Communication in Radiology

By:  Board-Certified Diagnostic Radiologist

Communication from Radiologists to their clinical colleagues is an increasingly important part of the interaction between care providers and Radiologists. In today’s faster-paced medical environment, the reality is that imaging has essentially replaced the bedside physical exam. The reasons for this are myriad and debatable, and well beyond the scope of this article.

However, this trend does require greater need for communication (read: TIME) between the ordering physician and their Radiologists. This dialogue often occurs through the patient’s care-giving nurse or physicians’ office staff; in the era of complex imaging protocols and an ever-increasing pool of diagnoses, this method may no longer be sufficient. Furthermore, given the diverse make-up of the US provider market, the physicians, office personnel or nurses may not be native English speakers, thus contributing to difficulties in communication. Sometimes, as should be obvious, it is incumbent that the ordering physician be notified immediately about a result from the interpretive Radiologist, rather than through an intermediary.

Let us start with what absolutely requires direct dialogue from an interpreting Radiologist to the care-giving physician:

• Acute life-threatening or potentially life-threatening findings (e.g. Ectopic pregnancy, Pneumothorax, Free air in the abdomen)
• An incidental finding on exam which will immediately impact patient management or is wholly unexpected
• Over-reads with an error (e.g. “Wet read” ER film over-read next morning with  finding)
• Non-diagnostic radiologic evaluation (e.g. suboptimal contrast bolus for CT scan for pulmonary embolism) that may necessitate immediate further evaluation

An excellent reference is the “American College of Radiology (ACR) Practice Guideline for Communication of Diagnostic Imaging Findings, Revised 2010 (Resolution 11)”. Although the authors attempt to distance their work from the malpractice arena (read the Preamble), these “guidelines” from the governing body of Radiology carry significant weight.

Let us not think that lack of communication, lack of timely communication, or insufficient communication is a new issue.  As far back as 1971, federal judges attributed fault to Radiologists for untimely communication.  Ultimately, patients are not concerned with differentiating responsibility and parsing out liability – they leave that to the courts. It does, however, behoove Radiologists to act in the most self-protective manner possible – as far as I know, not a single radiologist has been sued for “over-communication”. Unfortunately and important to note, the radiologist usually does not have an opportunity to develop a true ‘provider-patient’ relationship, further leaving them at risk of facing litigation as they are just a “faceless” name on a report.

It would be a disservice to lay the full burden of communication on the shoulders of my Radiology colleagues. Many of them, very justifiably, feel that responsibility for obtaining report results should be shared.  If a physician orders an exam, he/she also should make an effort to obtain the report in timely fashion.  Often, the Radiologist will make a concerted and time-consuming effort to reach the ordering provider with no success.  One only needs to reflect on their personal ability to reach a physician on the weekend to realize how difficult a task this can be.  However, if the ordering provider is also actively attempting to obtain the results of his patients’ studies, it provides an added layer of protection.  If the report is unclear, direct communication is warranted to avoid implementing an incorrect treatment plan based on an assumption.  These sentiments are not included to provide an “out” for the Radiologist, but rather, are actions in the best interest of the patient.

On a side note, an especially challenging situation is that of “curbside consults”.  A radiologist is often asked to review imaging read previously by one of their colleagues, or perhaps an outside institution.  This may result in the new radiologist’s name being placed in the patient’s chart as a reference.  In the event of litigation, the radiologist may be liable based on notes that another has placed in the patient record. Some publications have gone so far as to state that Radiologists would benefit by recording these types of interactions and what was discussed, even if only in abbreviated form.

One last point to bear in mind is that while technology has expanded greatly, with pagers, digital pagers, cell phones, text message, email, etc. available as options for communication, physicians must be wary of violating HIPAA guidelines.  Although these technologies are abundant, hospitals have been loathe to implement the necessary IT infrastructure to allow them to be used as medical record communication devices due to cost and potential for litigation.

In the end, more communication is better than less. How this occurs in an ideal world is through the collegial interaction of medical colleagues. It is crucial to the welfare of the medical system, and ultimately, patients need not know the struggles that occur behind the scenes. Rather they should be the recipients of good service and care, as they deserve.