Radiology Consults: Help Them Help You

May 16, 2014

Tips on getting a favorable response when asking for a consult. Part 2 of 2.

You’ve got a radiological mystery confronting you and are not entirely sure how to deal with it, and you’re contemplating reaching out to a colleague for his/her input. Or, you’re plugging along with your workload and you receive a request for such assistance from another rad.

In either case, the response is likely to be shaped by the style of inquiry (or the track-record of previous inquiries from the same source). Yes, we’re professionals and, supposedly, colleagues uniting in the name of teamwork and the best possible patient care. But as was mentioned in last week’s column, other factors do play into how eagerly and generously one gives of their time and effort, and if a request for help is perceived poorly, that help will likely as not be grudging, delayed or absent altogether.

The following suggestions, more or less, could all be summed up by the “golden rule” of treating others as you would wish to be treated…alternatively, the “silver rule” of not treating others in a way you would rather not be treated.

Remember that you are asking for a favor. It doesn’t matter if you think the rad you’re consulting is in your debt, subordinate to you in some way or doing work less important than your own-he might not have the same view of things. Request assistance; don’t demand it. Express thanks when it’s given, even if you don’t agree with what he said. Gracefully back off if your colleague is currently swamped with other things or, having looked at your troublesome case, doesn’t feel he can give you any additional insight with it.

Show that you put in some of your own effort. If a colleague gets the impression that you glanced at your images for about three seconds before calling him so he could tell you, verbatim, what to put in your report, don’t expect a good response. Have a rudimentary notion of what you might dictate if, say, you were the only radiologist in the world and had to go on the record with something. Rather than asking your consult “What the hell is this?” at least have a couple of guesses as to what it might be, even if that means you had to consult some texts and/or journal articles (Heaven knows, you might learn something in the process).[[{"type":"media","view_mode":"media_crop","fid":"24477","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7171686818105","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2117","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: 214px; width: 300px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Give your colleague the tools he needs. You know how much it vexes you and impairs your radiological acumen when you are given an inadequate history, not supplied with relevant prior studies or reports of those studies? Don’t propagate these sins by passing them on to your consultee. If there’s legwork to be done with the clinicians, file-room, technologist, etc., have it all done beforehand. If, for whatever reason, you can’t or have chosen not to, at the very least be up-front about what’s missing, and why.

Be organized and honest about what you are asking. Sure, you might be embarrassed to be asking for assistance…but don’t play head-games with your colleague by pretending you are just showing him an “interesting case,” followed about five minutes later by the real reason why you brought it to his attention. Similarly, have the question(s) for your consultation thought-out in advance, such that you can almost begin the conversation with them. Don’t punish your consultee by turning the conversation into a never-ending series of “Oh, and another thing…” just as he was about to return to his own workload.

Stand on your own two feet. Yes, there are days when it seems every case you open is a nightmare with a bunch of uncertainties…but you don’t want to become the guy who seems to need a consultation on every little thing. (A fond recollection of my residency: One of our seasoned neuro attendings got a little fed up with extremely-frequent visits from a more junior member of the department. After the umpteenth request for assistance one morning, the consultee sighed: “You’re worse than Freddy Krueger; you just keep coming back.”) If you have more than a couple of colleagues, spreading your inquiries around a little might help, too.

Offer something in return. No, I’m not talking about flat-out bribery. But likely as not, you have some skills in areas your consultee doesn’t. Don’t just let it be an unspoken assumption that he knows he can come to you for consults; call attention to it, for instance when thanking him for what he just did for you. Even better, specify what you believe is your area of strength…he might have forgotten, or never known in the first place. Eventually, this might help you too…

Forge alliances. After awhile, you’ll have formed opinions as to who you trust to respond to your requests for aid both promptly and capably. If you’re able to make that a two-way street, wherein he’s your “go-to” guy for his subspecialty and vice versa, it takes a lot of the uncertainty out of the process. You’ll both know, at least for your areas of expertise, exactly who to consult when you need it, rather than rummaging around the phone-list and hoping for luck with someone as yet unproven to you.