I would whole heartedly agree with you John on forming
links with other specialties in term of clinical
effectiveness meets, M&M sessions, critical incident
reviews etc.
This has certainly been our experience with the CDU
work here and gaining access to diagnostics. We have a
good working relationship with our radiology
colleagues!
Unfortunately there are occasions where Radiology SpRs
are difficult but they usually relent as is often the
case when you tell them that in your 'senior' opinion
it is appropriate. It is our SPRs who have the
hassles usually in the middle of the night and I like
many of us have had to speak to a radiology SpR in the
middle of the night. Occasionally I have fed back to
the Clinical Director for Rdaiology about the poor
attitude of his SpR. This has had good results.
The scenario was of a difficult consultant
radiologist. These people are usually well known to
the organisation and everyone has difficulties with
them. John Paskins may tell us if that is the case.
Again insuch circumstances.....bridge building is
undoubtedly the way forward. In the heat of the Resus
Room however where a critical decision depends upon a
test result after a clear presentation of the facts
and asking 'for help with the case'....I would have
absolutely no qualms in proceeding down the path
outlined previously. It makes people listen and get a
reality check....as I say the art is to keep it
pleasant :-). I have never had to ring the Med
Director.
Taj
--- John Ryan <[log in to unmask]> wrote:
> The issue of 'stubborn', 'difficult', whatever you
> want to call them
> radiology registrars is clearly a pervasive problem.
> But surely it is for us
> to provide solutions to why it happens not look for
> reactive solutions to
> when it happens. Why does this keep happening ?
> Surely we are not that
> naieve as a specialty to think that when we convince
> today's radiology
> registrar that we are clinicians, or know better, or
> whatever it is we want
> to convince them that when they change over jobs
> then next year's lot will
> never have the same attitude again ?. But they do.
> And they will. Just
> like the surgical trainees will still use Pethidine,
> will want to be called
> early but won't respond because they are in thatre
> etc etc, we all know the
> lines.
>
> The challenege for us as a specialty is surely not
> to react to today's
> perceived egotistical trip by radiology juniors but
> to spend our time
> looking at why it is we receive such a response.
> Surely these are nice
> people and not genetically linked to be difficult as
> with some other
> specialties ! lets give them the benefit of the
> doubt and engage them I
> think none of us have the same problems with
> consultant colleagues as we or
> our juniors have with Radiology registrars. This is
> because we are in
> closer dialogue with consultant colleagues and
> understand and respect each
> other' s fields better. I believe we need to spend
> our time encouraging our
> registrars to liaise directly with the radiology
> registrars to draw up
> evidence based guidelines on when people are
> justified having advanced
> imaging. Sure this won't provide the panacea but in
> our experience it sure
> helps.
>
> I can recoomnd a reading of the diatribe of
> responses from radiologists to a
> particular BMJ filler last year. It does give some
> insight into how they
> think and the pressures they are under:
> .
> http://bmj.com/cgi/eletters/325/7368/831#26283
>
> John Ryan
>
>
>
> ----- Original Message -----
> From: "Doc Holiday" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Thursday, June 26, 2003 02:08
> Subject: Re: Are we Clinicians?
>
>
> > I have been in some serious doodoos before for
> writing about this subject
> in
> > the press. I had exceeded the limits of good
> tastes in making comments
> > implying that "it takes a clinician to identify
> another" to explain why
> > radiologists ask these stupid questions.
> >
> > I have grown up (a tiny bit). I no longer even get
> angry when this
> happens.
> > When they lose contact with patients, many
> radiogists lose contact with
> the
> > whole world of medicine as a whole. Some of them
> last saw daylight
> (outside
> > the viewing room) when A&E did not yet exist as a
> specialty... Did someone
> > say "dinosaur"? So, Simon, it is not YOU who is
> out of touch with
> reality...
> >
> > I have seen these situations diffused in many ways
> (although never through
> > an "incident form"). One of the best solutions
> recently thrust into our
> > hands are the government targets:
> > 1. Radiologist demands "clinician" see patient
> before CT.
> > 2. ED doc says "thanks. I'll get back to you."
> > 3. ED doc calls up one of those recently
> materialised manager-types whose
> > life seems nowadays to revolve around the 3h59m
> target. Tells him/her that
> > patient could be discharged if CT normal or
> prepped for respective
> admission
> > if not. Patient will be "on the clock" waiting for
> a "clinician".
> > 4. Management-type makes radiologist understand...
> (yes, they DO have
> their
> > uses)
> >
> > Phil, last time I was asked whether medics have
> agreed to do a LP if CT is
> > normal, I explained to the radiologist that the
> medical SHO on duty had
> just
> > recently been my SHO and that he would love to
> practise this skill, which
> I
> > taught him, but he needed my to OK it first, since
> this was MY patient and
> I
> > would not OK it without a CT. It is also easy to
> just say "hold on" and
> pass
> > the phone to one of the A&E SHOs who can then say
> he IS the medic on
> call...
> > They really appreciate the laugh when you do that.
> Once, I got a medical
> > student to say it...
> >
> > A really good one is when a radiologist comments
> about what a waste of
> time
> > it is to CT a person with neurological deficit who
> is XX years old (same
> for
> > DNAR orders or any other procedure for which
> ageism is proposed as a
> > gate-keeper). My favourite reply is something
> along the lines of "sorry, I
> > haven't checked this for a while. What IS the age
> limit nowadays?"
> >
> > But once I was witness to the funniest "clinician"
> request episode.
> > 1. SHO and consultant involved in case of
> young-ish man with severe
> > headache. Teaching session ends with all satisfied
> that CT indication is a
> > no-brainer in this case.
> > 2. Consultant calls radiology registrar but
> identifies self as "Dr. X in
> > A&E" (I don't think radiologist realises this is a
> consultant).
> > 3. Consultant looks up from phone in disbelief and
> says, "she wants me to
> > approve this with a clinician..."
> > 4. I jokingly point out the medic in call writing
> notes next to me.
> > 5. Consultant, loud enough for radiologist to hear
> over phone, calls over
> > the medic to "tell her he wants a CT"
> > 6. Medic comes to the phone and says, literally,
> "please do a CT". I'm not
> > kidding - that's what he said.
> > 7. Medic listens some and then hands phone back to
> consultant. "I know he
> > has not seen the patient. Neither have you. That's
> why I (emphasis here)
> > made the decision to have a CT done." The tone of
> voice now is not angry,
> > but is the one which, if you have any insight,
> tells you to curl up in a
> > ball and humbly submit... No such luck.
> Conversation continues. Consultant
> > at some stage DOES mention he is a consultant - it
> makes no difference -
> > radiologist wants medic to look at patient and
> request CT.
> > 8. Still polite and good-natured, although
> obviously disappointed,
> > consultant gives up. Calls radiology consultant on
> call. Problem sorted.
> > Radiology consultant contacts radiographer and she
> does the scan (it's NAD
> > and so is the LP later). Consultant is present in
> CT while scan is done,
> > reads own CT then radiographer calls radiologist
> to come down and report
> it
> > anyway.
> >
> >
>
----------------------------------------------------------------
> >
> > From: Dr P Munro <[log in to unmask]>
> >
>
=== message truncated ===
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