The Referring Physicians Wish List: What Clinicians Need from Radiologists

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There are easy answers to the question "what do referring physicians want from radiologists?" A few brave clinicians offer glib replies that range from "rapid turn-around time" to "perfect certainty." But physicians readily admit that these aren't their real needs, which are far more complex and place much greater demands on radiologists. Many cite intangibles such as clinical value and relationships, while acknowledging the pressures that radiologists face.

"As we get better at interpreting our own images, radiologists have to bring more value and information to the process," says Laura J. Trombino, MD, a pediatric orthopedic surgeon with Essentia Health in Duluth, Minn.

It's challenging as each specialty and each physician brings different expectations. The common denominator on the wish list, however, is the patient. "The whole idea is to provide the best possible information to help the patient get better," says Thomas C. Peterson, MD, chair of family medicine at Fletcher Allen Health Care in Burlington, Vt.

The irony, notes David M. Panicek, MD, vice chair for clinical affairs in the department of radiology at Memorial Sloan-Kettering Cancer Center in New York City, is that imaging is integral to many clinical activities. Yet, radiologists' contact with patients is often limited to the diagnostic image.

"Radiologists often are not looking at the entire imaging exam history of a patient; more often viewing only the ordered study in isolation," observes Alec J. Megibow, MD, MPH, director of outpatient imaging services at New York University Langone Medical Center in New York City. Viewing the study as a patient with the context of patient history could satisfy referring physicians and help radiologists reframe their workflow, reports and relationships—for the better.

The imaging order: Dissected

The patient care process begins with the order, and as with every other step in the imaging chain, some approaches are superior to others. "A request for a radiology study is more than a test order. It's a consultation," says Peterson.

A simple, but occasionally overlooked, first step: Read the chief complaint. That way, the radiologist understands what the referring physician is looking for in the study. It guides the report and may inform the study and diagnosis.

"We may make a good request, but there may be better capability. If the radiologist can preview the order and say that for this question about intracranial hemorrhaging an MRI would better answer the question than a CT, the best test can be done for the patient," Peterson says.

In addition to ensuring that physicians have the optimum imaging data, this approach helps patients avoid unnecessary diagnostic imaging (and costs). Consider, for example, the pediatric patient who presents to the emergency department with a suspected shoulder fracture. It's not uncommon for the patient to be sent for generic x-rays of the arm. "There are better uses of imaging. A physician can miss a subtle growth plate fracture without the right views," says Trombino. After a suboptimal initial study, the patient often requires repeat imaging.

A study, published online Nov. 15, 2011 in Radiology, estimated that 6 percent of radiologists' recommendations for high-cost imaging exams were preceded by an inappropriate or suboptimal imaging order by the referring physician.

"These errors in imaging exam choice indicate a knowledge gap among referring physicians, which could