Surgeon-Radiologist Relationship

[blastoise]

Hello everyone, medical student here.

I have a question about the interactions between surgeons and radiologists in the day to day scope. I recently started a surgery elective (ortho) and I have heard an insane amount of bashing about the uselessness of the radiologist report/interpretation. I am interested in radiology and very much because of inter-specialty interactions. However, I did not expect to see much disregard for their interpretation, essentially it appears as if the radiologist adds now value to the surgeon.

I posted on the surgery thread because I wanted to see across all surgical subspecialties if this is a common theme. I would love to hear if any med students, residents and attendings have any comments about this particular topic. Is it really widespread that surgeons nowadays have almost no interaction with radiologists and rarely even care about their report? Or, is this just a unique/individual experience I am having.

Thanks !

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[Wordead]

I think surgeons universally advocate for learning to read their own imaging. From what I've seen/heard, they think that most radiologists do not have the clinical context or knowledge of the surgical subspecialties to give you a good read, unless they've done some specialized fellowships. We trusted the head + neck neuroradiologists we had tumor board because they knew what they were doing. The general guys not so much. So not quite "zero value added" as you say.

 

[Vandalia]

Surgical sub-specialists are usually very good at reading the imaging as it pertains to the aspects that they are interested in. However, the radiologist adds value when it comes to the other stuff. For example, an orthopedic spine surgeon may be able to interpret the spinal pathology in an MRI as well as a radiologist, but isn't likely to pick up kidney pathology or an aneurysm in the abdominal aorta that appears in the periphery of the images. In the same way, the surgeon may do as well when it comes to looking at the shoulder in the MRI, but will miss some of the other pathology that can pop up on the scout images.

Looking for what you expect to see is probably at most only about 50% of actually practicing radiology.

 

[ACSurgeon]

Hello everyone, medical student here.

I have a question about the interactions between surgeons and radiologists in the day to day scope. I recently started a surgery elective (ortho) and I have heard an insane amount of bashing about the uselessness of the radiologist report/interpretation. I am interested in radiology and very much because of inter-specialty interactions. However, I did not expect to see much disregard for their interpretation, essentially it appears as if the radiologist adds now value to the surgeon.

I posted on the surgery thread because I wanted to see across all surgical subspecialties if this is a common theme. I would love to hear if any med students, residents and attendings have any comments about this particular topic. Is it really widespread that surgeons nowadays have almost no interaction with radiologists and rarely even care about their report? Or, is this just a unique/individual experience I am having.

Thanks !

- radiologists are super useful to surgeons, don't let anyone tell you otherwise.

- trash talking other specialties is common among all disciplines. Doesn't truly reflect the true value of the other specialty.

- radiologists read things without adequate clinical context. This is usually the fault of the providers ordering the imaging study.

- because of the point above, radiologists either over read things (eg: can't rule out x) or saying "clinical correlation recommended." This is a freebie to poke fun at.

- even the best surgeon looking through a CT or MRI will succeed at identifying obvious things or identifying findings that confirm or refute their ddx, but not so much at reading the entire scan and identifying subtle findings that might seem irrelevant to the ddx but in fact have clinical significance. There's a reason radiologists are paid well.

- do what you enjoy regardless of what others think

 

[Pir8DeacDoc]

Lazy Med with excellent advice.

I look at my own images, especially for things like tumors or sinus scans. I can find an acoustic tumor on MRI but otherwise MRI isn't my strong suit. After I look at images myself, I check out the radiology read to make sure they didn't see something else floating around in the scan that I might not have noticed. Also agree with above that subspeciality radiologists can be really helpful. Our head and neck radiologists were amazing when I was in training.

 

[Apollyon]

I have a good friend that is a neurorads (but, as she says, every rads subspec also does general rads) say that the surgeons are the best with questions, as they directly say that "I am concerned about [X], and the patient has [Y]". The IM (residents, where she is), on the other hand, order the study, and say "uhhh...what do you see?"

 

[VisionaryTics]

I think surgeons universally advocate for learning to read their own imaging. From what I've seen/heard, they think that most radiologists do not have the clinical context or knowledge of the surgical subspecialties to give you a good read, unless they've done some specialized fellowships. We trusted the head + neck neuroradiologists we had tumor board because they knew what they were doing. The general guys not so much. So not quite "zero value added" as you say.

