Another Radiological Halloween

October 24, 2014

The scariest part of the middle-of-the-night call for a radiologist is the lack of efficiency.

A suddenly ringing phone breaking the dead after midnight silence has a fear-inducing quality in and of itself. Even if one hasn't spent the previous Halloween evening viewing a horror movie or two, with fresh recollections of unexpected phone calls (a la Scream) and ringing doorbells (The Strangers).

Perhaps a guilty conscience renders one more susceptible to the effect. The now-awake and anxious physician took the call, and a stranger's voice murmured to him about a bleed in someone's brain.

No, not a prank, nor even a surprise. He already knew about the bleed, had known since his previous day in the hospital when he had seen the patient in question. Fear melted into irritation; why was he getting called about this now?

The caller, a radiologist who had just interpreted a CT on the patient, explained. He had received the study to "R/O bleed," the same generic history the on-call doc provided for most of his patients, and the rad had no way of knowing that the bleed was being followed after its original detection at another facility. With neither pertinent history nor prior exams for comparison, he had treated the abnormality as a "critical result," which necessitated the call.

The on-call doc could swear he detected a bit of smugness in the rad's apology for having needlessly disturbed him. Whether out of annoyance at this or the false alarm, or perhaps a lingering frisson of anxiety from the original call, he went on to toss and turn in his bed for the rest of the night.

Meanwhile, the radiologist, and others like him, proceeded in the role of anti-Sandman with other on-call physicians. As with actual horror flicks, their prey tended to be guilty of misdeeds, which objective viewers might consider justly punishable.

Surgeons ordering scans for "R/O perf," receiving calls for free air because they hadn't bothered to let the rads know their patients were freshly postoperative. Hospitalists declaring all of their studies to be STAT to get their patients imaged faster, only to find that facility-policy required all STAT cases to be called in as critical results, positive or negative. Physicians and noctors with administrative roles who had, themselves, been responsible for enacting such call-in-all-results policies hospital-wide.

And, as in many Halloween-worthy tales, some more innocent docs eventually wound up being targeted by the anti-Sandmen, and recognized that they would have to do something to avoid being thus terrorized in the future: providing more thorough clinical histories; being more judicious about their ability to label things STAT; getting involved with the administrative process to roll back overzealous facility policies on what was truly a "critical test" as opposed to a "critical result;" and supporting their fellow physicians' ability to once again exercise professional judgment as to what warranted a call at 3 AM.

Some of them, with sufficient insight and effort, might have a fighting chance to not be suffering through endless sequels of the same silliness.