Referring Docs to Radiologists: Communicate, Communicate, Communicate

CHICAGO -First, answer the question. Talk to us. Less is more. Unbidden, be wary of recommending treatments.

Just a few nuggets of advice from referring physicians at an RSNA 2011 session to help radiologists understand what their colleagues in other departments want – and don’t necessarily want.

Sharing views were two very different sorts of referring doctors. Mary Mulcahy, MD, a professor of hematology/oncology at Northwestern University; and Jeffrey Graff, MD head of emergency medicine at NorthShore University HealthSystem in the Chicago area. While their diagnostic imaging needs may differ, their messages were the same: radiologists are vital to their work, and communication is key.

“In this era of RIS and PACS and EMRs and texts and e-mails, we’ve forgotten how to talk to each other,” Graff said. He described the hallmarks to effective communication as “the five C’s”: contemporaneous, consultation, collegiality, cooperation and clarity.

Mulcahy added that “face-to-face” conversation – even if it’s on the phone – is vital in getting referring physicians and radiologists on the same page. An audience member said his hospital helps facilitate such contact by appending phone numbers to the physician’s name in the Epic electronic medical record.

Graff said he values face-time with radiologists to the point of annoying them.

“Sometimes they think I hover over them and sometimes they think I’m trying to read it the way I want,” he said. “But I can’t tell you how helpful it is.”

He and Mulcahy agreed that communication need not extend to the patient herself, though they had no objections to direct contact if the radiologist insists. Mulcahy stressed the importance of radiologists understanding that patients will pore over every word in an imaging report. So the next time you write “pulmonary micronodules consistent with metastatic disease,” consider whether it’s relevant to diagnosis, she suggested.

Communication works both ways, Mulcahy said. With cancer patients, radiologist should know the patient’s treatment history (has he been irradiated?) and the pathway of care going forward, Mulcahy said. From her perspective as a gastrointestinal oncologist, the vital information coming back from radiologists incudes the identification of new lesions, changes in target lesion size, and changes in density, perfusion and necrosis, Mulcahy said. At Northwestern, radiologists are so central to GI tumor boards that they cancel them if they can’t be there, she added.

Graff emphasized a focus on the question at hand.

“Tell me what’s wrong. Don’t tell me what’s right,” he said. “All that ancillary stuff doesn’t help me.”

If you can’t answer the question, that’s O.K., Graff said. No need to tell him that “a CT or MRI might be useful for further testing,” he said, because the referring physician can make that call.

Electronic medical records are a blessing and a curse, he added.

“There’s so much stuff that people miss out on what’s really important,” Graff said. “It’s not enough to put it in the computer. It’s really important that things don’t get missed. And trust me, things get missed. Pick up the phone and talk to the person who ordered the test. Not a nurse, not a student.”

Recommending treatment in reports is probably not necessary, Mulcahy said. For one thing, the presence of the suggestion in a report may muddy the waters of patient communication. In addition, with increasing specialization and complex cases that might involve treatment options as diverse as surgical resection, radiation therapy, ablation or other approaches, such suggestions “might not be helpful,” she said.

“We need you probably more than you understand, and we want talk to you more than you maybe would like,” Graff concluded. “But if we communicate more, I think the result would be better care for all of our patients, and I think that’s ultimately what we’re all here for.”