Lazy Med with excellent advice.

I look at my own images, especially for things like tumors or sinus scans. I can find an acoustic tumor on MRI but otherwise MRI isn't my strong suit. After I look at images myself, I check out the radiology read to make sure they didn't see something else floating around in the scan that I might not have noticed. Also agree with above that subspeciality radiologists can be really helpful. Our head and neck radiologists were amazing when I was in training.

I have a good friend that is a neurorads (but, as she says, every rads subspec also does general rads) say that the surgeons are the best with questions, as they directly say that "I am concerned about [X], and the patient has [Y]". The IM (residents, where she is), on the other hand, order the study, and say "uhhh...what do you see?"

Totally agree. Our neuroradiologists are outstanding and are invaluable part of tumor board. We really don't even look at outside reads. All scans must be interpreted by one of the H&N neuroradiologists.

That being said, the quality of the general reads can be uneven. I've seen missed fractures, neck nodes, etc. And I don't think I've ever seen at outside read that even mentioned perineural invasion or spread, while our neuroradiologists routinely pick up tumors tracking intracranially.

 

[Pir8DeacDoc]

There are a host of reasons that head and neck cancer is primarily treated in tertiary care facilities. One of them is certainly the quality of the radiologists in the tumor board helping with treatment planning.

 

[Fab5Hill33]

Couldn't agree more with @lazymed.

 

[meister]

We may get gruff from surgeons from time to time, some of it deserved, but in a just world they would love us considering how many consults we save them for non-surgical bullsh*t the ED or medicine guys would have thrown their way in the past prior to CT/MR.

I'm only half joking. But seriously, don't listen to the overworked, stressed out ortho resident or academic orthopod, the majority of our interactions with surgeons are very pleasant. It's not surprising ortho picks up subtle fractures we may miss since the patient directly tells them "IT HURTS RIGHT HERE" whereas we get an incorrect clinical history of "stroke" and are reading the films prior to any actual documentation being added into the EMR. Do what you want to do and don't let perceived inter-disciplinary respect or other such things dissuade you.

 

[Pir8DeacDoc]

Excellent point.. Reading a film without being given a good clinical history isn't fair..

 

[shark2000]

I am an attending radiologist with two fellowship training: Body imaging and MSK. Obviously I am biased towards radiology, but I try to be fair in my post.

- I have interacted with different surgeons and other clinicians and I work in a private practice setting where half of the physicians mention UCSF, Hopkins, Stanford, Harvard or ... as their training background --> Very high egos in radiology, surgery, medicine, .....

- There are several clinicians in my practice including many surgeons who come specifically to me to get my opinion about something that is already read by another person in my group or in an outside facility. They email me or call me or page me. I have always had very good interactions with them. My point is that surgeons can be very pleasant to work with, but they have also high expectations and to be fair I understand them. A bad radiology report can hurt the patient very badly.

- I have come across some surgeons who are very good at imaging, some who are fine and some who are not good. However, almost all of them appreciate a high quality radiology report. To be honest, most surgeons know stories that one of their colleagues had been screwed because the radiologist misguided them or it may have happened to them. As a result, it takes a while to have a surgeon trust you. Once you make multiple good calls, they start to rely on you more and more. But without proving yourself, don't expect them to trust you just because you have done a Neurorad fellowship at Hopkins.

- To be fair, I have come across some terrible radiology reports. Many of these come from older folks who have never had official training in a certain modality. One thing to consider is that many private practice radiologists learned MRI and CT in 90s without any official training and they are still in practice. On the other hand, new graduates are all fellowship trained and many have two fellowships under their belt (you can spend your last year of residency as a fellowship). So I think the quality of radiology reports will be better in the near future. Nevertheless, as I mentioned it takes a while to have a surgeon trust you.

- Academics is way different than private practice. You may get surprised if I tell you that there are some surgeons in my practice that don't look that much at images if it is read by certain radiologists (they trust the read). On the other hand, in academics because of the educational environment and much more time available, a lot of surgeons spend a lot of time learning imaging or hanging around radiology department. Since many in academics only focus on one or a few pathologies, they can get really good at it.

