<Applause>
Probably the most dangerous thing we do is give someone a blood
transfusion. Has anyone ever had to beg blood from a haematologist?
R
> 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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