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When Radiologists and Physicians Disagree

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How do you know when to stand up for yourself?

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How do you know when to stand up for yourself?

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News By Profession

Radiology

How do you know when to stand up for yourself?

By Sarah Sutherland

Healthcare professionals within the realm of radiology play a key role in identifying and treating a wide range of maladies. Still, they usually don't form the same connection with patients that physicians and surgeons do. For the most part, radiologists don't have much contact with patients aside from the imaging itself. While it's up to these professionals to both conduct and interpret the scans, once those scans are sent back to the doctors who requested them, they're essentially out of the radiologists' hands.

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, like 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

Doctor-and-radiologist_300xReluctance to analyze potential errors isn't unique to radiology. A study conducted by the Radiology Quality Institute 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," said Glaser. "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 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 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.

Consult the Referring Physician
If the radiologist decides that there is immediate risk for the patient, the referring physician must be notified. As physicians themselves, radiologists have the same professional obligations to patients as the referring physician. According to medical ethicist Georg Marckmann, MD, MPH, a member of a 2013 panel hosted by the European Congress of Radiology (ECR), these obligations include "respecting [patients'] well-being, using the best available diagnostic and therapeutic interventions, and minimizing harm, respecting patient autonomy, and contributing to social justice."2 Even if the radiologist doesn't know the patient as well as the referring physician, it's important to remember that the patient still trusts the radiologist to make the best decision regarding treatment.

While medical culture tends to deter healthcare professionals from confronting each other regarding disagreements in treatment, it's crucial for these professionals to speak up if they feel that something isn't right. Radiologists might struggle even more than their colleagues when it comes to voicing opinions about patients' treatment, as they aren't necessarily as familiar with the cases as the referring physicians. However, it's important for radiologists to remember that as physicians themselves, they can -- and should -- expect their opinions to be regarded with the same respect as those of the referring physicians.

When radiologists decide to speak up about a disagreement over a scan, they shouldn't be nervous -- in fact, the referring physician could appreciate the input, and the conversation could strengthen the professional relationship between the two. An Irish radiologist at the 2013 ECR panel recommended, "If you need to communicate with your clinician, then just pick up the phone," and the panel's clinician agreed.2

"You may have evidence from your own expertise or literature showing that the physician's clinical question may be better answered by an alternative test, technique or other alteration that you may be able to suggest and present to them," said Glaser. "When this is positively received, you can then alter the patient's test to everyone's satisfaction."

Despite the pressure that radiologists face not to disagree with referring physicians, it's pivotal for radiologists to defend themselves and their patients' health. If patients can't trust their doctors to always do what is in their best interest, who can they trust?

Sarah Sutherland is a staff writer at ADVANCE. Contact: ssutherland@advanceweb.com

References

1. Radiology Quality Institute. Diagnostic accuracy in radiology: defining a literature-based benchmark. 2012: 1-9.
2. McCall, B. A 3-piece jigsaw: patient, radiologist, clinician. But do they fit together? AuntMinnie.com. 2013.


Comments

The title to the article would be more appropriate if titled "When Radiologists and other physicians disagree". The original tile implies that Radiologists are not physicians. Good article!
Chip Searle
November 17, 2016

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