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Radiology Life • February 2017

18 | ADVANCE FOR RADIOLOGY LiFE | PRACTICE MANAGEMENT / Sometimes, however, radiologists might notice that the physician who requested the scan requests further testing that doesn’t align with the initial findings. There is always a risk for these disagreements, but it’s highest — a shocking 32% disagreement rate — when involving extremely complex scans, such as CT abdominal and pelvis interpretations. 1 The radiologist’s first thought may be to notify the patient directly, but unfortunately, this usually isn’t the best choice. “It is a very bad idea to force the patient to choose between the opinion of their physician, who they often know and trust over a much longer period of time, and your own opinion,” warned Joseph Glaser, MD, nuclear medicine physician at Radiologic Associates PC, in Middletown, N.Y. In cases like these, it’s best to speak with the referring physician directly. But how can radiologists determine whether or not questioning the physician is necessary and, if it is, how that conversation can be effective while still maintaining a positive professional relationship? Analyze the Results If there is a disagreement between the referring physician and the radiologist, it’s crucial for the radiologist to revisit the scan and consider whether there could be an error. While this may seem like obvious advice, surprisingly, most radiologists don’t follow it automatically: More often than not, radiologists don’t analyze possible errors, but instead simply correct them as they are identified.1 Reluctance to analyze potential errors isn’t unique to radiology. A study conducted by the Radiology Quality Institute1 emphasized the strong focus of traditional medical culture on personal responsibility and autonomy of action. However, it’s crucial for all healthcare professionals to move away from the dangerous expectation that “mistakes should not be made, and if they are, they are indicative of personal and professional failure.”1 Mistakes are possible in all industries, and healthcare is no exception. The problem is that improvement cannot be made with the existing stigma around making errors. Additionally, it’s possible that the referring physician didn’t fully explain the thought process behind the steps chosen to follow the scan. “One outcome is that they have a very specific reason from their own field of expertise and the tests they are ordering may specifically answer it,” Glaser said. “However, this may not have been conveyed to you at the time the test was originally requested.” If this is the case, further research or a discussion with the referring physician can gently diffuse the situation. Consider the Immediate Risk Do the results of the scan present an immediate risk for the patient? If so, the radiologist should not hesitate to reach out to the referring physician to express his or her concerns. Even if the physician doesn’t seem to outwardly appreciate the advice, the radiologist should try not to take it to heart. If his or her suspicions ultimately prove true, there is no doubt that the physician will be thankful in the long run. However, if there is not an immediate risk, confronting the physician may not be necessary or even beneficial, especially if the physician is referring the patient for further testing. It may not be ideal, but giving another professional the opportunity to examine the patient can lead to further defense of the initial findings or unearth something that was missed in the first scan. It is a very bad idea to force the patient to choose between the opinion of their physician, who they often know and trust over a much longer period of time, and your own opinion.” — Joseph Glaser, MD FEBRUARY 2017


Radiology Life • February 2017
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