What do you see here?
One of our favorite and most rewarding parts of managing patients was a trip to the radiology suite and a talk with the radiologist. We became Watson and Holmes together as we tried to unravel the mystery of disease. We also became friends. We talked pollitics and kids. We enjoyed both the mystery and the company.
We were doing what was both expected and was fun, but now it needs a special label... "medical collaboration." We shared a little bit of suspense and mystery and a little bit of joy. We miss all of that.
Without collaboration, what did you think of the above CT scan? This study was about perception, but really there is more to it than that. As described in the referenced below, 83 percent of the participating radiologists overlooked an image of a gorilla superimposed on lung scan (it's small and up on the right, in the left anterior lung!). This finding is worrisome in its own right, but the truly alarming implication is the increasing likelihood of such "misses" in a highly technological environment that encourages efficiency and cost-effectiveness at the expense of medical collaboration and open communication.
The recent push towards incorporating innovative technologies into health care has encouraged the adoption of Store and Forward methods such as picture archiving and communication systems (PACS). While this technique has created cost savings by changing how films are obtained, processed, distributed, read and stored, it has reduced or eliminated the need for physicians to consult in person –– and talk about the case. By cutting out the most natural and primary means of sharing knowledge and information, we have inadvertently removed both the context and the human element from radiologic images.
Most people would agree that a team of individuals working together can create synergy. Traditionally, health care providers met with a radiologist to view and discuss a patient's film. Although the conversation might cover everything from the patient's image and test results to their kids' baseball game, the setting encouraged physicians to quickly and easily apply their combined knowledge and experience to the case at hand. This created context for the radiologist, helping him to understand what he's looking for and making him more effective at examining the film –– especially if the referring doctor had a suspicion but needed confirmation from someone with more expertise.
If a Store and Forward system lacks a component that enables and promotes similar collaboration and communication, then context vanishes. Even the best radiologists are only human, and without specific indications on what the referring physician has noticed, the radiologist may unintentionally overlook something important. Even more significantly, any potential synergistic effect has been lost due to the lack of communication. At best, this may fail to enhance the patient's care; at worst, this could lead to a delayed or missed diagnosis.
Behind Every Film Is a VIP
As if losing context were not troublesome enough, Store and Forward systems separate the film from the individual, which risks creating the illusion that the imaged lung is being treated rather than the person. Without effective medical collaboration, teamwork becomes non-existent, and it becomes too easy for each provider to lose sight of the goal: restoring the health of the entire human being. In such a scenario, the patient may not even feel like a valued member of his healthcare team, instead feeling like a number, a piece of data or a diseased lung.
What Can We Do?
As healthcare providers, we are ultimately responsible for determining how we balance the savings and efficiencies of new technologies with our patients' best interests. When we choose to communicate and collaborate with our colleagues and patients, we create context that can enhance the quality of care and reassure the patient that we are working together for his care. A system that encourages Store and Forward medical collaboration can only help achieve the end goal of a patient's restored health.
And in the case of the gorilla on the CT scan, what type of note could a provider leave for the radiologist? Anything from "There's something funny about the left anterior lung (upper right side of this scan)" to "I heard a snort, heavy footsteps and a Tarzan yell" would do.
A two page primer on the upcoming ICD-10 codes is available. They are the opposite of fun and collaboration, but the whitepaper is offered to you with the hope that it will make your life a little easier. Don't forget to enjoy the mystery. Life has a lot not to be missed.