Bernadette Keefe MD
Classically, the radiologist was known as the doctor’s doctor, and many consultations were carried out in person. Radiology reading rooms of the past were vibrant hubs, where radiologists received in depth and nuanced patient histories from the clinicians, then reviewed /discussed the images and finally the two physicians would reach agreement about next treatment steps.
The conversations in the reading rooms fostered bonding between radiologists and other medical specialists and cemented mutual respect. Another feature was the degree to which clinicians had their favorite radiologist with whom to discuss cases. It was not uncommon for a clinician to bring a second opinion to a specific radiologist for interpretation. Features such as quality of the images, diagnostic acumen and the overall presentation and communication skills all were considerations that clinicians used when deciding which radiologist to consult.
Further, depending on the attending radiologists, the radiology reading room had an air of a physicians lounge. After the business at hand: the discussion of the patient and review of the images and diagnosis, it was not uncommon for the clinician to sit (occasionally collapse), chat and just catch their breath from the hectic day. These muted quieter rooms filled with many other physicians in conversation and camaraderie provided respite from the hub of the clinic.
However, with he advent of technology, PACS systems, the relocation of the radiology department remotely (out of the clinical setting,) this intimate bond fostered by the “reading room” experience completely disappeared. Gone were face to face conversations about patients, the in-person discussion of the images, and the enriching back and forth Q and A. An out of sight, out of mind, mentality set in among clinicians, and the radiologist, over time, was relegated to the radiology report.
Certainly the radiology report is the key product of the radiologist and the service for which the radiologist receives compensation. Going forward this report will become ever more prescribed (via structured reporting). This has advantages and challenges. We must continue to make the radiology report the best it can possibly be regarding language ( remove jargon) clarity (remove hedging, add value) increased engagement (add multi-modal, contact info) and providing patient access. But is there more? What other value does the radiologist have? What about the considerable diagnostic skills of radiologists?
The other major legislation which affecting radiologists in the near future is the clinical decision support mandate. Starting January 1, 2017 physicians ordering advanced diagnostic imaging exams (CT, MRI, nuclear medicine and PET) must consult government approved evidence based-use criteria through a CDS system. Radiologists will only be paid if CDS is used (either followed or at least consulted) This mandate will bring the clinician back to the radiologist in a most necessary way. Clinicians will need radiologists to help them re CDS. Radiologists must signal to clinicians their willingness to help them with information and clarification about CDS criteria in general, as well as CDS applied to a specific case.
The centrality of communication between clinician and radiologist will, by necessity,come full circle. In anticipation: it’s time for radiologists to re-channel some of the past camaraderie, to realize the considerable potential of quality communication between clinicians and ourselves, thus providing significant value-add to patient care.
Note: The American College of Radiology hosts a global tweet chat (under hashtag #JACR) for radiologists and other MDs and, indeed all interested in imaging’s role in healthcare. The tweet chat is monthly, 4th Thursday of the month at 12 noon EST. Please Join Us.