There’s a relatively new radiologist on staff at our hospital. He and I just don’t seem to see eye-to-eye.
The radiologists like to do real-time readings of xray studies from the emergency department during business hours. Then the radiology tech brings us a report. I tend to look at most of the radiology studies I order regardless of who reads them or when. Many times I have picked up abnormalities that the radiologists have missed … and vice versa.
The new guy doesn’t seem to like the ED physicians very much. Once he called me and berated me for ordering a CT scan of the lumbar spine to rule out a fracture on a patient instead of just doing an MRI. I told him “Fine, change the order.” He couldn’t change the order, though, because he had waited until the CT scan was completed and after he read the study before calling to “discuss” the matter with me. His preliminary interpretations – which are made part of the medical record – include written statements such as “sinus CTs are never an emergency procedure.”
One report I got this week really got me ticked.
A patient comes in with severe dyspnea. She had trouble finishing her sentences without gasping for air. Her blood pressure was good and her heart rate was a little fast. I ordered labs and a portable chest x-ray. I went and looked at the xray and it was fairly normal. Maybe a little CHF, but otherwise good. The report comes back saying “Limited study. Why did you order a portable exam?”
I grabbed the report and walked over to his lair.
Sooo … I got your report. Just wondering … did you examine the patient?
“Did I examine the patient? No.”
“Did you take a history from her?”
“Do you know anything about her condition?”
[Cocking his head to the side as if he is now getting annoyed with me] “She’s short of breath.”
“Then why would you write something like this on the chart?”
He just looked at me.
“Does the reason for a portable film have any bearing whatsoever on your interpretation of the film?”
“Yes. Portable films are more difficult to interpret.”
“Listen to the question. Does the REASON for a portable versus PA/Upright film have any bearing on the interpretation?”
“Then please leave the commentary to yourself. OK?”
He just looked at me.
I have him a half smile. “Thanks.”
Next time, I’m going in there with a Rey Mysterio mask on.