A clinical colleague walks up to you and the following conversation ensues.
Clinician: Can you take a look at my chest film? I have had a cough for the past several weeks that won’t go away.
Radiologist: Sure. Let me take a look at the image.
The name of the clinician is typed into the computer and the images pop up on the screen
Clinician: Well, what do you think?
The radiologist stares intensely at the screen. Beads of sweat begin to form on his forehead as he sees a spiculated 6 cm left perihilar mass with adjacent interstitial changes and pulmonary nodules in the opposite lung. The clinician stares at the radiologist in front of the desk.
Radiologist: Well… Ummm…
Clinician: Well, what do you see?
By far, reading your fellow clinical colleague’s imaging studies has the potential to be one of the most stressful clinical situations as a radiologist. (as witnessed above) Even worse, the physician-patient may stand directly in front of you while you are looking at the films for the first time. God forbid we find something potentially lethal or unexpectedly harmful.
Over the years, similar scenarios have played themselves out several times. And, it’s not just me. Inevitably, it happens to most radiologists at some point in their careers, probably you as well. So, what do we do in these situations? Well, you guessed it. That is the theme for today’s post… Let me try to give you a few pieces of sage advice.
Take Time To Read The Study And Call The Clinical Colleague Later
Just like I previously advised in prior posts such as Radiology Call- A Rite Of Passage, you are better off taking your time and going through your search pattern rather than being interrupted and making the wrong diagnosis. When a physician-patient is standing right in front of you and staring at the screen, your attention can be directed toward your emotions, leading to poor discrimination and interpretations. You are not doing justice to good clinical care.
I know. It is very difficult to say to the physician-patient, “I can’t look at your images while you are in the room.” Instead, just say, ” I will look at your images later when I can really make my best interpretation.” Most of the time, your clinical colleague will comply (But not always!). It certainly allows you, the interpreting physician, to have time to think about the films and diagnosis in the appropriate manner.
Don’t Beat Around The Bush
Your colleagues are physicians and generally, know a bit about imaging/radiology. They will know if you are holding back a finding. So, regardless of whether you are on the phone or in person, you really need to just tell them what you see. In the world of radiology, however, most findings and impressions (even malignant looking ones) have the possibility to have numerous outcomes. In this situation, it is reasonable to say I think it may be x (a malignant diagnosis), but I have seen when it turns out to be y (a benign diagnosis). Of course, you don’t want to give false hope. But we as radiologists are rarely 100 percent correct! That gives you a little bit of an out.
Never Farm Out This Responsibility To Another Radiologist!
Generally, there is a reason why this physician-patient comes to you to read their study. Maybe, he likes your skills as a radiologist. Or perhaps, she sees you as a confidant and friend. But for whatever reason, this person came to trust you to read his film. It is never appropriate to shirk your responsibility to talk to the physician-patient by doling the responsibility to another physician. It is part of your responsibility as a colleague and physician. Not to say, you cannot get help with the interpretation, if complicated. But, you need to be the one that directly speaks to the physician-patient.
Be There As A Friend/Colleague
Finally, we as radiologists and physicians are all interconnected to our fellow clinicians through the shared medical experience. It is important to remain present as a friend and colleague to the physician-patient that you diagnosed. Give the physician-patient your number to call if he/she has any additional questions. Commiserate over the diagnosis. Treat this person as you would any friend.
Our hardest jobs as radiologists and clinicians are not the day-to-day interpretations of films and coming up with differential diagnoses. But rather, they are the difficult interactions that we may need to have at some point with our colleagues and friends. We need to relay the information to them about their images in a way that is appropriate, correct, and thoughtful. Even though there is no perfect way to do so, it is important that we treat our colleagues as we would want to be treated ourselves.