When I was doing my transitional year in internal medicine, I was essentially bullied for going into diagnostic radiology by my co-residents and the internal medicine attending doctors I worked with. They used to tell me that my “forever job” would be to sit on a chair in a dark room and dictate “correlate clinically” all day long. And I would immediately argue: No! That’s terrible! I would never do that!
I did not have a full sense of the meaning of clinical correlation before starting my diagnostic radiology residency. All I knew was that it was very bad, and I should never dictate this sentence in my reports. I walked out of my intern year hating to correlate anything clinically and promising everyone there that I would never use it in the future.
During my first weeks of diagnostic radiology residency, I was spotting the reports for « the bad sentence» and profiling everyone based on how often they used it. I continued to do that until the day of enlightenment when I understood the exact application of clinical correlation.
When a radiologist dictates “recommend clinical correlation,” they are simply communicating to the clinician that they did not give them enough clinical information about the patient to make the appropriate diagnosis. The radiologist means that there is a radiographic finding, it is described in the report, and it can be associated with many diagnoses. Only one diagnosis is correct based on the relevant clinical picture of the patient — including present history of illness, personal and family medical and surgical history, physical exam, blood and urine results, etc.
When a radiologist advises clinical correlation, they are asking for a collegial relationship with the ordering physician to make the proper medical decision. Medicine was never an individual work. It has always been collaborative and team-based. Some radiologists have the time to call the ordering physician and inquire more information about the patient to get the full clinical picture, but many of them are too overwhelmed to take the extra step for every patient, especially in a hospital setting with an emergency department running around the clock. Therefore, they list a differential diagnosis based on the radiographic appearance, age, gender, and any relevant information that is available to them and advise the referring physician to correlate with the clinical information they have available from their end.
I must say that the most important piece in an order slip for any imaging modality is the clinical indication of the study with pertinent patient information. That highlights optimal patient care, a shared and equal responsibility between the radiologist and the clinician. If we don’t work together, we will not provide the best care for the patient. I also highly encourage the clinicians to share what they think is going on with their patients and call the radiologists to discuss concerns with them, because it helps put the puzzle pieces together to originate the best diagnostic information available in a particular study.
During multidisciplinary conferences, where complicated cases are presented to a panel of different specialists, including medical oncologists, surgeons, radiation oncologists, pathologists, and radiologists, everyone participates in a fruitful conversation, contributes with their expertise and shares their well-educated opinions to reach a consensus on medical decisions in diagnosis and treatment.
I believe this approach should be applied in all cases, not only in challenging cases. I realize it is hard to apply it for every case in this increasingly demanding world, but at least we should all be aware of the great difference it makes in patient care outcomes and make every effort to implement this practice in medicine.
Houda Bouhmam is a radiology resident.