What Have You Done for Me Lately, Radiologist?
While worklist demands and a reluctance to bruise the egos of colleagues may conspire against it, obtaining prior imaging often yields a treasure trove of information.
Chugging through my worklist last week, I pulled up a renal MR: “Eval mass on US.” The sono wasn’t worth much for comparison but I noticed there was a CT in the patient’s timeline from 2022. What do you know, the lesion was there at that time, a bit smaller, and properly reported as suspiciously enhancing.
We already evaluated this years ago, I imaginarily complained to the referrer.
The imaginary reply came back: “That’s water under the bridge. What have you done for me lately? Just do your work and give me a report now.”
The imaginary dialogue could have continued. I could ask if he had even bothered to look back at older imaging for the patient before ordering this new study or gotten involved in a separate convo with the rad who had read the ultrasound (his report didn’t say anything about a prior CT). Had that rad ignored the older study too? Should I get into the weeds with the IT people about how and when potentially relevant prior studies are made visible to rads, referrers, and techs?
None of that would matter for the MR I currently held of course. It still needed a reading. Plus, I would have to apply a little finesse, so my report reflected that, yes, the lesion was identified in 2022 but not imply that anybody else involved was in the wrong for not having acknowledged it. One must not give any ammo to the medmal goons, of course, nor bruise egos.
Aside from that bit of effort with wordplay, I could look at the case as a gift in the form of some easy RVUs for a diagnosis I couldn’t possibly miss because others had already made it.
On the other hand, a radiologist taking pride in his or her profession, especially one who is not paid by the RVU, might not be so sanguine about it. For him or her, it’s just another chunk of work, and on top of that makes our diagnostic imaging apparatus look clunky and inefficient. One hand doesn’t know what the other is doing.
There is also a potential sense of futility. We can do everything correctly, and have diagnostic issues sewn up years, months, even days ago but all of that gets blithely cast aside by a referrer who finds it easier to just order a new study: “What have you done for me lately?”
A kissing cousin to this is when we have followed some pulmonary nodule or pancreatic cyst, carefully referencing guidelines such as those from the Fleischner Society or the American College of Radiology (ACR). We indicate what those respectable sources advise for future surveillance or when none is needed at all, and then we get a premature follow-up exam. Time for another imaginary chat with the referrer: If you didn’t trust my appraisal six months ago, why are you asking for it again today?
I don’t let this stuff unglue me (again possibly because I work per-click), but I am kind of primed to be rubbed the wrong way by it. Way back, as a med student, I got into the habit of pre-researching non-emergent patients by digging through their files in the hospital’s computer systems. I would check old radiology reports, bloodwork, and path results. That often yielded a treasure trove of information, stuff I would never have gotten from a standard history-taking session.
None of that was a stroke of brilliance. Anybody could have done it. It just required a willingness to put in some time and a bit of effort. If a med student like me could do it, why on earth can’t actual health-care professionals?
The argument might be made that physicians, nurses, and PAs are just too busy for all that. Folks have to juggle more cases per day and do a bunch of ancillary stuff that they weren’t tasked with before. Fine, let’s grant that. I don’t know if there is any fixing this in our current mess of a health-care system.
Still, maybe it is worth trying. At least some practices might see value in making the attempt.
Why not get someone of lower rank to do it? Perhaps it could be an individual who doesn’t have to generate any particularly high amount of billable codes to pay for him- or herself? How about a med student or even an on-the-ball premed who wants to get his or her feet wet in the health-care system? Obviously, the individual would have to be trained to meet HIPAA standards but if this person is going into the field anyway, he or she would have to learn about them sooner or later.
Alternatively, since it doesn’t seem to be possible to talk about radiology for five minutes without someone bringing up AI, why not have a dedicated agent whose sole purpose is to counteract this? Any time someone is trying to order an exam or put one on the schedule for imaging, let the agent look through all prior reports and pipe up if it thinks the exam might be unnecessary.
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