"don't trust the radiologist"
Started by oscarshi
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Ask your attendings why they say that. And if you cannot trust the radiologist who can you trust? (Rhetorical question).
I've heard the same thing a few times, but it definitely wasn't in the context of bashing radiologists. Basically, those docs emphasized that it's ultimately your responsibility to diagnose your patient, so taking a second look at the films or whatever is worth the time.
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It refers to the fact that Radiologists are not clinicians & that not every diagnosis can be made radiographically.
And equally importantly, not every diagnosis need be made radiographically. Few clinicians these days are clinicians (if that makes sense).
I think there are several reasons behind this. I know that the best surgical and medical residents I have worked with make an effort to come to the radiology department to see and confer with the radiologist, even if its a study they will never read themselves (HIDA scan, V/Q, MRI body, etc.). They do this in order to provide their clinical input and discuss the imaging findings in difficult or equivocal cases. They also see more of these scans and can get an understanding of how to use them, what they can show, and what their limitations are.
Secondly, as stated above, the final decision making power is in the hands of the clinician and they should see the images, even if they do not fully understand them.
Thirdly, they provide a useful second eye. Despite the training of radiologists, things can be missed, and the more people see the study the less likely it will be that a finding can be overlooked.
Secondly, as stated above, the final decision making power is in the hands of the clinician and they should see the images, even if they do not fully understand them.
Thirdly, they provide a useful second eye. Despite the training of radiologists, things can be missed, and the more people see the study the less likely it will be that a finding can be overlooked.
I find it funny how some clinicians who don't trust radiologists order unecessary studies because they can no longer trust their poor clinical skills.
After the clinicians get burned a couple of times they appreciate the radiologists input much more. I always find it funny how gung-ho some surgical subspecialty residents are about reading films. They have this attitude of- who needs the radiologist. I think that they are in a cloud of ignorance and will change once they get burned. Any radiologist or resident knows how subtle significant radiological findings can be.
After the clinicians get burned a couple of times they appreciate the radiologists input much more. I always find it funny how gung-ho some surgical subspecialty residents are about reading films. They have this attitude of- who needs the radiologist. I think that they are in a cloud of ignorance and will change once they get burned. Any radiologist or resident knows how subtle significant radiological findings can be.
One of my attendings during inpt. peds made it a point to go over to radiology every time she had a question about a read - and she took eveyone who wanted to go with her (reminiscent of a field trip). This was not because she didn't "trust" the radiologists, thoug. She would repeadetly say that "we have to remember that the radiologists are DOCTORS, too" (her emphasis). She was basically reminding us to go talk to them and give them the clinical picture they need to make the diagnosis as accurately as possible. The 2 minute walk made a difference in patient care more than once during that rotation.
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Frankly, these discussions have gotten boring. I was hoping to help transform this previously dull and rarely visited forum into something where rads residents and others could exchange relevant information and advice. Instead, this is what constitutes most of this forum.
Bottom line: Above average and great clinicians understand the value of a good radiologist and use them to their advantage in patient care. We are here to provide this service. I respect these doctors and will often go out of my way to accomidate them (adding on their patients, calling them often with findings etc) Stupid and sh*tty clinicians tend to dismiss the radiologist probably out of some deep sense of self-loathing created by their own miserable lives. They are on their own as far as I could care.
I believe the above comment is more along the lines that ALL clinicians should look at the studies they order, which in my opinion is a good habit.
Bottom line: Above average and great clinicians understand the value of a good radiologist and use them to their advantage in patient care. We are here to provide this service. I respect these doctors and will often go out of my way to accomidate them (adding on their patients, calling them often with findings etc) Stupid and sh*tty clinicians tend to dismiss the radiologist probably out of some deep sense of self-loathing created by their own miserable lives. They are on their own as far as I could care.
I believe the above comment is more along the lines that ALL clinicians should look at the studies they order, which in my opinion is a good habit.
I find this approach interesting. Wondering on a philosophical level whether it is preferable to NOT give the radiologist a thorough "clinical picture", lest that might tend to "lead" the diagnosis. Wondering what radiologists think of this. Is the accuracy of a read impacted by the amount of clinical information the radiologist has - and if so, in which way? Is more info better or worse?
judd
Pretty much every radiologist that I have worked with agrees that more clinical information is better. We are physicians who use all of the the data provided to come up with a diagnosis, including differentials. With no clinical history, narrowing the differential is pretty much impossible.
Some examples: Recent clinic x-ray with only history being: Pre-op. Right lower lobe diffuse patchy infiltrate on radiograph. Looks like pneumonia, bad enough that the patient should be very symptomatic. The doc calls to review film with me, I ask if patient has symptoms of pneumonia or had recent pneumonia. She says no, she has been feeling fine, totally asymptomatic. Basically, I told her that this moves bronchoalveolar carcinoma much higher on the list. Recommend close follow up x-ray (next week) to make sure this isn't an early or resolving pneumonia and if still there, CT of chest. If I had not known patient was asymptomatic, I would have called it pneumonia. The only other option would be to provide a very broad differential, which is what clinicians complain about in the first place.
Another example that happens pretty much daily: Extremity x-ray with history of "pain." Very questionable area that could be a very subtle fracture or not. ER doc comes in and says, the pain is nowhere near there (finding in phalanx, pain in proximal metacarpal for example). This questionable finding will not be a fracture.
It is vital in my opinion, and in the opinion every attending I have worked with that we recieve good clinical history. We are physicians and take into account all of the factors when helping make a diagnosis. The alternative would be a long differential list (trust me it can be very very long for most findings) which is of help to no-one.
Some examples: Recent clinic x-ray with only history being: Pre-op. Right lower lobe diffuse patchy infiltrate on radiograph. Looks like pneumonia, bad enough that the patient should be very symptomatic. The doc calls to review film with me, I ask if patient has symptoms of pneumonia or had recent pneumonia. She says no, she has been feeling fine, totally asymptomatic. Basically, I told her that this moves bronchoalveolar carcinoma much higher on the list. Recommend close follow up x-ray (next week) to make sure this isn't an early or resolving pneumonia and if still there, CT of chest. If I had not known patient was asymptomatic, I would have called it pneumonia. The only other option would be to provide a very broad differential, which is what clinicians complain about in the first place.
Another example that happens pretty much daily: Extremity x-ray with history of "pain." Very questionable area that could be a very subtle fracture or not. ER doc comes in and says, the pain is nowhere near there (finding in phalanx, pain in proximal metacarpal for example). This questionable finding will not be a fracture.
It is vital in my opinion, and in the opinion every attending I have worked with that we recieve good clinical history. We are physicians and take into account all of the factors when helping make a diagnosis. The alternative would be a long differential list (trust me it can be very very long for most findings) which is of help to no-one.
i find the last post to be very true - i know there is a BIG difference in radiology reports on a film with minimal clinical history... Usually when i write in my rads request a thorough BUT CONCISE history with specific question, i usually get a very specific answer because rads knows what i am concerned about... so for those who complain that the rads report is too broad and too vague they can for the most part only blame themselves for not providing enough info.... a similar analogy would be if you showed a KUB to a surgeon and said: "pt is complaining of abdominal discomfort" the only thing that you will get out of the surgeon is a huge differential.... 🙂
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