Therapeutic Radiology

September 23, 2016

Diagnosing and beyond.

Every now and then, I have to remind myself, as well as some clinicians, that I was trained and board-certified in, and routinely practice, diagnostic radiology.

It’s not that there’s anybody in health care liable to mistake me for a radiation oncologist. But there are occasional invitations, even requests, for me to step out of the role of diagnostician (looking at imaging and rendering opinions of same)…and provide therapeutic advice. If not actual marching orders.

No, I’m not talking about when Aunt May asks what I think about her achy knee. These inquiries come from clinicians, referring, and otherwise.

I’ve been asked whether a c-spine collar could be removed from a trauma patient (my negative X-ray interpretation wasn’t good enough; they wanted me to give them permission to remove the collar). Whether NG tubes could be used (I’d already reported the tip’s location), or for that matter venous catheters. Whether patients with DVTs I’d reported should be anticoagulated. The list goes on.

I can’t be the only one, but I haven’t heard other rads talk about this phenomenon. Thus, not sure how they tend to handle it. I presume some are sufficiently wise, or at least egotistical, to rise to the challenge and offer advice on how to manage an imaging abnormality, or conversely make pronouncements as to the ramifications of a normal imaging appearance.

As for when I find myself in the decision maker crosshairs, I try to demure as diplomatically as possible. Sometimes, that’s easier said than done.

Some of my questioners are only halfheartedly asking, on the off-chance that I’ll have some guidance for them. They might be interns, med students, or nurses. They have insufficient experience, confidence, or authority to know and/or act on their own, or they don’t relish the sometimes impossible task of chasing down their superiors…so when they encounter a rad who seems to know what’s going on with the imaging, they take a stab at asking him.[[{"type":"media","view_mode":"media_crop","fid":"52171","attributes":{"alt":"Decisions in radiology","class":"media-image media-image-right","id":"media_crop_6333116655442","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6471","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: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Alex Oakenman/","typeof":"foaf:Image"}}]]

With others, it’s a little more disturbing to hear that an attending physician, managing any number of patients onsite, is willing to punt responsibility to a complete stranger rad. They essentially have no other “lifeline,” to borrow from the Millionaire quiz-show, and they can be more tenacious in getting an answer from me, its unreliability notwithstanding.

So cornered, I’ve found myself saying things like, “Well, the last time I dealt with [clinical topic of interest] was when I was an intern, a little over 16 years ago. I’ve got to imagine things have changed since, but back then…” and then I offer up whatever relevant recollections I have.

It gets the point across, I think, yet provides the diplomatic veneer that I did try to help in some way, and the inquirer can maybe hang up without a sense of being totally empty-handed. Then, I try really, really hard not to think about being a patient under such circumstances.