This PCP is frustrated that radiologists are blurting out diagnoses and suggesting treatments after imaging tests:
Several months ago a radiologist, after performing a bone scan on a patient with a PSA of 70, went out and told the assembled family that my patient was “full of cancer.” Then he suggested a treatment direction which was somewhat different than what I had already discussed with the patient. Just the other day I received a call from a patient who had gone to have an MRI of the brain and she called our office afterward to inform us that the radiologist said she had a brain tumor and that she needed a CT scan, which was scheduled the next day and would we send an order for it.I am all for communication with our patients. But I do not understand this sudden desire by radiologists to interfere with my doctor-patient relationship. Are they billing for a consultation along with the procedure now? Do they just wish they were actually engaged in ongoing care with patients?
Related posts:
- How many radiologists cheat or take short-cuts in their interpretations?
- Who is responsible for an abnormality on pre-operative testing, or, aren’t radiologists doctors too?
- Should radiologists apologize to patients?
- Radiologists and communicating mammogram results to patients and their doctors
- Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine
- Are radiologists overstepping their bounds?
- Evidence based medicine and shared decision making
KevinMD.com on Facebook
{ 11 comments }
I had an X-ray tech tell me, after a mammogram, that there was something in there, and my doctor would want to take it out. It was inappropriate, and scared me practically to death! My doctor would not have worded things that way. I had a biopsy, and there wasn’t “something in there” at all.
Rads are probably doing this as they wonder how that person with the lump in their lung turned out as there’s no feedback loop to the rad after he signs off. Well unless he gets sued for a bad diagnosis.
But really they shouldn’t be scaring anyone and just find a way to communicate with the original doctor directly.
Before people spin this into one profession onto another, let’s keep this in context. No need to scream things along the lines that the doctor does in the Medical Economics article, although I agree I’d be upset to if that way my patient.
First, all patients ask “so what did it show”. The only person the patient sees is the tech and the tech tells them out of courtesy -not malice. So lesson one, all techs should be taught not to say ANYTHING and give a standard stump response, the radiologist or your doctor will inform you.
If radiologists want to be involved in the clinical aspect of what something shows, as a courtesy and acknoledgement of their role and expertise, they should consult with the physician first. And the PCP or most innvolved MD should be in charge of relaying info.
Like anything in medicine, it’s always best if medical information is channeled through proper docs, not passerbys.
The ACR should issue formal guidelines to the tech assocations, and they should clarrify this position of the radiologsits role in communicating with patients.
Essentially, anon said it correct, …just find a way to communicate with the original doctor directly. Let’s not attack our colleagues. No malice is intended.
Just from my personal experience having multiple visits to a radiology department over several months, I can say that the radiologists were sometimes clearer and more communicative than my doctor. I got a lot of info from them, because I asked. When I asked them to tell me what he saw on the exam, I would get a much more detailed explanation than I did from my main physician. I was also glad to have the radiologist’s thoughts on what the doctor might want to do. I feel there’s no such thing as too much information, and I like to collect what each physician has to say. If you’re uncomfortable with the radiologist offering opinions, make sure that you’re being clear and detailed with your patients. I don’t think it’s bad if I hear different things from the radiologist and my doctor- I just want to know why they differ, and it bothers me when I go to a consultation and my own doctor tells me a lot less about my condition than the radiologist just did.
Here’s what I don’t get: how is it that all these patients are geting unsolicited (at times solicited) second opinions from a radiologist? I’ve been to the rad booth on several occasions and I’ve NEVER seen a radiologist in the vicinity. The last MRI scan I had done was at a facility where I dont’ believe there was a radiologist on the premesis. They don’t seem to be around to corrrect flaws in the imaging studies which would otherwise render them (the studies)inadequate, but they’re around in droves to shoot the breeze with patients? Something isn’t making sense here.
The only time I’ve heard a tech speak was when she was discussing the state of her nails with one of her fellow techs- all during my study, in which I was made to feel like a piece of meat.
In the medical group I go to, the radiologist is right there and in the back room. After a test – I only had mammograms and pelvic ultrasounds, the technician asks you to wait, and then invites every one to talk to the radiologist. If a mammogram is abnormal they can do additional studies right there. A fried of mine had a biopsy the same day. Otherwise, she’d have to wait for her doctor to get back to her, then schedule an appointment, then wait more for the results. This would mean weeks of unnecessary anxiety.
I think scaring people to death is wrong, but making everyone wait unnecessarily is not right either. What some doctors who complain here don’t seem to realize is that uncertainty is very stressful as well. I see that all the time – doctors minimizing or simply not understanding how stressful the wait for the results is. For those who are fine and whose results are fairly simply to communicate, this extra stress is basically unnecessary harm. Especially for those of us with high risk of heart desease or stroke.
Considering how long it takes the average doctor to get back to you about a radiological procedure (days, sometimes weeks), I would prefer the radiologist to give me really terrible news so I can jump on it and force my doctor to actually treat me in a timely manner. Otherwise I’d be waiting for weeks to get in to see the primary care physician again.
Anon 12:21 –
Do you have any evidence to support the notion that the “average doctor takes too long [days, sometimes weeks] to get back to you”? Do you have a study or credible statistic to back this up? What is the standard for how long it should take? What panel of experts set this standard? (It can’t be the “what an average phsyician would do” because by your definition that average is sub-par). Do you have any other evidence other than your own feelings about what the “average” physician does?
Anyone else see a double standard being applied here? Oh, That’s right, only physicians have to back up their claims with data (”Have you reviewed the medical record?” “How do you know it was not malpractice?” “Have you reviewed the insurance companies financial reports?” “Have you asked what risk pool you are in?” ) whlie others just state the “self-evident facts.”
I guess radiologists have just seen the handwriting on the wall. AStart interacting with patients or you’re job will get outsourced to Bombay.
“Oh, That’s right, only physicians have to back up their claims with data (”Have you reviewed the medical record?” “How do you know it was not malpractice?” “Have you reviewed the insurance companies financial reports?” “Have you asked what risk pool you are in?” ) whlie others just state the “self-evident facts.”"
Physicians don’t ever back that up with facts when asked, so what would be the double standard?
This is indeed a problem as it is bad medicine. The radiologist does not (usually) know the entire history well enough to know where the findings fit in with the whole picture, and doesn’t know the patient, their personality, their family circumstances and so forth need to know how best to inform the patient and walk them through the decision making process.
Traditional collegial respect would prevent this but that alas is not always learned in med school now and not very uniformly practiced. You must teach them. Call the radiologist and discuss your concern. Ask that they call you with the findings, take the call when they do, and respond.
If the radiologist continues the behavior, refer to another center. Tell the new center why you are refering to them so they will know what you expect.
If you work in an unfree system where you, as the primary care doctor, cannot select the radiology center, then just sit and fume and watch your profession go down the tubes, your patients get confused and scared, and yourself go slowly insane with frustration–or fight back.
Comments on this entry are closed.