Well, you've hit the nail on the head Paul. I think the level of poor
cooperation we find from radiologists in this country has nothing to do with
IRMER or radiation exposure. It's just plain "work avoidance" if you ask me.
AF
----- Original Message -----
From: "Paul Bailey" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, December 12, 2006 12:36 PM
Subject: Re: alleged drug ingestion
> Here we go again.....
>
>
> From an Australian perspective, it's amazing when you start working with a
> "fee for service" (ie paid for each individual test) radiology department
> how these concerns seem to evaporate.
>
>
> Paul Bailey
>
>
> _____
>
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Vallis, Jacquie
> Sent: Tuesday, 12 December 2006 8:30 PM
> To: [log in to unmask]
> Subject: Re: alleged drug ingestion
>
>
> Whether or not you can abide it, under IR(ME)R, radiology still has the
> ultimate responsibility for justifying the use of radiation to patients.
> As
> I have said already, the main problem is the minimal information on the
> request in the first place. If there can be no justification made from
> the
> information on the request, then radiology will just keep bouncing it
> back.
>
>
>
> At the end of the day, it should all be centred around what is best for
> the
> patient, and that is why everyone should work together as a team in the
> hospital. The lack of respect for other specialities such as radiology is
> astounding, and I'm sure that my radiologist colleagues would be
> interested
> to hear your views.
>
>
>
> Jacquie Vallis
>
>
>
>
>
>
>
> _____
>
> From: Accident and Emergency Academic List on behalf of Adrian Fogarty
> Sent: Mon 11/12/2006 23:49
> To: [log in to unmask]
> Subject: Re: alleged drug ingestion
>
> ----- Original Message -----
>
> From: "Vallis, Jacquie"
> I do dispute the comment from someone that radiology has no clinical
> responsibility for the patients, as that was a completely unfounded
> comment.
> Radiology sees patients from the entire hospital, not just the A&E
> department. [Jacquie Vallis]
>
> What I actually said was "radiologists don't have primary responsibility
> for
> patients" but since you brought it up I'm happy to clarify, and maintain
> they have no direct clinical responsibility. They do have responsibility
> for
> their reporting decisions, and can be held liable for reporting errors,
> but
> that is not the same thing as direct clinical responsibility.
>
>
>
> And it has nothing to do with patients from other parts of the hospital as
> you suggest. The same thing applies: all patients who undergo imaging are
> referred from direct-care clinicians, who take ultimate responsibility for
> their patients' management. Radiologists don't, and what I can't abide is
> radiologists - or radiographers for that matter - trying to impose their
> views on patient management on to referring clinicians, particularly since
> the former (i.e. radiologists) are no longer in clinical practice.
>
>
>
> Adrian Fogarty
>
>
>
>> No, it is the concept of "refusing" that does not facilitate good
>> relationships between departments. Fine, I don't mind a radiologist
>> (or radiographer) suggesting a different imaging strategy, or I don't
>> mind a radiologist (or radiographer) asking for more detail on a
>> request form, but I don't accept a radiologist (or radiographer)
>> refusing a request because they don't believe it's indicated.
>>
>> That's my job, to decide if someone has sufficient clinical evidence
>> to warrant imaging, not the radiologist's job. Just this week a
>> radiology reg tried to persuade my reg that a CT head was not
>> indicated. Fine, it was a very borderline request and both registrars
>> suspected it would be negative, but ultimately it's my registrar's
>> call, not the radiologist's. My registrar has ultimate responsibility
>> for the patient, not the radiology registrar.
>>
>> Put it this way, when the debate had reached an "impasse", my
>> registrar - rather than simply accept the radiologist's advice not to
>> scan - held firm in his request for a scan. The impasse was finally
>> broken when my registrar calmly suggested that since he still wanted
>> the scan then he would have to document that the radiologist had
>> refused the scan. The radiologist immediately then acceded to my
>> registrar's request.
>>
>> The bottom line was, that once we record that the radiologist has
>> refused the scan, then they have to accept a share of the
>> responsibility for the patient, and they were not prepared to do
>> that. I thought this was quite illustrative. Radiologists are happy
>> to try to persuade us that the scan's not needed, but only insofar as
>> we change our mind and so we take responsibility. But if you ask the
>> radiologist to share some of the responsibility, then they're not so
>> keen to refuse to scan.
>>
>> At the end of the day, radiology is a "service" specialty, not much
>> different from pathology or neurophysiology or any other service
>> specialty. By that I mean that radiologists' workload is determined
>> by referring specialists who in turn have primary responsibility for
>> patients. Radiologists don't have primary responsibility for
>> patients; their only responsibility relates to the exigencies of the
>> imaging modality itself.
>>
>> So, at the end of the day, you may feel more comfortable making a
>> distinction between "requesting" and "ordering" but I can tell you
>> now, when a senior clinician "requests" an image, it's a lot stronger
>> than a polite "request", and more often than not for practical
>> purposes he's "ordering" it. I know you folk aren't comfortable with
>> that concept, but that's the reality of the situation.
>>
>> I suspect a lot of this has got to do with semantics: "request"
>> suggests subservience while "order" suggests dominance. Perhaps we
>> should use the more neutral phrase "to book a scan" which more
>> realistically describes what's going on.
>>
>> Adrian Fogarty
>>
>> --
>> *Included Files:*
>> am2file:001-HTML_Message.html
>
>
> /Rowley./
>
>
>
>
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