Running Interference

At some point during my more-hectic-than-usual Thanksgiving work week, I got messaged from our telerad support-staff: A patient whose spinal MR I had read wanted to talk to me.

Your mileage may vary, but in my practice it’s vanishingly rare for a patient to speak directly to a rad who interpreted their stuff. Excepting things with a personal touch, such as interventional or other fluoro, diagnostic mammo, etc.

I could go into all sorts of reasons for this, but a lot of them can be summed up: prior to the referral for imaging, there’s been an interaction between a patient and his physician. When that physician decides that it’s time for imaging, s/he’s creating a new interaction with a radiologist.

The referrer is the only one in the mix with a full understanding of the circumstances necessitating imaging (think of the difference between a patient’s chart in the referrer’s files and the typical “reason for imaging” that the rad receives). Thus, he or she is the best person to explain or discuss results of that imaging with the patient. Creating a new interaction between patient and rad, excluding the referrer, opens wide the door to potential misinformation—not only for the patient, but also for the rad to potentially enter into the medical record. More than a few referrers would be perturbed, if not downright angry, to learn that this had happened.

So, when I received this message, it got me on high alert. Something potentially unkosher was afoot, and I’d best tread carefully. I had our support-staff advise the patient that he should speak with his physician, who had all of the relevant info, and if, then, needed, his doc could speak with me.

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Support-staff successfully did this, mentioning to me along the way that it seemed like the patient wanted me to amend my report, which had described his spondylosis as being mild, to say it was “moderate.” Regarding getting his insurance to pay for something, perhaps surgery. (By the way, I had another look at the images, just in case, and there was nothing on them to justify such a change from me.)

Fast-forward a couple of hours, and his physician was on the line. I took a deep breath, ready to be pressured to alter my interpretation in order to get the insurer to play ball. Happily, the physician was not after this—indeed, had no idea why the patient had contacted her office to get her to speak with me until I told her. She was mildly horrified at her patient’s request, and reassured me that there was no way she would ask such a thing of a rad. A few pleasantries later, we returned to our respective workdays.

Aside from my internal fretting, I can’t think of an easier/better way this episode could have gone, thanks to the telerad support-staff who ran interference for me. If, instead, there were no buffer at all to people ringing me up at my workstation, the patient would have easily gotten ahold of m, and caught me flat-footed. And, depending on how insistent he was, no amount of diplomacy might have enabled me to stand my ground without him going away mad.

He wouldn’t be the only one able to directly contact me. It could be any random patient (or referrer), whose studies might have been read by other rads. Family members of patients. Insurance companies. Recruiters. Political pollsters. Nigerian princes, you name it.

Pretty much anybody reading this has had the unpleasant experience of trying to phone someone—their own doc’s office, maybe, or some other business (banks and airlines leap to mind)—and being in that patient’s position of not being able to get through to the person who seems most suited to solve a problem. There’s an entire industry built around running interference.

The big difference there, however, is that most of that is about wearing down the caller to the point that s/he hangs up, or maybe doesn’t even try in the first place, thus diminishing the business’ overall burden of incoming calls. This often happens with the assistance of a touchtone-maze and recordings that steer the caller to dead-ends, if not an on-hold purgatory.

Legit instances of running interference do exist, however, and I’ve happily been shielded by them for the past 9-plus years of my radiological career. It was such a seismic shift in work environment from my previous jobs that I am increasingly amazed when I hear of other rad groups that haven’t instituted similar measures. So much efficiency is needlessly lost, and so many avoidable problems allowed to occur.

Screening out telemarketers and other outright fluff is a good start, but that’s amateur-hour. It doesn’t take much more training and effort to have phone-answerers direct calls so that rads are only interrupted by queries pertinent to them (cases they personally have read, or are capable of reading/protocoling, for instance).

It can get even more efficient than that. Suppose a referrer wants to talk to a rad about a specific case. If the support-staff can get the relevant information (medical record number, for instance), and shoot that in an instant message to the rad, he can get the case on his screen and message back that he’s ready to talk. If the instant message can be embedded with a hotlink to the case in question: rad clicks on it, and the case (including report) comes right up on his screen, ready for review/discussion.

Coordinate this process with support-staff in the referrer’s office, and neither doc has to get on the phone till they are both prepared to discuss the matter at hand. Referrer tells his staff he wants to talk with the rad about patient’s X’s scan. Staff contacts rad group staff with the request, and rad group instant messages the details to the relevant rad. Rad indicates that s/he got the instant message and has the case open, staff connect her/him with the referrer, and the game is afoot. Just about every second the docs spend on the phone is with each other, discussing the case…no wastage of doctorly time.

Of course, some might like hearing a referrer breathing in their ear as they fumble around to get the case on their screen, including spelling out the patient’s name in a search function, and, then, trying to re-familiarize themselves with the case on the fly. To each his own.

Follow Editorial Board Member Eric Postal, M.D., on Twitter, @EricPostal_MD