Articles online and in print aim at helping you in practice

September 13, 2010
John C. Hayes

Diagnostic Imaging, Diagnostic Imaging Vol 32 No 9, Volume 32, Issue 9

In recent months we've found a steady and strong interest in the practice-related material we've been presenting on our website.

In recent months we've found a steady and strong interest in the practice-related material we've been presenting on our website. With all the changes under way in radiology, and a high degree of uncertainty among practicing radiologists, the old ways of doing things can no longer be counted on.

As columnist Pat Kroken put it in a recently concluded three-part web series on protecting your radiology contract, not so long ago, radiology groups could maintain an adversarial stance when dealing with hospital administration, reasoning that, “What are they going to do? Replace the entire group?”

Once it was a legitimate question. Now the answer is, "Yes." And hospitals, some of them with long-term radiology relationships, have terminated contracts, she said. A key point of the series: you need to look carefully at what you're doing and how you're doing it.

Which brings us to probably the most durable and important part of the radiology product, the radiology report. In this issue we include a look at one effort to reform the radiology report. Dr. Stephen Baker, chair of radiology at the University of Medicine and Dentistry–New Jersey Medical School in Newark, explains how his department rethought the report (“Radiologists refrain from editorializing,” page 23). The result: more collegiality between radiologists and referring physicians.

You can get more detail in the column, but in essence the process was this: A survey revealed a couple of hot button phrases-no doubt present in many reports-that were turning off referring physicians and accomplishing nothing. They were banned. In addition, it became the policy that all crucial findings be verbally reported to the referring physician. As you might guess, initiating the conversation was a challenge at first, but as it became a management obligation, contacting the referring physicians became easier.

Imagine what this might do in today's world, where PACS and soft-copy reading have replaced many of the interactions that used to take place in the reading room, leading to isolation for busy and often overworked radiologists. Imagine also what learning which terms in a report, in this case “clinical correlation suggested” and recommendations for additional imaging, and banning them might do to improve clinician perceptions of radiologists. Finally, imagine what more frequent conversations might do to further improve the relationship between radiologists and referring clinicians.

True, Baker's practice is academic, but lessons learned there, including trying new things to strengthen relationships, is an idea that can easily be imported to hospital-based private radiology practices.

Strengthening relationships is an important part of Kroken's series as well. In the first article she examines the origins of today's challenges to practice-hospital professional services agreements, and how hospital-based radiologists have found themselves vulnerable to incursions from outside groups, including teleradiology companies. In the second article, she explains what hospitals are looking for in terms of quality. This is often defined as clinical excellence by the radiology practice, but for hospitals, clinical excellence is an assumed component. Beyond that, hospitals are looking for more interaction and commitment from their contracted radiologists. In her third article, Kroken outlines specific steps that can be taken to repair a damaged relationship between a hospital and its contracted radiologists.

I recommend Baker's article and Kroken's series to any radiologist wondering how he or she can succeed in today's very challenging environment.