Self-referral has been a topic in several of my prior postings and recent research from physicians at Georgetown University Children's Medical Center in Washington, DC, helps to support my opinions. Their study, published in the Journal of Critical Care, August 13, 2009, an article from AuntMinnie.com assessed how interpretation errors by pediatric intensive care physicians (intensivists) affect patient management in a PICU. They concluded that radiology departments in hospitals with pediatric intensive care units (PICUs) should provide 24/7 radiology services, either by onsite staffing 24 hours a day or by utilizing a teleradiology service offering pediatric radiology-specific services.
Nonradiology specialty training in imaging is extremely varied. Medical schools and nonradiology residency programs provide limited training regarding how to acquire and interpret images accurately. Radiologists are physicians with four years of residency training following medical school that is completely dedicated to acquiring and interpreting images as well as focusing on patient protection from ionizing energy and magnetic resonance safety. The American Board of Radiology validates the training and expertise of Radiologists, and provides criteria for validating maintenance of that expertise. The American College of Radiology further provides Board Certified Radiologists with continual updates regarding patient protection (lowest dose) along with appropriate utilization of imaging. None of the other residency certifying Boards specifically validate imaging expertise or maintenance thereof. Several weeks of general radiology training, in a nonradiology residency compared to years of subspecialty radiology training, followed by daily practice, continuing education and exposure to the newest imaging technologies gives me and my fellow radiologists an edge over our self-referring, image reading physician colleague counterparts.
The pediatric nonradiology physicians who were followed in this study achieved a 92.9% accuracy when interpreting PICU chest x-rays over a 15-month time period. This percentage is not an impressive accuracy rate and more importantly three of the misinterpretations correctly identified later by a pediatric radiologist, were clinically important changes that affected the child's management.
This study highlights several points:
#1 - Collaboration is Key. Radiologists are physicians expert in acquiring and interpreting imaging and are consultants to nonradiology physicians. Subspecialty nonradiology clinicians NEED to consult with their radiology colleagues when evaluating an imaging study and deciding on treatment.
A physician operating in a vacuum without sufficient training can misinterpret images which can either delay needed treatment or be responsible for instituting the wrong treatment. Additionally, inexperience can cause unneeded additional imaging to be performed. Overall, poor interpretation of images dilutes the perceived usefulness of imaging and causes a decline in patient care quality, contributes to higher costs of healthcare and poor patient outcomes and satisfaction.
#2 - There is too much medical information and it is impossible to be a specialist in every aspect of medicine and in order to remain current even specialists further subspecialize. A resident and Fellowship trained medical subspecialist knows their specialty. For instance, I am a radiologist with subspecialty training in musculoskeletal orthopaedics, with special focus and interest in trauma and further focused in imaging of sports-related trauma. That is academic medicine in today's world. That focus benefits the patient. Expertise in imaging with subspecialty specific emphases is in the interest of the patient. Physicians need to stay within their focused turf and collaborate effectively. Nonradiologists need to collaborate and consult with radiologists. Radiologists are "unbiased patient advocates." Radiology expertise must be recognized and respected. Consultation by nonradiology physicians with a subspecialized radiologist is a win-win for the patient and the healthcare system and will permit a continuation of the access to health care which we have become used to, expect and deserve.