Referring Clinicians: Another Bestiary

January 10, 2014

Here’s my referring clinician bestiary, representing some common categories of referrers you likely run into.

Multiple moons ago, I blogged about some of the radiologist subspecies which populate our reading rooms. After a couple of recent run-ins with a certain type of referring clinician (the Cross-examiner, below), it occurred to me that there is at least as much fun to be had by categorizing the folks who generate our workload:

The Absentee. This “attending” physician never actually seems to be in attendance. Call his office, the ward where he was just seen, his answering service, his cell phone, or his house - you’ll never find him easily. Even when you do get ahold of him to give critical results of a scan on one of his patients, it turns out he wasn’t present when the study was ordered. He hasn’t seen the patient yet, doesn’t know the answers to your questions, or the importance of the information you are trying to convey.

The Professor. Undeniably brilliant and at the cutting edge of his field. Probably can read his subspecialty patients’ cases better than you can. Always publishing and aware of the latest research, and wanting the studies he orders to utilize protocols and techniques of which you’ve never heard. Needs your reports to include specific verbiage and measurements that would be meaningless to anybody else, like the proportion of splenic surface area to the length of the common bile duct.

The Clueless Underling. A scut-runner for the real referrer, ordering studies and receiving results without really knowing why. Often utilized by the Absentee, above. The classic underlings are medical students and interns, and perhaps some slow-learning residents and fellows. As the impact of the health reform law percolates through the system, be on the lookout for more nurses and PAs to be filling this role -possibly no longer as underlings.

The Pan-scanner. Leaves no stone unturned and no type of study unordered, whether because he has an active imagination and can think of a pinky toe etiology for the patient’s headache or because he has no idea what to look for and everything is a fishing expedition to him. Loves to order studies “with and without contrast” because he can’t think of a reason not to.

The Illiterate. Despite insisting that he has received and read your report on his patient’s imaging study, the Illiterate proceeds to demonstrate otherwise, asking you a series of questions whose answers are all clearly available in your signed dictation. (They love playing “20 questions” as addressed in one of my earlier blogs.) Avoid implying that they didn’t read or understand your report; just like real illiterates, they can be quite touchy when their deficiency is pointed out.

The Cross-examiner. May initially seem to be just another Illiterate, but soon reveals himself to be more troublesome. Prior to ringing you up about one of your reports on his patients, he has carefully gone through the document and come up with half a dozen unimportant items to nitpick. No answers you give will satisfy; at best, you’ll get something like a skeptical “Hmmm…” as if he’s pretty sure he’s catching you in a lie. The appendix is normal, you said? He wants to know why you didn’t report a measurement anyway. You tell him you’re measuring it right now and it’s 2 mm? He all but demands that you remeasure. Gets downright triumphant if he actually finds an error you made, even if it’s just a typo.

The Social Butterfly. Eager to talk about anything other than your mutual patient, or indeed anything medical. He can be manning the ER singlehanded when a 12-car pileup comes in, but he’ll find a way to reference a current sports event while you’re calling him with results on half a dozen of his trauma CTs. Always seems to be somewhere fun when he’s on the phone with you from outside of the hospital or his office.

Doctor Doom. His patients are always the sickest, and if they aren’t they’ll get that way soon enough - this guy has upon him what residents often call the “black cloud.” Even when his patients don’t seem badly off, he smells their misfortune on the wind, and he’s right with disturbing frequency. If he ordered a case and it looked normal, better look again.

Your No. 1 Fan. If you ever need a letter of recommendation from a clinician, here’s your author. Fascinated by everything you do - the technology, your reports, probably the sound of your voice. You could be apologetically notifying him that his PE-protocol CT was nondiagnostic because the patient yanked out his IV and sprayed contrast all over the scanner, and your fan would probably still be thanking you profusely. Found a perfed appy? The fan is beside himself over your brilliance. We need more like him.