"Sure, Just Come Right In…"

September 29, 2016

The four different types of radiologists.

Just the other day, while sitting in my office, deeply involved in a complicated CT of the maxillofacial bones, which demonstrated a very large, expansile lesion involving the maxilla, one of my favorite hospitalists walked right into my office, exclaiming, “Let’s read some CT scans! Who is going to help me read some CT scans?”

Now, granted the door to my office in the radiology department is always open, and by definition, the field I have chosen to practice is based on consultations, I almost always welcome my fellow colleagues at any time to review cases with them. But, it would be so much nicer, and certainly a little less startling for this doctor friend of mine to perhaps knock quietly on the door, and say, “do you have a minute to review a few cases with me?” It just sounds so much nicer, too.

Isn’t it ironic that this month’s edition of Radiologyhas an article by Gunderman and Chou titled, The Future of Radiology Consultation, that deals specifically with this very topic. In their article they talk about the four different models of radiologic consultation:

1) The isolated radiologist. This is the rad that sits alone all day, in an isolated, often far away, unmarked reading room (or bunker), banging out case after case, who rarely ever speaks to another clinician, and is often irritated when someone calls or stops by to review a case.

2) The available radiologist. This is the rad that every so often gets a visit from a referring doctor, and will help out, if asked to. They call in critical values, when they come upon them, but phone calls and reading room visits remain, for the most part, a distraction.

3) The eager radiologist. This is the rad that actively seeks to build relationships with colleagues by interacting with them on a regular basis. They function in a reading room that is well marked, easily located and accessible.

4) Finally, there is the embedded radiologist. This is the rad that epitomizes “I will do whatever you ask me to.” They act as if they are a critical component of the health care team, often going as far as making rounds with them. They answer all phone calls that come in to the reading room directly, with no middleman. They even go as far as ordering things on physician order entry and write notes in the patient chart (eewww!)[[{"type":"media","view_mode":"media_crop","fid":"52365","attributes":{"alt":"Radiology department","class":"media-image media-image-right","id":"media_crop_1036765716350","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6500","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: 140px; width: 171px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Sam72/Shutterstock.com","typeof":"foaf:Image"}}]]

The article goes on to say that it is not so important to choose a single one of these types of radiologist and stick to it, but rather to find a blend, and to find a balance so that you are not only a productive member of the department, but also a key member of the health care team whose expert interpretation of imaging studies, is sought after and respected.

Whose opinion is worth something from the clinicians who are directly responsible for taking care of patients. It reminds me of when I was a member of the staff of a department whose health care network had just built a brand new, state-of-the-art, suburban hospital from the ground up, with magnificent radiologist offices, top-of-the-line equipment, and everything you could possibly ask for. But when the weekend came, and it was time for us to take weekend call, our chairman felt that the hospital, and, in particular, the physicians covering the weekends, would be better served by having us, the radiologists, sit in a run down, dirty, decrepit urban hospital (ie, the mother ship for the network), rather than a brand spanking new hospital in the suburbs so that there would be collegiality with our city colleagues and shoulder-to-shoulder discussion of interesting cases.

Thus, every weekend, the beautiful new state-of-the-art suburban hospital radiology department was shut down and closed, and in place was a little 8×10 sign that read, “If it is Saturday or Sunday, and you need to speak to a neuroradiologist, please dial xxxx, if you need to speak to a body imager, please dial xxxx, and if you can’t reach anyone, just call the resident on call.” Makes a lot of sense right? Not! I would call that an extreme example of the isolated radiologist. Here’s a phone number, call it if you need someone. Good luck to you. Who cares if it’s an inconvenience to you? Who cares if you actually wanted to look at the images with the radiologist, next to you?  Who cares if the radiologist reading your patient’s CT exam is not on site, and is reading from another hospital, while also reading 100 or so other cases.

Quite a contrast to my hospitalist friend who basically barged right into my office, unannounced, no “pre phone call” to tell me that he was coming, and expects instantaneous service in going over several studies, regardless of what I might be doing at that very minute. A classic example of the embedded radiologist. Sure, just come right in…