This radiologist wants more stringent controls on ordering radiology tests. “Unfortunately, well over 10 years of a ‘just say yes’ philosophy applied, not just in a clinical realm, but in academic realms, is now paying off with grave and dire consequences. While ‘just say yes’ is an effective means of expediting and efficiently obtaining imaging studies for patients, this works when the referring physician is an adequately and competently trained clinician, referring cases for which they have already performed some pre-screening evaluation.”

This probably won’t change for two reasons: 1) more studies equates to greater compensation for radiologists; 2) are radiologists willing to shoulder the liability if they deny a diagnostic study? (via Sumer’s Radiology Site)

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  • gasman

    It’s about time for radiologists to begin to behave a consultants.

    They should be well versed in providing information on which type of exam is most likely to answer the clinical question being posed. The best imaging modality differs depending upon whether the most likely diagnosis is brain tumor or brain hemorrhage. Should a contrast agent be utilized? the radiologist should be the one to suggest this also.

    Why must the radiologist be involved in imaging selection? Because then they can give more meaningful answers. All too often their reports state ‘inadequate techniqe, correlate with clinical picture’ {gosh, I wonder who is responsible for x-ray technique or can determine whether better technique by repeating the imaging would be helpful}. Radiology reports are a bit like an autopsy report; what they can illuminate about the patient’s condition is too late to be of benefit. Clinicians involved in patient care must interpret x-rays, make clinical decisions and act upon their interpretation hours before the radiologist gets around to their reading. Radiologists charge huge professional fees for reading these films, but their read is often of little importance because all clinical care has already been decided and done. The clinician first seeing the film takes all the liability but gets no offsetting professional fee for their reading. The radiologist gets the benefit of hindsite bias, knowing the outcome, before applying their opinion of the film.

  • Anonymous

    I WOULD BE THRILLED if Radiologists stepped to the table and limited the out of control number of studies we do in emergency medicine. I cannot imagine how many cases of cancer the legal profession has caused by our need to “rule out” everything. Of course, in addition to refusing tests, the radiologists of course will have to come to the Emergency Department and discharge the patients (and take it up the ass when the lawsuit occurs) they refuse to do studies on.

  • Anonymous

    “their read is often of little importance because all clinical care has already been decided and done”
    That may be true for studies involving only the old fashion Xrays. At the ER, we rely on the reading of the Radiologists for the CT’s to rule out pulmonary
    embolism, acute appendicitis,volvulus, intussuception,etc and rely on their reading before giving TPA to patients with CVA. We rely on their reading of the ultrasound to rule out ectopic pregnancy. Their reading a lot of times determine the disposition we make in the ER. At night before waking up the Neurosurgeon we wake up the Radiologist to verify our reading for the epidural or subdural hematoma or a cerebellar hematoma. These radiologists have been playing a big role in the ER to the point now that a lot of hospitals in the U.S. use Radiologists in Australia at night(because it’s daytime there) for the reading of CT’s and ultrasounds. Radiologists whether they like it or not have assumed a bigger role in the hospital emergency departments.

  • dr john

    Shoot; the radiologists here don’t stoop to read my requests.
    You too can be a radiologist. Can you dictate, “Suggest MRI”?

  • Anonymous

    This guy’s quasi-Bayesian statistical approach seems very odd. Of course, if the population getting imaging has more people with no detectable ailment (because doctors fail to screen propery), the imaging diagnostic ability falls.

    But, even if that were true, doesn’t the radiologists’ read add the the mix of information–which altogether–leads to a better diagnosis? I.e., the question is not whether a radiologist correctly detects something, but rather if cases with imaging have better results than those that do not.

    BTW, the cost stuff is nonesense. If people just paid more of their bills, the whole problem would dissappear. THe choice to have that MRI or CAT scan would be the patient’s.

  • Anonymous

    “The radiologist gets the benefit of hindsite bias, knowing the outcome, before applying their opinion of the film.”

    That’s wrong. The usual case is that the radiologist gets no useful clinical information before, during, or after the test (unless he’s wrong). The referring doc at least knows the clinical history so it is in fact him who has the big advantage when looking at the Xray. It’s a lot easier to see a subtle fracture on a 40-film total bodygram when you know where the patient hurts.

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