Thank You for the Call

May 13, 2015

Longing for the days when physicians called each other.

As work volume has increased and radiologists are burdened with reading more cases that get more complicated as patients live longer and, therefore, develop more medical issues, there seems to be less and less time to reach out to our colleagues to discuss interesting cases. Further leading to this decrease in physician-to-referring-physician contact is the omnipresence of PACS.

Work stations are now located in most of the nursing stations, ICUs, physician lounges, and many outpatient physician offices. Gone are the days when the surgeon would stop in the radiologist’s office to review a CT exam prior to operating on a patient. It’s been years since I can recall when a pulmonologist or urologist would meet me in the consultation room to review a CT chest or a renal ultrasound, just before heading off to the bronchoscopy suite or OR. Why bother with the radiologist, when I can just pull up the case on my monitor, or tablet, or even my iPhone and see where the tumor is or where the pulmonary nodule is that I need to biopsy?

In light of these recent changes to the field of radiology, some genius came up with the innovative idea of having critical values instantaneously sent to the referring physician. In theory, this idea would seem to have many advantages. First, it would avoid the legal issues of documenting that a critical value in a radiology exam was reported to and received by the ordering physician. We all know that one of the main reasons that radiologists get sued is because of lack of communication and lack of documentation of communication.

Second, by ranking these critical values into a level of priority, such as significant, emergent, or significant-document only (because I only want to document it in the report-not bother the referring physician), one can prioritize certain imaging findings, so that they get acted upon in an appropriate and timely manner.

Finally, the documentation gets embedded in the dictation and the patient’s legal medical record, with a date, time, and name of the health care worker that was notified of the finding.[[{"type":"media","view_mode":"media_crop","fid":"37703","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4345636521131","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3732","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: 107px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Gajus/Shutterstock.com","typeof":"foaf:Image"}}]]

When I first was introduced to one of these critical value-reporting systems, I must admit I was quite skeptical. Call me old school, but very few things in radiology are more gratifying than hearing a close physician friend who just sent in his patient for a CT of the chest, say to you, “I really appreciate you taking the time to call me to tell me that Mrs. Jones has a lung cancer on her chest CT. I will call her right now, and get her in for a biopsy. Thank you for the call.” Nevertheless I began to use it, and found out very quickly that some of my initial doubts were proven to be true.

It was only after using the system for a short while, that I found out that, A) it doesn’t work after 5 PM, B) it doesn’t work on weekends, C) it doesn’t work for the emergency department, and D) it takes many months for the majority of referring doctors to register with the system, and the system needs to be constantly updated and refreshed for every new doctor. Not being told these facts before using the system, I recall reading a CT of the abdomen late one Friday that demonstrated hydronephrosis of the kidney secondary to a distal ureteral stone. Not knowing that they system did not function on the weekend, I used it to notify the urologist. Little did I know that he wouldn’t receive the message until Monday morning.

One of the more annoying faults of the system is that it doesn’t work for the emergency department, which just so happens to be one of the biggest referral sources for all imaging in the hospital. In summary, after learning from these mistakes and the shortcomings of this new technology, I only use the system to document that I spoke to a referring physician, after I go old school and call them on the phone. After all, like I said before, few things are more rewarding during a busy day, than five simple words, “Thank you for the call.”