- Example: An academic ENT who is the referral guy for CPA tumors is his town. He has 20 years of experience and only does CPA tumors. He knows that if something is referred to him, it is definitely a CPA tumor. He is sure that the patient does not have for example brain Stem ischemia or ossicular dissociation or acquired choelsteatoma of middle ear because it has already been worked up somewhere else and it would have not been referred to him. After going for 20 years to tumor boards, he is now very good at looking at a CPA MRI. As I mentioned he doesn't look at the rest of the anatomy because it has already been worked up somewhere. Now compare it to a community ENT doctor who provides a comprehensive ENT service. He may see a CPA tumor once in a while and not everyday. When he is consulted for example from ED, first he wants to make sure that this is not a stroke (happened to me on call when ENT called me). As a result, he relies on radiology interpretation a lot.


In summary you can have very good interactions with surgeons. You have to understand that everybody is very busy in medicine and we should not make other people's jobs more difficult. If you make other people's jobs harder by generating bad reports, don't expect them to respect you. You have to gain the respect yourself. It goes both ways. If a surgeon gives you a wrong history or indication, they should not expect a helpful report or a timely answer to their question. That is why it is called interaction. It is two sided.

 

[JayDoc06]

Same as in other areas- crap in crap out. Give as much information as possible in the order to help the radiologist and order the correct imaging for the pathology you are wanting to investigate. If the report doesn't make sense or it misses the mark on what you were looking for- call the radiologist and discuss it. They might learn something, you might learn something and it will increase the chance of being able to help the patient. Another challenge in community centers is the lack of trained specialists in a given area of radiology all the time- ie pelvic mr for rectal cancer staging is a learned skill. If he is out town, reads will be less accurate and that can affect patients. And our hospital is a referral center.

 

[vhawk]

Surgeons have a lot of advantages over the radiologists when it comes to things in their field. We get to examine the patient first. We only care about the pathology relevant to us. And we very often get direct and thorough feedback on our reads....by cutting the patient open and looking around inside. Contrast this with the disadvantages of not having thorough comprehensive training and, in some instances, less raw experience (though I've looked at a LOT of ct abd/pelvis scans and am almost certainly over whatever the learning curve is). It would be a little surprising and embarrassing if I WASN'T better than the radiologist some of the time at ruling in or out the specific diagnosis I have in mind.

So you couple that with some standard surgical arrogance and the frustration that comes with being painted into a corner by an incorrect or vague radiology read, and sometimes, I'll admit, I talk some **** about radiology.

I also talk to radiology face to face more than anyone I know because I respect them and their expertise a ton.

 

[Bombrainiac]

Radiologists and surgeons should be the best of friends. They work together all the time. I often have my colleagues in radiology call me to ask questions about a patient and I go down to the reading room and we read scans together. We both point out things that the other will re-evaluate or could have missed. I work mainly with neuroradiologists and they are extremely smart and helpful. Lots to learn from both sides. That being said, as a surgeon, you better be able to read your scans and make informed surgical decisions.

 

[shark2000]

Simply put, if a surgeon is not willing to cooperate I don't give a crap about him/her. I do what I have to do. I make my recommendations. It is up to him whether he wants to follow those or he believes that he can read the scans himself.

In my experience, as a surgeon or any other physician if you think you can read the studies yourself and you ignore the radiology input, sooner or later you will end up in the court for missing something. My 2 cents.

 

[greg1184]

In my program, radiologists and surgeons have a synergistic relationship. The trauma team always comes down to get every CT heads, spines, c/a/p's read with the radiologist.... this is part of the resident's learning experience. The attending general surgeons always come to the body room to discuss preop/post op/complication cases. They need us, we need them; there is generally a mutual respect. This goes for attendings and residents. We get along with the residents very well.

I feel it is an outstanding learning experience for both parties.

 

[JayDoc06]

Simply put, if a surgeon is not willing to cooperate I don't give a crap about him/her. I do what I have to do. I make my recommendations. It is up to him whether he wants to follow those or he believes that he can read the scans himself.

