Are You an Order-Taker or Radiologist?

June 15, 2011

Radiologists are in a unique position to enter into the fray on healthcare spending and utilization. We should be doing so aggressively at the highest levels of policy. Is it possible we don't because over-use doesn't hurt our business in a tangible way? In the end, day to day, we need to be true to our calling and to ourselves. That is, we need to help make local policy and everyday decisions.

It is one of the greatest frustrations for many of us. Radiologists have extensive general medical training and multi-disciplinary experience. We are uniquely positioned to help make decisions about utilization of radiologic services. Many of us do so daily when clinicians call to ask about studies. but numerous studies are performed without radiologist input. How many times have you read a study while you were thinking, "unless I'm missing something, this was not worth scanning".

Personally, I believe radiologists are in a unique position to enter into the fray on healthcare spending and utilization. We should be doing so aggressively at the highest levels of policy. Is it possible we don't because over-use doesn't hurt our business in a tangible way?  In the end, day to day, we need to be true to our calling and to ourselves. That is, we need to help make local policy and everyday decisions.

So what are the obstructions to accomplishing this? Here are a few of the concerns I've heard.

- "I can't change anything about this." Like most things, you can act locally to impact globally. If you make some headway in utilization at your institution, you have improved the situation overall.
 
- "I only find out afterward that the wrong study was ordered." So, be pro-active. For outpatients, you can review the schedule and orders each day. You'll improve the care of your patients, avoid frustrations and short cut problems down the road.
 
- "I don't know enough to discuss the right study." While there may be situations that is true, it is rarely a blanket statement. Act where you have expertise. When possible, rely on your colleagues. Overall create a culture that embraces shared opinions and consensus about appropriateness.
 
- "It may hurt our business." Possibly. But that is short term and personal thinking. It may be true, but added care and attention to your patients studies will likely result in more overall referrals when referring MDs see your interest in their patients' care. Moreover, we need to deliver the right care, as most of us try to do, not the most care.
 
- "This will make clinicians irritated." From time to time, I have had that happen. most physicians don't mind your guidance. When they do, there are a few things that can make this less impactful. First, make sure you are readily available if the techs or you are calling to ask about an order. Second be patient and listen to the concerns offered. Many times there is more to the story than you get from the order. That is good and can help guide the type of study done, or the interpretation. The toughest part of this is the situation where there is a demand for something you realize is wasteful. in those situations, you must strike a careful balance between respectful disagreement between professionals, versus harm to the patient.
 
- "If I offer a different opinion, I'm taking a risk." It is only a risk if you are doing something that is not medically justified, and based on sound medical reason. So make sure your recommendations are. Don't state opinion as fact. When consensus recommendations are available, be aware of them and use them.
 
- "It takes too much time." Yes, this can occupy some time. That does not obviate the need to do the right thing however.
 
- "The hospital may not like it." There are several reasons that are offered as to why your hospital might question your efforts. As with most hospital interactions, the solution is communication. It is a rare hospital administrator who will quibble with you when you offer a cogent plan to improve quality of care. so have a plan, and bring it to them. Show them your interest is in improving quality, not obstructing studies being done. They'll embrace your efforts.