Ever Have a Clinician Refuse to Take Imaging Results?

I’ve noticed an unsettlingly growing trend, in which I reach a clinician to communicate results of an imaging study on one of their patients… and the clinician refuses to take those results.

This is the ugly successor to an older (yet ongoing) issue, in which I can’t get ahold of anyone at all regarding a patient, whether to give results, to better protocol a study, or simply to get some clinical history beyond “R/O pathology.”

Any number of scenarios can have this effect; the most frequent I encounter is where I call the listed number for the referring doc, and get their answering machine which tells me what the office hours are and that, if this is an emergency, I should dial 911. No option to speak to an operator, no pager number. If there’s somebody on call, they’re hiding very successfully.

Call it an imperfect system or call it intentional and/or passive aggressive, its frustrating impenetrability hinges on preventing us from speaking with a human, much like the customer service phone lines for credit cards, utilities, and insurance companies. Somehow, the idea has taken root that they only start to bear responsibility if you manage to communicate with one of their employees. Even if you’re speaking with the most unskilled desk clerk, they theoretically have the ability to contact someone who *can* help you, or at least who has a way to contact the right person.

The frightening newer development is testing the waters of bypassing this chink in the armor. An increasing number of clinicians will get on the phone in the name of caring for patient X, and, as soon as they find out they’re getting test results, they start telling me why they cannot take these results (some actually “refuse” them).

They suddenly don’t know who the patient is, for instance, or they haven’t seen the patient yet. The hospitalist says the patient is still in the ER, and the ER docs should take results. The ER docs say the patient has officially been admitted, and thus the hospitalist should take results.

It seems the most instances of this new abdication of responsibility are when the clinician who gets on the line is a nurse. LPN, RN, NP…even those who have gotten themselves some kind of doctorate - usually nonclinical - so they can introduce themselves as “Doctor” (they’ll answer the phone this way). If the results were normal, maybe they’d take them. But then, how many normal cases do you call in?

No, you’re calling in results on the abnormal ones, the ones that need action. And as soon as that becomes evident, the non-MD who took the call starts getting antsy. Sometimes, even the nurses who have gained the authority to order imaging studies in the first place will refuse to take results, on the grounds that they’re too complex and/or abnormal for the nurse to manage.

You, the radiologist, should really talk to the urologist, since you’re calling about renal stones. Or to the pulmonologist, since you’re calling in a positive PE. Never you mind that these guys aren’t even on the case yet. The nurse promises she’ll order consults from them right away - whatever it takes to get you off the phone.

I’ve even had nurses who initially offer to take results, then, upon hearing my next few words, do an about-face and say they’ll ring up the physician on the case. I’ve gotten accustomed to saying, up front, that these are abnormal findings - is the nurse *sure* she wants to take them? I’ve yet to get an affirmative answer to that question.

Perhaps, unlike me, you have endless spare time on your hands to play these hide-and-seek games. Or your office staff has the willingness and the know-how to do it for you, so you can refrain from getting on the line until they’ve actually found someone. In a hospital setting, one might pursue the quixotic course of begging the administrative hierarchy for new policies to address this - knowing in advance that there will be strong pushback from the clinical folks who like things the way they are, thank you very much. A simple “If you ordered the study, you get the results, and it’s your responsibility to relay them as necessary,” could conceivably do the trick.

If you’re in the outpatient world and eternally courting referrers, tread more carefully. If a clinician sends you about 30 percent of your patients, you might be a little more supplicative and cajoling than you would be with a guy who sends you one case per month. Then again, hopefully your heavier referrers aren’t trying that hard to hide from you.