In my experience, as a surgeon or any other physician if you think you can read the studies yourself and you ignore the radiology input, sooner or later you will end up in the court for missing something. My 2 cents.

Wow, I can count more misses by radiologist that WOULD'VE KILLED THE PATIENT had I not looked at it myself than me "ignoring" the endless stream of follow up imaging recommendations that offer nothing except allowing you to CYA. That being said, I like my radiology colleagues. However, don't post stuff explicitly saying that following radiology reports will keep me out of trouble.

 

[vhawk]

Simply put, if a surgeon is not willing to cooperate I don't give a crap about him/her. I do what I have to do. I make my recommendations. It is up to him whether he wants to follow those or he believes that he can read the scans himself.

In my experience, as a surgeon or any other physician if you think you can read the studies yourself and you ignore the radiology input, sooner or later you will end up in the court for missing something. My 2 cents.

In my opinion, if you follow radiologys reads every time, you will end up hurting patients a lot of the time and wasting valuable resources even more. There that's about as helpful and useful as what you said.

You sure aren't doing much to dispel the notion that surgeons have that it's fear of lawsuits that drives every radiologist read. America should thank surgeons every day for frequently ignoring radiology read . The system would come to a crashing halt in a week otherwise.

 

[shark2000]

Wow, I can count more misses by radiologist that WOULD'VE KILLED THE PATIENT had I not looked at it myself than me "ignoring" the endless stream of follow up imaging recommendations that offer nothing except allowing you to CYA. That being said, I like my radiology colleagues. However, don't post stuff explicitly saying that following radiology reports will keep me out of trouble.

Radiology/imaging is only part of the whole picture. When something is just a part of picture, there is no way that following the reports can keep you out of trouble. So even if all the radiology reports are 100% accurate, there is a bigger picture and there much more to it that can cause trouble.

Tunnled vision is something that many people have in their subspecialty. A lot of endless stream follow up imaging seems useless to you because you are only interested in the pathology that you are familiar with or you care about. For example, in the case of trauma surgeons are only interested in Pneumothorax, fractures and ... on a CXR. If the radiology report points to a lung nodule and recommends a follow up, most surgeons find it annoying and unnecessary.

Then this is what happens:

http://www.nydailynews.com/life-sty...es-single-mom-6-months-live-article-1.1233989

In summary the radiology report mentioned a lung nodule and recommended further work up. However the ED doctor THOUGHT that he is competent at reading a CXR himself. He ruined his own career and also the radiologist's career.

Anyway, this was my recommendation. I never said that if you follow radiology report your will be out of trouble. Now if your ego doesn't let you read the radiology reports, that is up to you. my 2 cents.

 

[shark2000]

In my opinion, if you follow radiologys reads every time, you will end up hurting patients a lot of the time and wasting valuable resources even more. There that's about as helpful and useful as what you said.

You sure aren't doing much to dispel the notion that surgeons have that it's fear of lawsuits that drives every radiologist read. America should thank surgeons every day for frequently ignoring radiology read . The system would come to a crashing halt in a week otherwise.

This is not the radiology report that hurts the patient. Radiology is just a part of the whole scenario. Even the bad radiologists just recommend more imaging. So your point of wasting resources is applicable in these situations. But hurting the patients A LOT is exaggeration.

Valuable resources are only valuable if the scanner does not belong to the surgeon. Otherwise, if an orthropod or a neurosurgeon or an ENT doctor own their own CT or MRI scanner, all of a sudden the volume of the follow ups boom and all the incidentals are follow very very closely.

Radiology is like any other consult service. Do you think all the other services follow your consult note word for word? I know as a surgeon you see yourself above medicine team. But do think for example GI service follows your recommendation all the time?

And you last statement is really egocentric. Come to a crash half in a week!! hah. . .

And I think America should thank radiologists everyday for preventing surgeons from taking everybody and their mother to the OR. If you are not in private practice, you don't understand what I am talking about.

 

[shark2000]

You read my opinion above and I stated that some surgeons are good at looking at their own imaging FOR THE PATHOLOGY that they see day in and day out.

