Don’t Interrupt Me

May 9, 2014
Eric Postal, MD

Consultations with other radiologists can seem disruptive, but there are ways to get a favorable response. Part 1 of 2.

Back when I was the medical training equivalent of knee-high to a grasshopper, consultations were a formal affair. You were asking a physician of another specialty to render an opinion, on the record, regarding a patient in your care. There were recognized right and wrong ways to do this, both in the interest of doing right by the patient and out of respect for the professional whose time you were about to occupy.

Entering the attending-level workforce after my fellowship, I encountered a very different breed of consult: Other radiologists, working alongside me (whether from the next reading room or another office nearby), wanting my input on cases that were challenging them. Unlike the inter-specialty consults I had previously seen, these were generally informal, off the record requests.

Initially, I considered these requests a sign of weakness, especially when the questioners were no less specialized than I in the subject matter. After all, in residency I had never seen such consultation going on. Hardly a surprise, in retrospect, since in academic centers the neuro guys read neuro, the MSK guys read MSK, etc. I remember, during my early days of taking “junior call,” seeking the opinion of my senior resident regarding an x-ray, with her response being that I would have to read my own films. (I trust she subsequently learned to play more nicely in the radiological sandbox, assuming she remained within the field at all.)

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In any case, once out in the “real world,” strictly adhering to the core of one’s comfort zone doesn’t play out well in terms of employability. Seeking consults is not only a good idea for one’s own peace of mind, but also for quality of patient care. I know I’d rather have two professionals collaborating on my behalf than one uncertain one making his best guess.

Ideally, this would be a smooth and seamless process; whenever a rad wanted a second set of eyes (and the synapses behind them), he would flag them down by gesture, phone call, or instant message, and the colleague would graciously accede. Out of a sense of charity, teamwork, professionalism or at least “one hand washes the other.”

Back to the real world mentioned above, however…colleagues tend to have their own work to do. They may perceive a request for consultation as an unwelcome interruption of their own productivity, especially if their compensation is RVU-based. Perhaps somewhere out there, somebody has come up with a clever system to counteract this, for instance giving fractional RVUs to those providing consults…but I’ve yet to see any such mechanism in action. Thus, some are less predisposed to provide their consulting services than others.

There are, fortunately, ways to increase the likelihood of a favorable response to your requests for consultation. I’ll delve into those next time.