Addressing Referrer Psychology In The Radiology Report
What are the most important differences between most resident and attending reports? Residents reports tend to be one size fits all. On the other hand, the attending will usually look at the name and specialty of the referrer before even beginning with a dictation. Then, he integrates referrer psychology into the report. And finally, seasoned attendings will approach a report as a solution to the specific clinician’s problem.
Why is it important to address these differences? Simply, the primary reason for radiology’s existence is to provide solutions for our fellow physicians in order for them to come back for more. So, it is imperative that we satisfy our referrers needs in our reports before anything else. And, therefore, we need to individualize these solutions in every dictation we complete. For today, I aim to teach how residents and even junior radiologists can change their “one size fits all” reports into a report with a laser-like focus that answers the referrers question. Let’s do just that!
Addressing Pertinent Positives And Negatives
Take a look a great radiologist’s dictation. If the patient has a history of an abdominal aortic aneurysm, you will see statements about dissection, rupture, mural thickening, or ulceration. Or, if the patient has prostate cancer, the dictation will detail the osseous sclerotic lesions, iliac and inguinal nodes, liver lesions, the prostatic bed, and pulmonary nodules. In the resident’s dictation, you are much less likely to observe these relevant findings. It is more likely to be a bland checklist. Addressing the pertinent information, goes a long way to addressing the psychology of the ordering clinician.
Keep In My Mind What The Referrer Really Wants To Know
Typically, the first paragraph of the findings should answer the question that the clinician has posed. Logically, this makes sense. The clinician most likely analyzes only the first part of the findings and impression, if any. In addition, make sure to start with those items that contain the most important information. Then, run down the findings in order of importance. For the clinician reading the report, it adds clarity to what is most important. Opposed to the typical resident report, the goal of the report remains clear, to answer the clinician’s question appropriately.
Give Some Leeway To The Referring Clinician
A clinician does not like to be hemmed in by the requirements of the report. So, make sure to give the clinician that leeway. Do not to lock in on one diagnosis, forcing her to pursue that avenue. What do I mean by that? I will give you two examples.
First, give all the relevant likely diagnoses. If you start talking about something in depth that is unlikely to be the cause for the patient’s illness, in essence, you may force the hand of the clinician to pursue the wrong diagnosis to the cost of poor patient care and expense to the system.
Second, if you recommend biopsy without alternative, you can legally bind the clinician to perform an unneeded procedure. If for some reason, something goes awry and the doctor did not pursue that avenue, legal consequences can follow. So, be careful what you say!
Don’t Leave The Referrer Hanging
I like to call this waffling. Instead of giving many differentials, make sure to come down on those most likely to be the diagnosis. Always, attempt to attach probabilities to the different possibilities. This makes it much easier for the physician to provide appropriate testing and quality care.
Ask For More History
You may think the clinician will get annoyed if you ask him for more information. But, it is usually the opposite psychology. It shows you are taking the initiative. And, you are more likely to create a relevant report that will be helpful to the patient and the clinician. Rarely does a good history ruin a report!
Communicate The Results More Effectively
Check the report over after it is completed multiple times. Very few things bother the referrer more than reports with incomplete unintelligible sentences. Perhaps unwillingly, you leave out the word “no” somewhere in your dictation. Believe it or not, this can be crucial to the treatment plan of the clinician. Most of the time, the unnecessary phone calls I receive are for the occasional grammatical or incidental mistake in the dictation. It happens to everyone. But, try to minimize this effect by checking your work!
Summary On Addressing Referrer Psychology
In order to create a sound report that helps the clinician, you need to get into the mind the ordering doctor. So, think like a clinician. Put all the relevant information into the dictation without the fluff, always keep in mind the goal of the ordering doctor, make sure to give some leeway to the physician, get an appropriate history, and make sure you look over your report so that it makes sense. Not only will your doctors appreciate your reports more, but your patients will too!