Been there. First month of consultant job, woman in 50s, cerebral
irritability, needed urgent scan. Went to on call radiologist and provided
clinical picture and politely requested. The subsequent conversation:
"Who's asking?"
"Me."
"A&E consultants can only request CT scans for trauma. Anything else has to
be requested by an inpatient consultant."
Now I reckoned that I had two options open to me: hardball or softly-softly.
I chose the latter because then you can revert to hardball if necessary,
it's not possible to go the other way around.
Softly-softly worked and we now have a much improved and more mature
relationship with the radiologists, to the benefit of the patients. This was
achieved without face loss and as a result things get better all the time.
It smooths the paths for all those other things that need to be done.
Definitions:
Softly-softly = giving them time to realise that you are good at your job,
that their unreasonableness is making them look foolish and letting them
change their approach without drawing attention to the fact that they are
doing so.
Hardball = 1. Fill out a clinical incident form on the basis of risk to
patient incurred because of unnecessary delay, 2. Write to medical director
with copy of said form, 3. Ditto duty medical consultant, 4. Etc.
If choosing latter route expect life to become more unpleasant for the
foreseeable future, do not plan to work in the hospital in the future and do
not depend on references from said hospital.
Here endeth the lesson. I apologise if it sounds patronising but know
exactly how frustrated you feel.
It's like the old chestnut:
Go to your office and write a really strong letter, let it all rip and put
down every last thing that has riled you. Then lock it in a drawer
overnight. Read it the next morning and decide whether to send it or not -
mostly such letters are not sent!
Cheers!
Jeremy Harrison
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, June 24, 2003 7:10 PM
Subject: Are we Clinicians?
> I've just had the most staggering conversation with a radiologist. I was
requesting an urgent CT scan on a young patient with acute onset of
headache, left sided hemiplegia and a history of previous SAH secondary to
an AVM. The radiologist smiled and said:
>
> "Has this lady been seen by a clinician yet?"
>
> When I suggested that I was the clinician dealing with this patient (and
to imply I was not a clinician was somewhat insulting) he refused to accept
my standing and insisted that she be seen by "a clinician".
>
> It would appear that five years of general training, five years of
specialist training, three postgraduate exams and a consultant job in
waiting is not enough to be classed as a clinician.
>
> Besides this general insult was the opinion that a CT for a ?sub arachnoid
was urgent and not an emergency as it would make no difference to the
immediate outcome. Now within reason I can just about understand this. I
don't request CT scans at 5am for 95 year olds with acute hemiplegias but at
16.35 for a lady in her 30s?
>
> Am I completely out of touch with reality?
>
> Dr Simon McCormick
> SpR Emergency Medicine (on of the last clinical specialties left)
>
>
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