And Another Thing...

May 23, 2018

Addendum requests are rarely worth fighting.

So there you are, plugging along in your usual Sisyphean grind at your worklist. Maybe you have hopes of leaving the office on time for once, or having enough time for more than a five-minute lunch. Perhaps other stuff earlier in the day already put you “behind the 8-ball,” and you’re playing catch-up.

And then the request comes in: Someone wants you to make an addendum to another radiologist’s report. A clinician who needs a measurement of something on the record, or a specific statement about whether a fluid-collection is larger or smaller than before. Maybe it’s from someone in billing, who knows that an ultrasound won’t get paid without another bit of verbiage in its report. Meanwhile, the rad who originally read the thing isn’t around, and the addendum purportedly can’t wait till s/he gets back.

There’s an active thread about this phenomenon in a popular online radiology forum. Unsurprisingly, there’s a variety of opinions about when such requests are reasonable, and how they should be handled. That’s not just because radiologists are an individualistic bunch…although perhaps you’ve heard the expression about trying to herd cats?

It’s also because very few of us, even within the walls of a single institution, have quite the same professional circumstance as one another. Some of us are in hardcore productivity-driven situations, wherein any time taken away from our reading new cases is a dig at our value to our employers or simply our own bottom line. Others are in super-duper subspecialized environments, and hesitant to step on any toes outside of their own areas of expertise.

Yet others might feel like they’re operating on a very one-way street, taking great pains to get their reports right in the first place so as to never need addending…and endlessly having to clean up the messes of other, less-scrupulous colleagues. And then there’s the concern of getting one’s toe caught in another doc’s medicolegal mess by going on the record in his report.

These requests for addenda have also gotten a lot more common as everyone under the sun has become comfortable making them. No matter how small the issue: Grammatical and spelling errors are now evidently fair game, and I’ll even get requests for addenda correcting errors that non-radiological staff have made. For instance, a facility might routinely enter John Doe trauma scans as all being of age 117.

That demographic information automatically gets populated into my report by the software I’m required to use. Now, however many hours later, they want me to specify that he’s actually 52.

Of course, it’s a no-brainer if the matter is a legitimate medical concern, like making an addendum because someone missed a huge pneumothorax. Or properly documenting in the medical record that you spoke to a clinician about someone else’s read because the other rad was gone for the day…let’s face it, the clinician is going to write in his notes that he spoke to you and might just put words in your mouth if you don’t.

But let’s go ahead and assume that the addendum request is complete nonsense. It’s interrupted you and gotten you good and annoyed, perhaps because you’ve already handled half a dozen just like it today. It is worth sticking your neck out and burning some “political capital” with your group or referrers just to make a point of refusing the silliness?

Of course not, you might say as you sit there and read this, outside of the stresses of a typical workday. The trick is to keep that enough in mind to guide your reaction in the heat of the moment.