Being and nothingness.

I am reminded of the title of this quintessential existentialist novel by Jean-Paul Sartre as I contemplate the current existential crisis of radiologists. Both a field of philosophical inquiry and a literary movement in the last century, so popular that it became a cliche in the works of Woody Allen, existentialism concerned itself with human existence and particularly its purpose: the meaning of one’s life in a transient, senseless reality. Existentialists sought a justification for being, meaning, and societal commitment in an ultimately haphazard, pointless universe. Sartre, in particular, argued that selfdefinition is a struggle and in constant conflict with how one is defined by others. In a random world, he felt that we create our values and nature through freedom of choice and sheer will (Nietzsche was a forefather of existentialism). Unlike the traditional view that one was endowed with a “human” nature determining one’s ultimate purpose and value, existentialists start with the notion that existence precedes essence. Existential philosophy insists that our essence is of our own making. Although we find ourselves existing in a world not of our own making, we are faced with the responsibility of choosing our own nature and values, our raison d’etre, and in doing so, we have the daunting responsibility of choosing those attributes and values of our nature that we would also wish for others. Despair comes in seeing the contrast between the world we are thrown into, one with little ultimate meaning and that we cannot control, and the absolute freedom we have to create ourselves, to determine that meaning which is under our own control. Yet the mass of men lead lives of quiet desperation, as Thoreau said well before the existentialist movement. Conquering despair requires choosing a meaning—an essence—through our actions, in the existentialist formulation. The rapidly mutating health care environment mirrors the haphazard external reality painted by existentialists; namely, it is a world we do not control and did not choose, and one that constantly tries to define us by nonrational determinations of value. Existentialists would argue that ill-defined external value allows us to create value from within ourselves—self-derived value being more powerful because it cannot be taken from us by others. So how should radiologists define themselves? What are the values, the attributes, we should choose for determining our essence? By extension, how would our professed selfdefinition incorporate those values we would wish for those around us? The issue of existence preceding essence is not entirely certain for radiologists. Our essence becomes a subject of angst only if existence is a given. Do radiologists need to exist in the first place? As clinical specialists adopt the increasingly facile, user-friendly imaging tools developed by radiologists and their engineering colleagues, and couple those tools with their perhaps deeper understanding of anatomy, disease pathophysiology, and specific patients’ clinical pictures, the need for radiologists has begun to be threatened. Imagine clinicians’ being further armed with advanced pattern recognition software, decision support with embedded neural circuits enabling choices for symptom-related protocols for various studies. For that