If you look at my post it was respectful. However, there is a reality I didn't want to mention but you opened the can. Many surgeons have high egos (God Complex). These days a lot of the time when the patient gets to a surgeon, the diagnosis is already made. A lot of surgeons find it egodystonic. Also the surgery training is based on "don't trust anybody and don't rely on anybody, you are the best...". Accepting the fact that he relies on radiology reports (even some times) is very ego-dystonic for a surgeon.

Anyway, I have good relation with most of the surgeons in my practice. There are a few who don't want to work together and I don't care. There is one surgeon who sends his PA to me (rather than coming himself even if he is in front of the radiology reading room) to ask questions about the studies done and she usually has a lot of questions. It is interesting that 2 hours after I go over the studies with the PA, his progress note (written by the PA) exactly says the same but is followed by the quote "independently interpreted".

After being a few years in private practice, I know how to handle these situations. I know how to work closely with the surgeons who are cooperative and I know how to encounter and even confront the ones with high egos and low respect for others.

One other thing to consider: The quality of radiology work is always evaluated by another doctor esp another specialist. On the other hand, there is no other service in the hospital that is similar. The number of mistakes that you make as a radiologist, interest, surgeon and ... are much more than what you think. But when you are a surgeon nobody really checks the quality of your work. On the other hand, as a radiologist always someone is checking the quality of your work.

 

[vhawk]

This is not the radiology report that hurts the patient. Radiology is just a part of the whole scenario. Even the bad radiologists just recommend more imaging. So your point of wasting resources is applicable in these situations. But hurting the patients A LOT is exaggeration.

Valuable resources are only valuable if the scanner does not belong to the surgeon. Otherwise, if an orthropod or a neurosurgeon or an ENT doctor own their own CT or MRI scanner, all of a sudden the volume of the follow ups boom and all the incidentals are follow very very closely.

Radiology is like any other consult service. Do you think all the other services follow your consult note word for word? I know as a surgeon you see yourself above medicine team. But do think for example GI service follows your recommendation all the time?

And you last statement is really egocentric. Come to a crash half in a week!! hah. . .

And I think America should thank radiologists everyday for preventing surgeons from taking everybody and their mother to the OR. If you are not in private practice, you don't understand what I am talking about.

I don't think you are seeing the big picture very well. When I say hurt the patient, I don't mean like physical pain necessarily l, you get that right? Unnecessary tests are harm. Unnecessary worry is harm. Unnecessary procedures, follow up, visits. All harm.

And to your point about resources. No. All health care resources are finite and most are fungible. It doesn't matter to me, in the grand scheme of things, who owns what. You make recommendations based on never missing anything and never being liable, and the system would collapse. No country, not even the US, could afford it. You are shielded from the consequences of your actions because people use judgment and discretion and ignore you when it is in the patients best interest to do so, which is often.

It's not your fault it's how your incentives are aligned. It makes perfect sense for you to always hedge and always recommend more scans or more tests. There is no downside to you. The costs of your recommendations aren't borne by you. The costs of underdiagnosing ARE borne by you.

But ultimately the buck does have to stop somewhere.

 

[vhawk]

You read my opinion above and I stated that some surgeons are good at looking at their own imaging FOR THE PATHOLOGY that they see day in and day out.

If you look at my post it was respectful. However, there is a reality I didn't want to mention but you opened the can. Many surgeons have high egos (God Complex). These days a lot of the time when the patient gets to a surgeon, the diagnosis is already made. A lot of surgeons find it egodystonic. Also the surgery training is based on "don't trust anybody and don't rely on anybody, you are the best...". Accepting the fact that he relies on radiology reports (even some times) is very ego-dystonic for a surgeon.

Anyway, I have good relation with most of the surgeons in my practice. There are a few who don't want to work together and I don't care. There is one surgeon who sends his PA to me (rather than coming himself even if he is in front of the radiology reading room) to ask questions about the studies done and she usually has a lot of questions. It is interesting that 2 hours after I go over the studies with the PA, his progress note (written by the PA) exactly says the same but is followed by the quote "independently interpreted".

After being a few years in private practice, I know how to handle these situations. I know how to work closely with the surgeons who are cooperative and I know how to encounter and even confront the ones with high egos and low respect for others.

