Connecting With Colleagues
Referring physicians and radiologists are working together more closely than ever. How can physician collaboration boost patient care?
The radiologist’s increased role in the care team will bring more opportunities to provide value in interactions with referring physicians.
And clinician colleagues are eager to connect with radiologists as they work together to care for patients. The American College of Physicians provides an internist perspective on the shifting role of radiologists in health care, the importance and challenges of clinical decision support, and the intersection between radiology and other areas of medicine.
Make Yourself a Consultant
Technology has vastly improved the quality of images and the speed with which reports are available, but in many ways it has distanced referring physicians and radiologists. We’ve all but lost the direct communication between previous generations of referrers and radiologists.
However, opportunities do exist for radiologists to play more of a consultant role. Direct communication provides support to referring physicians and establishes a relationship in which both sides feel empowered to seek further information. What does this look like in the modern health system? It may mean picking up the phone and making a call about critical results or passing along an article that might be of interest. Pre-imaging communication can also be critical in ensuring patients receive the most appropriate studies. Encourage your referring physicians to come to you with questions and then do the same yourself. Seek them out to ask questions, to offer help, to discuss interesting findings, and they will follow suit.
Champion Clinical Decision Support
One of the key areas of collaboration going forward is around imaging appropriateness. As health systems move in this direction, radiologists must make themselves integral to the processes of implementing these tools and supporting their colleagues in using them.
While radiologists should absolutely encourage their referrers to come to them with pre-imaging questions, the reality is that embedding appropriateness criteria in the electronic health record is the most time-effective way to support referring clinicians in ordering the correct study for a given clinical scenario. As they order imaging, referrers should have easy access to radiologist-created guidelines, such as ACR Select®.
As 2017 nears and consulting clinical decision support becomes a requirement for reimbursement, referring physicians and radiologists alike are motivated to implement processes that maximize the educational benefits of these tools and impose minimal burden on clinicians as they order studies. By advocating to get clinical decision support tools into the hands and onto the screens of clinicians, radiologists can better support their colleagues and care for their patients . And consider asking your clinical colleagues to join you in communicating with your health system around clinical decision support.
By taking the first step, you can set the tone of the relationship and demonstrate your genuine desire to support your colleagues.
Establish the Relationship
While the majority of a referring physician’s interactions with radiologists revolve around patients, there’s also value in reaching out physician to physician. Consider touching base with your colleagues simply to say, “I’m here to help, not only in terms of the patient care but also with education and professional development.” By taking the first step, you can set the tone of the relationship and demonstrate your genuine desire to support your colleagues.
Technology can aid physicians in establishing relationships with other providers. A radiologist might send a quick email related to an interesting finding in a shared case. Or if you’re looking at images together over the phone, point out an unusual item or give a little background at how you arrived at the diagnosis. These moments of connection can really strengthen a professional relationship. You don’t have to discuss every case or call about each patient, but taking a few minutes each day to foster relationships with your colleagues will go a long way.
Approach Each Colleague as an Individual
Different physicians prefer different levels of interaction. Some referring physicians appreciate a phone call anytime a study brings back something unusual. Others prefer to be the one to initiate contact in all but the most urgent circumstances. Consider asking outright how you can best support your colleagues. By saying, “How actively would you like me to be involved?” you reinforce your role as consultant and demonstrate your willingness to establish a relationship that works for both of you.
In the changing world of medicine, all providers face the challenge of keeping their knowledge and skills up to date. We all want to keep growing as physicians, and interspecialty communication can be key. Radiologists are in a unique position because they interact with patients from across the specialties. In a single day, they may see scans from a patient in the ED, followed by a routine mammogram, and then a CT screening for lung cancer. The vast majority of referring physicians appreciate the perspective radiologists bring to patient care and are eager to share information. On the flip side, ordering physicians are typically the closest to the patient and may be able to offer insights gleaned from their interactions and experience.
Keep the Patient at the Center
The first priority for both referrers and radiologists is quality patient care and a positive patient experience. While some controversy exists over when and how radiologists should deliver test results, a good guiding principle is to
put yourself in the patient’s shoes. If a study is normal, it’s generally fine to communicate these preliminary results to the patient. They may be anxious, and knowing the results will ease their mind and save them the stress of waiting to hear back. When a study is abnormal, the situation can be trickier. In a perfect world, the radiologist could check in with the referring physician before speaking with the patient. This sequence of events ensures the patient is not getting mixed signals or confusing information from their physicians. However, it is not always possible for radiologist and referrer to connect directly after a study. In these situations, radiologists should inform patients that the ordering physician will contact them with their results. Doing so ensures that the patient receives a more complete discussion of their results and guidance on how to place this information in the context of their health.
Patients are also well served by radiology reports that communicate findings clearly. Interpretations with many instances of “cannot rule out” and suggestions for additional studies may give referrers the sense that the radiologist is more concerned with malpractice liability than with conveying actionable diagnostic information. Reports like these can give the impression that the radiologist is attempting to shift responsibility over to the referring physician. Make your reports clear, concise, and actionable in order to provide the most value for referring physicians and patients alike.
The relationship between radiologist and referring physician has real effects on how a health system runs, the quality of care patients receive, and the ongoing education of both physicians. Current shifts in health care offer opportunities to connect and collaborate beyond an imaging order and a radiology report.
Imaging 3.0 in Action
Engage referrers with the ACR PQI project
The ACR’s value-based PQI project includes a step designed to help radiologists share imaging appropriateness information with their colleagues.
Meet the American College of Physicians
The American College of Physicians is made up of 141,000 members,including general internists, hospitalists, internal medicine subspecialists, and medical students, residents, and fellows. The organization’s mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.
By Steven E. Weinberger, MD, CEO of the American College of Physicians