Well, you're still missing my point. That's really rich you know. Since when
have radiologists been interested in doing "what is best for the patient" or
in "working together as a team"? And it's got nothing to do with lack of
respect. I'm just telling you how many radiologists treat their clinician
colleagues up and down the country. Of course I'm biased, as I tend not to
hear about the good ones, but I hear all about the bad ones as my juniors
come running to me every time they have a problem getting a scan etc.
And don't talk to me about IRMER. Every week I do a medicolegal case where
someone has suffered serious harm, or died, because someone failed to carry
out a diagnostic imaging procedure. I've never heard of a hospital being
sued for causing harm by wrongly carrying out a diagnostic imaging
procedure. IRMER has got its priorities all wrong if you ask me, and it
tries to impose its ridiculous values on the clinicians, who then end up in
Court desperately trying to defend their decision not to carry out imaging.
AF
----- Original Message -----
From: "Vallis, Jacquie" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, December 12, 2006 12:29 PM
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
>
> --
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/Rowley./
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