The Radiologist-Tech Relationship: Why You Should Care

This is the second of a two-part series on improving communications. Click here to read the first part on improving communications with referring physicians. 

When you spend most of your waking hours each week at work, good relationships with colleagues go a long way in helping you improve your performance, and you’d likely feel less stressed. Often in radiology, much attention is paid to improving relations with referring physicians. What about your radiologic technologists?

How can radiologists improve communications and relationships with technologists, and why should you care?

Fortunately, the collaborative relationship between radiologists and technologists is better than it was years ago, though of course it depends on the facility, said Cathy Dressen, MHA, RT, affiliate relations and volunteer manager for the American Society of Radiologic Technologists and an MRI technologist in New Mexico. Facilities with less successful relationships, she said, are where technologists don’t feel empowered to offer their opinions or make comments. “I think that there’s been a progression towards a positive change in that philosophy,” she said.

During the 35 years she’s been a tech, Beth Weber, MPH, RT, director of imaging services and the privacy officer at Avera Heart Hospital in Sioux Falls, S.D., said she thinks the positive trend is due to several factors. One is the doctors’ employment structure, which can change a facility’s culture. Many doctors, including radiologists in her area, are moving out of private practice and into an employee or partnership role with other specialists - which includes more teamwork. The relationship with the technologist is no longer hierarchical, and now involves more teaching and partnership, she said.

Weber also attributed the shift to the increase in technology. “Through the years, the radiologists were trained to have such a sharp turnaround time, and they didn’t have the technology to make that happen,” Weber said. Now that technology makes things more efficient, the radiologists are taking some of that extra time to get to know the employees better.

Why it Matters

Patient safety is one reason communication needs to be good between radiologist and tech, said Weber, especially for interventional procedures. A patient is better served if the tech feels comfortable alerting the radiologist to a potential issue during a study.

Dressen added that the patient will notice if communication isn’t good between the team and that affects where they go for future medical care. “If there isn’t a good relationship, it’s going to become painfully aware to the patient. It will be very awkward,” Dressen said. “It’s a competitive market where the patients are savvy and have choices about where to go for medical care. Everyone is vying for the patient, to provide the best experience.”

The workflow can be impacted as well, said Weber. If the radiologist empowers the technologist to make decisions on the protocol, only asking for assistance if there are exceptions, the workflow will be much smoother for both of them. Weber said that some radiologists get irritated by constant interruptions.

Technologist as Professional

One reason techs are better perceived by radiologists these days, said Weber, is that they’re more mature going into their careers. Now most techs need to earn an associate’s or bachelor’s degree. They’ve been exposed to the workforce and taken key classes in sociology, psychology or communications on dealing with relationships, Weber said. They’re better able to have a mature relationship with the physician, balancing the need to respect the physician with the understanding that the physician is also human.

“We’re trying to build a relationship with them, not that we want to be their friend, but they’re human too,” she said.

How Technology Helps

Both Dressen and Weber said that technology has improved the ability of medical staff to communicate. “It’s an added enhancement,” said Dressen, since it’s easier to convey information to the radiologist without needing to make a phone call or visit in person.

Technology is not a substitute for in-person communication, though. “I’ve seen many cases where you send information to the radiologist, and if he has concerns about it or wants further explanation on something not captured in the text of the communication, he’ll pick up the phone up or come back and talk to you,” Dressen said.

Dressen said that the electronic medical record has been helpful for sharing observations. “Before, when it was a matter of paper, [the radiologists] may not have looked at the paper,” she said, adding that with an EMR, the radiologist is generally looking at the screen when dictating.

Of course you can’t force someone to read something, and Dressen said that those who aren’t computer savvy may skip the notes or comments, which can impact the case. It’s also a source of frustration for the technologist who spent the time to document observations and comments. “If the tech takes the time and trouble to put something in, it’s generally meaningful,” she said. Of course making the comments is also a form of self-protection, she said. “Oftentimes, the tech puts it in the EMR to cover themselves, so at least they covered the bases.”

Weber said that her hospital PACS lets her insert an electronic sticky note in the file, making it impossible for the radiologist to miss the communication when reading the study. She said the sticky note doesn’t enter the medical record, but can be used to convey information about a patient’s body size or an infiltrate, that could affect the reading. Weber said that there are other places in the medical record where they document things like infiltrations for the legal record, but that’s not a place the physician would necessarily look first. The sticky note pops up every time the image is clicked.

Technology also enables her to send digital messages to the physician, like when the patient is prepped and ready, or sending the emergency department’s phone number for the radiologist to call when the study is read. The information is conveyed without directly interrupting the radiologist.

Weber said that the department’s intranet allows them to share learning opportunities as well as privately share case-specific feedback. “It would have to be a secured environment for HIPAA compliance,” Weber said.

What Radiologists and Techs Can Do Better

Both radiologists and technologists can do things to improve the relationship. Weber advises techs to continue to build relationships and trust with physicians, keeping in mind that physician training doesn’t always provide them with business or team player skills. She recommends sharing interesting reading or research projects with the physician, to show commitment to the field. Also, try to pass along positive feedback, especially if it comes from a patient.

“They don’t get strokes from their peers as often as they should; their peers don’t know that they had successes,” Weber said.

As for radiologists, Weber recommends continuing to work with the tech to build a strong team, making the tech feel welcome and showing their knowledge is needed.

Communicating with the tech about their expectations for a study, and allowing the tech to figure out the best technique is a great way of showing trust. Weber also recommends listening to the tech if they have social media or technology tricks to share. “The tech may have a little more time to experiment with some of the tools on the work station,” she said. “If the radiologist isn’t open to that, they’re limiting themselves in growth.”