Radiologist to Clinician: Parting is Such Sweet Sorrow

August 10, 2012

How do you end a conversation with the referring physician after calling in abnormal radiological results?

Jerry Seinfeld had a clever bit about the awkwardness of ending a bad date - how there’s nothing quite right to say in the situation. “See you around” falls flat, since you’re hoping not to. “Take care” belies your lack of caring for the individual, and non-intention of changing that.

I find myself in a similar situation when calling in results for abnormal radiological studies. Having successfully established a phone connection with the patient’s clinician (not always an easy feat in and of itself), I’ll proceed with my urgent communiqué. Perhaps there’ll be a moment or two of question and answer, but the awkward bit is never long in coming. I’ve said what I have to say, and then there’s a pause.

The clinician doesn’t speak, either because he’s writing down what I’ve just told him, or he thinks I might proceed with another urgent finding after I let my first statement sink in. I don’t speak, because I think the clinician might ask me to repeat something I said, or ask about something else. Meanwhile, both of us have other things to do, so we’d desperately like to conclude the call. We just don’t want to seem like we have other things we’d rather be doing.

One feels clumsy and less than professional to just blurt out something like “Okay, buh-bye,” especially since this invariably happens just as the other party starts to speak anew. Confirming that the other party has nothing else with a terse “Any questions?” or even a colloquial “Are we good?” accentuates one’s eagerness to end the conversation - even implying that one would rather not have had to deal with the call in the first place.

I think part of the issue is that under other circumstances we usually know the person with whom we’re telecommunicating. There’s always a little bit of banter about something that happened earlier in the day (or week), upcoming events, etc. I seem to recall a bit in a Simpsons episode where a stockbroker referenced some rule like “I’m supposed to ask you about your family before we can talk about business.”

If one is cold-called by a complete stranger, like a telemarketer, this rule doesn’t seem to apply. But a doc or nurse with whom one has a mutual patient? Something of a gray zone.

Subspecialists who communicate via notes in a patient’s chart have tag-lines like “Thank you for this interesting consult,” but that sounds borderline sarcastic when spoken. Heck, sometimes it seems smarmy in print.

I’ve toyed with winding down lines like “Okay, you have a good evening.” Problem with that is, working across several time zones, my evening can be someone else’s afternoon. Also, if I just finished telling a doc how much of a clinical train wreck his patient is, necessitating that the doc start hustling with calling in new consults, ordering more blood work and imaging, and generally worrying about the newfound pathology, I just played a central role in confirming that his evening will NOT proceed to be a good one. Certainly, his ailing patient’s won’t be.

I’ve caught myself saying things like “Sorry for the bad news,” but I hate myself for it even as the words are coming out of my mouth. How is the pathology in any way my fault? I don’t call up and take credit for the good stuff, like a patient’s noninflamed appendix.

Once or twice, I worked in facilities which tried instituting “readback” policies about important phone communications regarding patients. That is, if I called in that the patient had “Acute colitis, without complication,” I would then tell the clinician to please read that back to me, and he would recite my exact words.

At the time, we highly trained professionals had a bunch of sour thoughts towards the Risk Management folks who came up with the idea. Now I appreciate their efforts - after participating in such a kindergarten-worthy exercise, we were more than ready to hang the phone up.