Dear doctor,
Congratulations! You have made it through medical school and are about to embark on a journey which will change you and which only few will understand. So before you get thrown in, some friendly advice from the Radiologist.
Whilst you are carrying notes, trying to scribble something legible, simultaneously updating your list, answering your bleep, wondering why the consultant is two patients ahead of you and what that smell is – you will have someone on the ward round say “order a CT” and they’ll be gone, moved on before you can write: obs stable, apyrexial.
Once the ward round is done and you are the lucky one who gets to request the imaging take note – You don’t order imaging. This isn’t Nando’s – you request it.
If you do not know why you’re ordering the test – ask a senior. If they don’t know – ask their senior – this is vital and leads us to our next point –
Ask a question instead of requesting an investigation – that’s your job. The Radiologist’s job is to tell you what investigation will give you the best answer. If it is a different test to the one your boss asked for – they’ll usually be fine with it and if they don’t like it, it’s their turn to go have a chat.
When a new doctor comes to request a scan on behalf of their registrar and they know it’s not justified…
Gather your thoughts and take the light of Eärendil into the darkness of the radiology department and see us instead of phoning us: it’s a lot more difficult to say no to your face than it is to you on the phone, plus it’s just more polite and we appreciate that.
Don’t lie to us. The radiologist is really good at bullshit – your Kung Fu cannot compare. If you do not know, be honest, a lie will make us focus on the wrong thing and may lead to the wrong investigation being done.
You will embellish, we know you will do it, but resist. If you turn into a good doctor, you’ll eventually say at times ‘I don’t agree but my boss wants it for this reason’ you will be surprised how often we will say yes.
You don’t order imaging. This isn’t Nando's - you request it.
Check the PREVIOUS imaging. It’s the first thing we will do and you look stupid if they had the test yesterday or the question has already been answered.
Always know the eGFR.
If you’re going to say ‘because my boss wants it’ or ‘I don’t know this patient I was handed this over’ – don’t be surprised if you just get a No. It’s lazy, it’s not acceptable and it’s dangerous. Go see the patient, read the notes, know in your mind why this scan needs to be done and then come to us.
Don’t be disheartened when we say no, we hardly ever say no, we are usually saying we need more information. Requesting imaging involves selling your case – there are limited resources (even if you had a fully staffed 7 day working Jeremy Twunt fairytale hospital, there are still limited resources). With experience you’ll get a yes almost every time.
The Radiographer – like the nurse on the ward, can be your greatest ally or your worst nightmare. They give great advice, they can probably vet your request before a Radiologist sees it and give invaluable advice. Ignore them, dis-respect them at your peril.
If you do not know why you’re ordering the test - ask a senior. If they don’t know - ask their senior.
You won’t get it right every time. That’s the job, to learn. What’s important is that you learn and don’t make the same mistakes repeatedly. If after two months on colorectal you don’t know what an anterior resection is and we remember explaining it to you, you’re branded as useless and will be treated as such. You’re the person who gets to the front of the queue in the coffee shop and doesn’t know what they want.
We were all the junior doctor once. More is asked of you than was once asked of us and you are busy and tired and we know that. If you’re stuck, if you do not understand, ask.
Oh and for those of you who eventually want to start giving the answers to the questions asked, come spend some time in the darkness, but please, leave your bleep outside.
This post was originally written by The Radiologist on Facebook. Link to original post.
Here’s a link to an excellent video giving a succinct summary of how to request imaging: Referral Tips – Radiology.