One other thing to consider: The quality of radiology work is always evaluated by another doctor esp another specialist. On the other hand, there is no other service in the hospital that is similar. The number of mistakes that you make as a radiologist, interest, surgeon and ... are much more than what you think. But when you are a surgeon nobody really checks the quality of your work. On the other hand, as a radiologist always someone is checking the quality of your work.

You don't seem to have a very accurate view of the perspective or practice environment of surgeons. Especially if you think that no one checks the quality of our work.

It's ok I probably don't have an accurate view of what it's like to be a radiologist either. With that in mind I try hard not to attribute my disagreements with them to moral failings or value judgments. When I disagree with you, it is because of my surgeons ego. When you do something I don't like, is it because of your radiologists cowardice or something? Probably not. It's probably because you, like all humans, respond to your incentives the best way you know how.

 

[shark2000]

You don't seem to have a very accurate view of the perspective or practice environment of surgeons. Especially if you think that no one checks the quality of our work.

It's ok I probably don't have an accurate view of what it's like to be a radiologist either. With that in mind I try hard not to attribute my disagreements with them to moral failings or value judgments. When I disagree with you, it is because of my surgeons ego. When you do something I don't like, is it because of your radiologists cowardice or something? Probably not. It's probably because you, like all humans, respond to your incentives the best way you know how.

Fair enough.

It goes both ways. I didn't mean that the resources are not valuable. Let me give you an example. An orthopedic group in my area own their own MRI scanner but not a CT or a gamma camera. We staff their MRI center (protocoling, quality control, interpretation, .. .). I can clearly tell you and prove to you that the number of MRIs that they order is ridiculously high. An 80 year old with severe OA on knee Xray still gets an MRI. For what? However, if radiology calls some lung mass on a shoulder Xray, they are reluctant to order the CT (which radiology owns the scanner) with the justification that this is wasting of the resources or for example in an 85 year old patient even if it is a lung cancer, the treatment may not change the prognosis (though the same 85 year old goes for shoulder surgery the next day or gets an MRI even a surgery is not desired).

I totally agree with your statement that everyone responds to their incentive, consciously or unconsciously. It involves radiologist, surgeon, hospital administrator, .. .
The followup that radiology is recommending may be consciously or unconsciously influenced by his/her incentive to increase the volume of imaging. But similarly, the disagreement of a surgeon with my report may consciously or unconsciously influenced by his/her incentive to operate or not to operate. For example, at 2 am or during the weekends if I call something critical that needs emergent OR, I see more disagreement from some surgeons that try to downplay the importance of findings. On the other hand, on a Tuesday morning if a surgeon does not have a full OR day and for elective cases, I see more disagreement with my normal reads. Are you sure it is not an appendicitis? Are you sure this is not an RCC and is only a hemorrhagic cyst? The MRCP was read normal. Don't you think this dot here can be stone and needs ERCP?

The way that the healthcare is going and fee for service is phased out, probably most of us will become hospital employees and a lot of these incentives and a lot of these kind of arguments will go away. Personally I think it won't be good for patient care in the long run, but it seems that this is the only option left on the table for now.

 

[meister]

Man y'all need to chill out.

 

[JayDoc06]

Radiology/imaging is only part of the whole picture. When something is just a part of picture, there is no way that following the reports can keep you out of trouble. So even if all the radiology reports are 100% accurate, there is a bigger picture and there much more to it that can cause trouble.

Tunnled vision is something that many people have in their subspecialty. A lot of endless stream follow up imaging seems useless to you because you are only interested in the pathology that you are familiar with or you care about. For example, in the case of trauma surgeons are only interested in Pneumothorax, fractures and ... on a CXR. If the radiology report points to a lung nodule and recommends a follow up, most surgeons find it annoying and unnecessary.

Then this is what happens:

http://www.nydailynews.com/life-sty...es-single-mom-6-months-live-article-1.1233989

In summary the radiology report mentioned a lung nodule and recommended further work up. However the ED doctor THOUGHT that he is competent at reading a CXR himself. He ruined his own career and also the radiologist's career.

