healthcare today?

In the UK healthcare has become unaffordable. This is not the problem, the problem is having politicians who are not prepared to accept this fact, or even to discuss the possibility that this could be true. Placing healthcare in the realm of politics raises many problems. With each new election comes a new set of ideas about how things should be organized, resulting in huge upheaval and changes, often back to systems that have been tried before.

In my view, we need a moratorium on political change in the NHS. Rarely has the intervention of politicians improved healthcare. Just as we have clinical governance whereby we try to do the right thing by basing decision on evidence, so there should be a system of political governance whereby changes made by politicians are put through a set of tests to ensure there is no harm done. Changes made should be small and incremental, and the emphasis should be on maintaining an environment in which excellence can thrive. Enforced system upheavals may make politicians look as though they are improving things, but the opposite is frequently true as clinicians put everything on hold, often for years, until everyone has established a completely new way of doing things.

These days real change is driven by technology and innovation, not by politicians or committees in ivory towers.

Where do you see medicine at large in five years?

Medicine itself is great, and I think I will always enjoy the work. The trouble is that we face an ever-increasing workload with a workforce which is static or, as the case of radiology, actually decreasing in size. There is no doubt that being a consultant radiologist in the UK makes you very employable.

As technological advances are made, so life expectancy extends, and expanding populations will put increasing pressures on capacity in healthcare systems. I anticipate that the pressures of work will increase for doctors and, by necessity, more activities traditionally performed by doctors will be taken on by healthcare workers who are not medically trained. In the current climate this is a necessity, but senior doctors have a duty to ensure that delegation of roles to non-medics is done safely. The role of the medical educator has never been more important.

Where do you see radiology in five years?

In five years, I think things will be much the same, at least in the UK.

People are starting to talk about artificial intelligence, and it will be great to see developments over time, as they are much needed. I expect that AI will be used a lot in radiology, perhaps not so much in the next five years, but I don’t think it will ever completely replace the need for radiologists to be involved in medical imaging. If you think back to the time when people said, ‘computers will take away people’s jobs’, yes that is true, but look how many people now work with computers to make sure they are doing their job properly and to push developments forward. I think the same will be the case for radiologists; we will remain central to the clinical pathway of many patients despite the work done by AI processes, and there will never be a time when we think, ‘job done, we’ve now got it all in radiology’.

What is your final piece of advice for students interested in pursuing a career like yours?

Be an allrounder! To be a good radiologist you need to have a very wide repertoire of medical knowledge, you need to hone communication skills, and you need to be good technically. The more medical experience in a variety of specialties you can gain prior to starting post-graduate training in radiology, the better. Good luck!