The Straight Talkers

November 21, 2014

It’s time for radiologists and other clinicians to be direct.

I have a recurring fantasy about my professional life. In it, a number of radiologists like myself, and a comparable cohort of clinicians, have gotten fed up with the clutter of obstacles in medical imaging that routinely prevent us from doing the quality medical work of which we know we’d otherwise be capable. We’ve formed a collective around this shared goal - a pact, an alliance, a secret society, a cult, however you’d like to define it. Call us the Straight Talkers.

To become a Straight Talker, a physician must be invited by the existing Straight Talkers, which only happens after the prospective inductee has demonstrated the right attitude, motivation, and capability when it comes to diagnostic imaging. Conversely, if against all odds a doc manages to become a Straight Talker and then proves himself unworthy, he can be kicked out of the group.

Worthiness is simply a matter of adhering to the core of the Straight Talker concept: An honorable exchange of efforts between clinicians and radiologists to, with a modicum of extra effort, make one another’s professional lives easier and more satisfying…and, in the process, do a better job for their shared patients.

For clinicians, that means giving real, straight talk clinical histories - specific reason for current imaging, known diagnoses on their patients, mechanism of trauma, location of pain and other pertinent findings on physical exam, results of previous diagnostic investigations, recent surgeries, etc. None of the usual “R/O path,” or “Pain.” No more sending patients for scans without having actually seen and evaluated them first unless there’s a damned good reason. And no skipping IV or PO contrast in the name of improving ER throughput. You want the radiologist to give you the best he can? Give him your best to work with.

For radiologists, that means answering posed clinical questions - pertinent positives and negatives. It also means actual straight talk - getting rid of the equivocating, hedging, or other obfuscation. Yes, include a brief differential when appropriate - but if there’s a clear-cut favored diagnosis, say so. Ditch the reflexive usage of “compatible with” or “suspicious for;” if it’s acute appendicitis, say so and leave no doubt. You want the clinician to do those nice things for you that were mentioned above? Show him there’s some payoff for his efforts.[[{"type":"media","view_mode":"media_crop","fid":"29693","attributes":{"alt":"talk bubbles","class":"media-image media-image-right","id":"media_crop_1711533172650","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3092","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: 160px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

I mentioned earlier that sometimes I imagine the Straight Talker thing to be more of a secret society or cult...unfortunately, I suspect this would pretty much have to be the case. Pretty much every radiologist out there has spent his whole professional life practicing defensive medicine, and was trained by previous generations of rads who did the same. It’s probably too much to ask a rad joining the Straight Talkers to start generating dictated reports without any hedging or the usual QA-protective doublespeak, lest he get slammed with bad peer review stats or nailed by an eager ambulance chaser.

Also, if word ever got out that some rads and clinicians were communicating with straight talk while others were not, there would be an understandable outcry that patients were getting unequal treatment. It might therefore have to be the case that the on-the-record stuff (exam-requisition paperwork, dictated reports) remains the status quo: “R/O pain” CTs with “Cannot rule out” reports…but then, when Straight Talker clinicians and rads were on duty, they would, off the record, communicate more plainly - verbally, via anonymous dead-drop, whatever worked.