Anyway, this was my recommendation. I never said that if you follow radiology report your will be out of trouble. Now if your ego doesn't let you read the radiology reports, that is up to you. my 2 cents.

I read every report and I speak with them often, usually to provide clinical information to help increase the diagnostic yield of imaging. It troubles me to hear that surgeons operate in your hospital for profit motives, ans less patient care- at least that's what you implied. Shameless plug for colorectal surgery- our field doesn't allow that type of practice due to either high potential for complications with our big cases or significant pain/suffering from anorectal complications.

My previous response was directed squarely at your comment about finding myself in court based on the degree to which I follow radiology reports.

 

[shark2000]

I read every report and I speak with them often, usually to provide clinical information to help increase the diagnostic yield of imaging. It troubles me to hear that surgeons operate in your hospital for profit motives, ans less patient care- at least that's what you implied. Shameless plug for colorectal surgery- our field doesn't allow that type of practice due to either high potential for complications with our big cases or significant pain/suffering from anorectal complications.

My previous response was directed squarely at your comment about finding myself in court based on the degree to which I follow radiology reports.

As I mentioned above, I have close working relation with most surgeons in my hospital that in many occasions has resulted in outside the work friendship.

 

[Trauma Surgeon]

Not the day for me to comment… major trauma last night and they missed a subclavian artery injury which was detected when the patient arm felt cold and blue…

 

[blastoise]

I hope that most situations where a radiologist misses something, the surgeon or clinician would offer some sort of feedback regarding the mistake. Hopefully it becomes a type of discussion where there is some level of progress. To figure out what the radiologist could have done differently or whether they would have liked more clinical information regarding the injury to the patient.

On the wards all I friggin hear is complaints about them missing something, so the clinicians end up reading their own image and do nothing to improve the quality of reads. I'm only a medical student with naive ambitions I guess, but as an aspiring radiologist I would encourage clinicians to tell me where/if I went wrong so we can work together to make sure it doesn't happen again. I'm fresh on startin clerkship, I can't believe how much pride some doctors have and dont want to admit a mistake they made regardless of specialty.

 

[Winged Scapula]

I hope that most situations where a radiologist misses something, the surgeon or clinician would offer some sort of feedback regarding the mistake. Hopefully it becomes a type of discussion where there is some level of progress. To figure out what the radiologist could have done differently or whether they would have liked more clinical information regarding the injury to the patient.

On the wards all I friggin hear is complaints about them missing something, so the clinicians end up reading their own image and do nothing to improve the quality of reads. I'm only a medical student with naive ambitions I guess, but as an aspiring radiologist I would encourage clinicians to tell me where/if I went wrong so we can work together to make sure it doesn't happen again. I'm fresh on startin clerkship, I can't believe how much pride some doctors have and dont want to admit a mistake they made regardless of specialty.

Its easy to see things with the benefit of additional clinical information and the "retrospectoscope". However, I have contacted radiologists when I've found that a malignancy was apparent on prior imaging or when surgical excision showed additional large burden of disease that should have been appreciated on pre-operative imaging. If you approach it in the right way, its almost always well received IMHO.

 

[Winged Scapula]

...I can't believe how much pride some doctors have and dont want to admit a mistake they made regardless of specialty.

Its more complicated than ego.

Surely ego is an important factor, but admitting mistakes (despite the fact that none of us are perfect) can be a legal issue if a case is litigated and the other physician is deposed.

 

[dpmd]

Not the day for me to comment… major trauma last night and they missed a subclavian artery injury which was detected when the patient arm felt cold and blue…

I recently saw a patient a week out from the prior er visit where the free air on ct was missed although quite a lot of ascites was seen and the patient had no sign of liver disease or other good reason for it, and the patient was sent home with a diagnosis of PID. Things went somewhat better than you would have expected post op though.

 

[Winged Scapula]

Today on the freeway:

I'm driving in the fast lane as is my practice to do and I notice ahead an older model SUV driving somewhat slowly with cars passing them in the center and diamond lanes.

I come up behind the car which is indeed driving slowly, but probably at the speed limit, and notice the license plate:

XRAY MD

 

[FranzLO]

Apparently surgeons and radiologists are not perfect and both are important.

