Comments on: Who is responsible for an abnormality on pre-operative testing, or, aren’t radiologists doctors too?

By: thirdparty

thirdparty — Fri, 25 Sep 2009 20:14:32 +0000

I agree with Dr. T. It is not unusual for benign and maligant pathologies to have the same or similar presentation on a radiology exam. Typically a radiologist would not know much if anything about a patient’s medical condition and history. The radiologist doesn’t know that the patient has microhematuria or has melanoma or has other signs and symptoms. Knowledge of that information can be key in narrowing down the radiological differential diagnosis.

Many PCP colleagues complain about how the radiologist doesn’t communicate enough with them regarding pertinent findings. Communication is a two way street. Not enough physicians communicate pertinent signs and symptoms to the radiologist. When the order for a chest x-ray or CT says “cough” or “pain” what is a radiologist supposed to say when he finds a lesion? Knowledge of pertinent info can make one diagnosis more likely than another.

It would be nice if the radiologist could call up the physician and have a discussion about each case but do we really want to be called on the phone multiple times a day to answer questions about patients? It’s not practical givent he sheer volume of exams done each day, 24/7/365.

By: thirdparty

thirdparty — Fri, 25 Sep 2009 19:58:52 +0000

Buckeye surgeon,

If I’m hearing you correctly you don’t neccesarily read the pre-op chest x-ray reports on your patient because sometimes they are ordered automatically by the surgical center?

Yes, radiologists are responsible for conveying results of suspicious or critical or immediately life-threatening results by calling the ordering physician and documenting it. On the flip side shouldn’t you as a surgeon be responsible for finding out the results of tests ordered on your patient?

Should these automatic pre-op chest x-rays be done or should they only be done when ordered by a physician who thinks that it is indicated?

By: thirdparty

thirdparty — Fri, 25 Sep 2009 19:51:40 +0000

Anonymous post#5,

It seems to me that you patient wants you to explain to them the results of the radiology report; they’re not asking you to read the exam. Would expect the pathologist to call your patient and explain biopsy results and lab results or do you do that yourself?

By: thirdparty

thirdparty — Fri, 25 Sep 2009 19:46:48 +0000

Anonymous post#7,

A radiologist could call the patient and inform them of the new results. The problem is that the radiolgist would not know what precations or treatment have already been done to the patient while in the ER. The ER doc would have access to the ER records of what happened to that patient.

By: thirdparty

thirdparty — Fri, 25 Sep 2009 19:42:25 +0000

The Happy Hospitalist,

A radiologist could call your patient and inform them of the results. What happens when the patient asks what should be done next? A radiologist could start recommending things to the patient even though he/she might not know anything else about the patient’s medical history. Is that what we all want to happen? What if the radiologist recommends to the patient something different than what the PCP would have done? At most the radiologist could inform the patient of the abnormality and that the patient should consult with their PCP regarding follow-up.

By: Mary

Mary — Thu, 30 Apr 2009 23:47:00 +0000

Michael Riesberg MD from Pensacola Florida responds. I am a surgeon and here is my experience with PRE-OP testing. If I do surgery at an OUTPATIENT PHYSICIAN-OWNED center, there is DEFINED criteria between anesthesiology and surgeons. I am aware of the pre-op labs required—-I order them and review them in pre-op. If the ANESTHESIOLOGIST needs additional testing, the ANESTHESIOLOGIST notifies ME and I order the testing and review it. If I do surgery at the HOSPITAL, I order labs pre-op for what I as the SURGEON deem medically necessary. If I do not see an indication for a CHEST X-RAY as the SURGEON, I very well may not order one. However, if the ANESTHESIOLOGIST decides that a chest X-ray is indicated, it is ordered under the ANESThssiologist NAME, NOT THE SURGEON. WHere this situation gets ugly is the incidental find of a lung mass. The RADIOLOGIST may call the abnormal result to the anesthesiologist—-but if the SURGEON is not notified about an abnormal result on HIS private patient, he/she can be stuck behind the 8-ball. We are ALL doctors whether we are surgeons, radiologists, pathologists, or anesthesiologists. I am fortunate to say that MOST of our radiologists or pathologists will give me a personal phone call for abnormal results. I, in turn, try to do the same thing when I am in consultation or when I see critical things that affect a patient’s well-being. I realize that radiologists can be very busy—–but the 2 minutes of time for a personal phone call to alert me on a critical problam on a patient really says a lot!! I will refer LOTS of patients to that radiologist because he cares about my patients.

By: Anonymous

Anonymous — Fri, 24 Apr 2009 22:21:00 +0000

Sometimes I notice that the radiologist dictates “Paged Dr. Me at the time of interpretation.” As a hospitalist, my pager is not always on – it is forwarded to the on call person though. This has happened several times where I KNOW I didn’t get the results of that scan over the phone at 2 in the morning, but I did see them the next day when I came back to work. Maybe they spoke to my colleague, but not me. And the statement says “Paged Dr. Me.” Not “discussed results with Dr. Me”. Who’s responsible if something bad is missed?

By: Anonymous

Anonymous — Fri, 24 Apr 2009 17:32:00 +0000

A common scenario:

A CT is read at night by a contracted on-line radiology group. The hospital group over reads it and discovers a missed brain bleed, missed appendicitis, missed tumor, etc.... Decisions and dispositions are made based on the real time reading. The over reading radiolgist expects an ER doctor the next day who was never involved in the case to reconcile the difference.

Why can't a radiologist look up the patient information, pick up a phone and notify the proper people?????

By: The Happy Hospitalist

The Happy Hospitalist — Fri, 24 Apr 2009 15:41:00 +0000

Why can’t the radiologist call the patient?

By: Anonymous

Anonymous — Fri, 24 Apr 2009 01:56:00 +0000

If a patient of yours asks you to explain the report/scan to you, whoose should do the explaining? Should you call the radiologist to come and do the explaining.

1)After all they are billing for the scan.
2)The ordering doctor has limited experience/ training reading the scans.
3)The patients decision for surgery might depend on how well the scan is explained to him or her.

What do you all think?