Beggars Can be Choosers

March 18, 2016
Eric Postal, MD

Positive enforcement in radiology hopefully goes a long way.

Radiologists who spend all or most of their working hours reading cases might have gotten the impression that their practices are in a constant state of instability, if not desperation. In the absence of a routine role in sales/marketing or client relations, usually if we hear about referrers it’s because we’ve incurred their displeasure, or are at risk of doing so.

Such dire warnings tend to come when a referrer, presumably in danger of taking its business elsewhere, either A) wants some sort of special treatment, or B) wants some aspect of the treatment they’ve been getting to stop. Special verbiage in reports, priority over other referrers, phoned verbal results on all cases no matter how routine or negative, etc.

One might think a referrer expecting to have its demands taken to heart would, in turn, be receptive to feedback moving in the other direction. For instance, a clinician wanting his radiology reports formatted in a particular way that takes the rad an extra minute per case might reasonably be expected to spend an extra few seconds to provide pertinent clinical histories (as opposed to unspecified “pain” for every patient). A facility that insists there be no verbiage in its reports regarding suboptimal technique theoretically would take action when rads reading for it point out that patients are routinely malpositioned, moving during image acquisition, etc.

Contrarily, I have been unable to find any correlation between the neediness of referrers and their receptiveness, using a trite turn of phrase, to help us help them. Some places seem to have a limitless ability to demand/complain, yet are deaf to recommendations. Others never seem to have the slightest dissatisfaction, but are eager for pointers (or, better yet, have their act so polished that none are ever needed).

Which makes little actionable difference to us rads reading cases all day. Again, the picture tends to get painted for us that relationships with referrers are hanging by threads, and our slightest misstep could ruin everything. (We) beggars cannot be choosers.

Or maybe we can, to some extent. Perhaps maladaptively, we are still human, and I have yet to meet the radiologist who doesn’t develop subjective impressions of routine referrers. Truth will out, as the Bard said, and even the biggest, most important client will eventually experience some degree of pushback if it overplays its role as the 800-pound gorilla.[[{"type":"media","view_mode":"media_crop","fid":"46936","attributes":{"alt":"positive reinforcement radiology","class":"media-image media-image-right","id":"media_crop_806504678676","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5491","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 186px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Karramba Production/","typeof":"foaf:Image"}}]]

Meanwhile, I’ve had more immediate satisfaction focusing on the good outliers. That is, referrers who always seem to send me quality stuff to interpret (pertinent histories, quality imaging technique, seeking input on protocols, etc.). Maybe it’s just because the good eggs are fewer and further between, but they stand out sufficiently that I feel the need to gush for them a little.

That includes sending messages to their personnel about what a good job I think they are doing, both for their professional satisfaction and to express my appreciation for the superior service I think they are giving their patients. When their techs have placed markers to indicate areas of clinical interest, I’ll make note of this “valuable diagnostic technique” in my reports, and of course specifically comment on the area even if it’s just as normal as everything else around it.

Will word get around and other referrers follow suit? I’m not holding my breath for it, but stranger things have happened. Will my efforts at positive reinforcement get the good referrers to keep playing their A-game? Hopefully. And maybe it will make them less likely to consider referring elsewhere down the pike.

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