 

[meister]

Today on the freeway:

I'm driving in the fast lane as is my practice to do and I notice ahead an older model SUV driving somewhat slowly with cars passing them in the center and diamond lanes.

I come up behind the car which is indeed driving slowly, but probably at the speed limit, and notice the license plate:

XRAY MD

Older model? Pfft, clearly made up.

 

[Vandalia]

"X-RAY" is all you need to know. If he was under 70, it would say "CAT" or "MRI".

 

[Winged Scapula]

Older model? Pfft, clearly made up.

LOL...well the fancy newer model cars I see in the physicians parking generally do not belong to the radiologists, so this may not be an anomaly here.

 

[turkeyjerky]

Not the day for me to comment… major trauma last night and they missed a subclavian artery injury which was detected when the patient arm felt cold and blue…

Does the patient not stop in the trauma bay on the way to CT at your shop?

Lol at blaming radiologist for missing a clinically obvious ischemic limb. Really hope I'm missing something here...

 

[dpmd]

Does the patient not stop in the trauma bay on the way to CT at your shop?

Lol at blaming radiologist for missing a clinically obvious ischemic limb. Really hope I'm missing something here...

You are missing how some injuries progress if missed on imaging and could have had pulses in the trauma bay initially.

 

[Winged Scapula]

You are missing how some injuries progress if missed on imaging and could have had pulses in the trauma bay initially.

Exactly. On presentation in the bay, the patient may have been asymptomatic or with soft signs and other injuries that took precedence.

 

[Trauma Surgeon]

Does the patient not stop in the trauma bay on the way to CT at your shop?

Lol at blaming radiologist for missing a clinically obvious ischemic limb. Really hope I'm missing something here...

Intimal injury! Initially no hard signs or soft signs of ischemia in the arm. The symptoms developed hours later when the flow was totally cut off. And since this was not penetrating trauma, even with hard signs (in blunt trauma) we are dependent on the radiology report for diagnosis!

 

[meister]

Do you guys run your chest traumas as ct angios? Half the time we get venous phase only which can make it pretty difficult.

 

[Trauma Surgeon]

We do all chest traumas with arterial phase and in particular this one, he was a lumberjack who had been pinned by a falling tree!

 

[turkeyjerky]

Intimal injury! Initially no hard signs or soft signs of ischemia in the arm. The symptoms developed hours later when the flow was totally cut off. And since this was not penetrating trauma, even with hard signs (in blunt trauma) we are dependent on the radiology report for diagnosis!

Good that's what I was hoping had happened.

 

[shark2000]

Everybody makes a mistake at some point during their medical career. The radiology images stay in patient's medical document forever and with the help of retrospectoscope it is easy to pick up one's misses or mistakes. This is in contrast to physical exam or history taking. Let's say the patient has no pulses and the upper limb is completely pale. You can go in, examine the patient and document that the patient has normal pulses and the upper extremity is well perfused. There is no way that someone can prove later that you were wrong.

I don't justify the big miss that was made. That was a huge miss. But as physicians we usually underestimate our own mistakes and overestimate others mistakes. A study a few years ago showed that 80% of radiologists believed that their work is on top 20% of quality. Another study a few years ago showed that something about 70% (I don't remember the exact number but it was close to 2/3) of neurosurgeons believed that their complication rate is in the lowest 5-10 percentile of their field. This last study was anonymous and there was no legal risk. So as you see most physicians, either radiologist or neurosurgeon think they are the best in their field.

 

[vhawk]

Good points. Every resident hears the phrase "if it isnt in the chart it didnt happen" but the corrolary, "if its IN the chart, then it DID happen" is almost as true.

 

[orangejello]

why are surgeons such dicks to other specialties?

you don't see the radiology forums full of "oh that stupid surgeon..." comments.

 

[dpmd]

Oh i guarantee somewhere out there is a radiologist griping to his or her buddies about the drainage i asked for when they think I should just operate (considering they sometimes try to talk me out of it). Or bitching about the way a study was ordered that made it harder to interpret. It isn't like any specialty is immune from talking about other specialties behind their backs.

 

[pd1112]

Or any person talking about any other person behind his/her back. Yet to meet the exception.