Tag: procedure

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Canceling A Procedure? Call The Clinician!

Not all ordered procedures make sense. Perhaps, the clinician decided on you performing a biopsy based on an incorrect typographical error in a report from the radiology department. Or, even though the clinician thinks that a carotid stent would be helpful, you conclude that the risks of a procedure outweigh the benefits. In the end, these decisions to perform or cancel a study are ours to make, not the referrers. And, sometimes, canceling a procedure for a good medical reason is the best we can do for the patient, end of story. You can feel good about yourself, doing right for the patient. Plus, you have one less procedure for the day!

But wait. Is that all? Well, you have not completed your work yet. What is the one way that you can get yourself into loads of trouble even though you canceled a procedure for a good reason? Hint! You can look at the title above, or instead, check out what I am about to tell you in capital letters: CALL THE CLINICIAN! And, let me tell you why.

It May Delay Clinical Treatment

Even though you serviced the patient well by canceling a procedure, it may not have benefited the patient as you thought if you do not notify the ordering physician.  Let me give you an example. You were planning on performing an angiogram to determine the location of a GI bleed. And now, you have canceled the examination because the GI bleeding stopped. And let’s assume you did not contact the ordering physician. Well, perhaps, the treating physician had delayed treatment for hyperthyroidism based on the assumption of your administration of intravenous contrast material. Look what you did! Now, the patient had her treatment hindered for many weeks by your lack of communication.

Potential Increasing Risks To The Patient

Sometimes patients temporarily stop necessary medications before a procedure. For instance, many patients take Coumadin as preventive medicine for stroke if they have a prosthetic valve because they are at increased risk for blood clots. Therefore, typically, you need to withdraw the patient from anti-coagulants to prevent bleeding during or after a procedure.

And, when you cancel a procedure, many times, the patient will not return to their regular scheduled regimen until the doctor reorders it. Moreover, the patient’s risk for stroke can increase each day he does not receive the medication. Therefore, it behooves you to let the ordering physician know. Why would you want to enhance a patient’s risk for further morbidity?

It’s Offensive Not To Notify The Ordering Physician

One of our prime roles as physicians is to communicate results (or lack of results) to our colleagues and patients. By withholding critical information from the ordering physician, you disrupt the link. And, yes, canceling a procedure counts as “critical information.” If you want to make sure not to get repeat customers in your department, be sure not to pick up the phone and call!

You Can Ruin Your Reputation

Technically, you may be the best neuro angiographer in the world. But, if you cannot let your colleagues know that you decided to cancel that stent placement procedure, then, who cares about how good you are? You are not giving patients the best medical care. And, you certainly do not want to establish that reputation.

There’s More To Do After Canceling A Procedure!

Practicing quality radiology involves more than just making quality clinical decisions and performing appropriate procedures well. Just as importantly, we also need to maintain the links of communication with our clinical colleagues so that we can give the best possible care to our patients. And, if sometimes, the best decision for the patient is to cancel a test, make sure to contact your fellow physician. Don’t spoil your excellent patient care with a lack of communication!

 

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How To Add A New Modality To Your First Practice Fresh Out Of Fellowship

modality

The most significant controversies in private practice often stem from workload/relative value unit (RVU) or differences in “earnings” among physicians. Anytime one physician “works more” or earns less on a daily rotation, partners and employees interpret that difference as unfair. Even more so, radiologists heighten this perception when one physician performs this rotation more than others. So, imagine starting and attempting to introduce a new procedure or imaging modality to a radiology practice right after graduating from a fellowship. Often, this will tip the workflow balance for an entire radiology business. So, how do you incorporate this new work into a practice’s current workflow? And what might you need to do to sway your partners to change the workflow for this new procedure in your practice? Today, we will delve into what you need to know as a new radiologist fresh out of fellowship who wants to start a new program or modality.

Show That The New Modality Increases Practice Value

To begin the process, you need to demonstrate that the new procedure adds value to the practice. What do I mean by that? Well, your job (if you choose to do so) becomes to convince your partners that your procedure or modality will eventually increase or at least maintain business.

How do you go about this process? One of the easiest ways to accomplish this goal is to give a practice-wide presentation. To do so, you need to show that your new modality will provide revenue above and beyond what the practice brings in. If this is not the case, you should demonstrate how the new procedure may act as a loss leader or at least increase ties with the hospital for all to benefit.

Another option to increase the buy-in of the partners would be to perform the art of “politicking.” Talk to your partners individually to get them to understand what the new procedure/modality will bring to the practice. So, when it comes time to discuss adding your new procedure to the daily rotations, each radiologist will be on board.

And finally, you need to consider what the practice will need to add and the costs to start the new procedure or modality. Is this procedure going to take away from other businesses in the practice? Or, in the case of new high-tech equipment, are the costs prohibitively expensive? These items are crucial to think about before beginning the new procedure.

Make A New Schedule That Is Fair For Everyone

Next, you need to think about not just the procedure value but also you should develop ways to incorporate the new procedure into the schedule reasonably. The less onus on the partners to establish a new schedule, the more likely you will be able to add the new modality to the practice. So, come up with ideas about how to add the new procedure. Perhaps you want to first tack it on to a current rotation. Or maybe, it is worthwhile to go full-steam into a new daily or weekly rotation. You must consider working out these factors before “going live.” If you cannot accomplish this, the chances of creating a new addition to practice dramatically decrease.

Be Aware Of The Politics

Sometimes beginning a new venture can wreak havoc on a practice or hospital system. For instance, adding a new SPECT/CT to one site may take away business from another within the system. This new equipment and procedure may decrease the employment opportunities for technologists within the site that does not have the latest technology. And, you may get a lot of pushback when you try to add it to the site. Therefore, taking the politics of the practice and hospital before beginning the new procedure is crucial.

Don’t Overwhelm The Decision Makers

These steps listed above are instrumental to creating something new in your practice. However, you have to tread very carefully. Frequently, your partners may be busy with lots of other practice requirements. So, try not to overwhelm them. What do I mean by that? Ensure the new procedure will not burden the partners and employees significantly. In the beginning, consider taking on much of the excess work yourself to get the new modality started within the schedule. Remember, you are the champion of this new procedure. So, it would help if you put in additional work to begin up front. If not you, then who else will do it?

Bottom Line For Starting A New Procedure Or Modality

Whenever you want to start something new within a practice, it is not enough to jump right in and begin. You need to put in much forethought and work before beginning. Starting something new not only affects the person initially responsible for developing the initiative. Instead, incorporating new procedures into the schedule affects the entire practice due to its effect on workflow. So, show that the modality increases practice value, demonstrate how to incorporate it into the schedule reasonably, be aware of the politics, and take on much of the initial grunt work yourself at the beginning. If you can accomplish these steps, you markedly increase the chances of starting a new procedure or modality within your practice for the benefit of all!