High-tech communication in 2012 is undeniably fast and efficient, but does it build trust? Among referring physicians who rely on radiologists, the question transcends the objective nature of science and drifts into the subjective world of personal relationships.
Allison Tillack, MA, a student in the MD/PhD program at the University of California–San Francisco, is not afraid to tackle such topics in her dual role as clinical scientist and medical anthropologist. The fourth-year medical student hopes to be a radiologist one day, and she is determined to integrate technical expertise with a patient-focused approach that belies the solitary-radiologist stereotype.
Tillack, who is now finishing her dissertation, sensed that old-fashioned face-to-face communication would build the most trust, but she needed evidence to back her intuition. Thanks to a vendor-sponsored 2011 RSNA Research Medical Student grant, she had the opportunity to interview and observe a variety of physicians for six months, asking them to reflect on the elusive bonds of trust and how they were formed.
Widely used PACS have revolutionized radiology, but trust and communication have occasionally fallen by the wayside. “Back in the film days, reading rooms were the information clearinghouses of the hospital,” Tillack says. “If you wanted to know what was going on, chances are someone would be down there talking to the radiologists. All the teams would talk to the radiologists, and that’s where patient problems were solved. Now, there really is not a space for that.”
Such conversations still occur in patient-care areas, but Tillack laments that radiologists are not usually present. In some cases, patient information might not be adequately relayed via electronic means. “This patient information is critical to how radiologists read the images and construct their differential diagnoses and recommendations,” she says. “The fact that they are not often in on these informal hypothesis-making sessions can be detrimental.”
What’s New Is Old
Despite increasing complexity in the imaging world, referrers in Tillack’s study appreciated an old-fashioned commitment to communication. They wanted radiologists not only to produce interpretations and link imaging findings to clinical information, but also to communicate actively with their physician colleagues.
How does this communication inspire that elusive trust? When Tillack asked a pulmonary/critical-care attending physician about certain radiologists, he responded that he didn’t really trust the night radiologists—and didn’t even read their reports. Because they were generalists, he said, they were not as good as the subspecialists working days.
He named a particular thoracic radiologist (available in the daytime) as someone who had his full trust, stating that his own interpretations matched those of the radiologist, which were correct. In addition to being pleasant and receptive to questions, this trusted radiologist did not hedge, gave differential diagnoses, correlated findings with clinical information, and described what he saw.
Another pulmonologist expressed similar opinions about how he learned to trust the same radiologist, telling Tillack that it took only a short time. The radiologist called him about a patient and recommended bronchoscopy. This radiologist wants clinical interaction, which builds trust, and he is proactive in contacting clinicians. His helpful interpretations provide more information and are more definitive than those of the other thoracic radiologists, the pulmonologist told Tillack.
While an affable disposition never hurts, Tillack found that even radiologists who are not particularly friendly can still be extremely trusted and valued. As one third-year resident in emergency medicine observed, a particular night radiologist is good, but is irritable when overloaded. Nonetheless, he always calls the resident when there is important information involved—while other night radiologists do not. That failure to call can interfere with the care of emergency-department patients, so the resident trusts the grouchy-but-responsible radiologist because he looks out for the clinical team.
Establishing a Presence
While the benefits of the digital revolution and PACS are clear, Tillack hopes that software manufacturers will create some innovative ways for radiologists to reinsert themselves into patient care. Companies are developing video-chat systems that would allow referring