Radiology question

Delancey

We have all doubtless seen the news items about the latest hospital
''scandal '' - this one being the X-ray situation at Tallaght . All the coverage has me wondering : what exactly is it that radiologists do ? Is their sole duty the review and interpretation of x-rays or have they other duties the media have not reported on ?

Vorsprung

Radiologist give a report on every scan or X-ray performed. In many hospitals there's weekly meetings to discuss the scans, at which most of the consultants, registrars and other junior doctors are present.

They also perform procedures that involve Ultrasound/X-ray/CTguidance to aid the procedure, e.g. putting in tubes with ultrasound guidance to drain an abscess.

DrIndy

A Radiologists speciality is medical imaging. A clinical doctor asks a question - "can you tell me if this patient has MS?" for example and the radiologist then gives an answer on what is the best scan bearing in mind cost and radiation exposure.

Hence they decide the best form of imaging (be it xray, ultrasound, CT, MRI, fluoroscopy) to answer the original doctors question. They then also interpret the images and see if they can answer the original doctors question. They sometimes add in scans or repeat them to give better views on their own bat if they see something wrong. They sometimes refuse a doctors request to do a scan if they think it won't answer the question and other times, change the imaging request to the right form of scan.

Radiologists and laboratory specialists and can be considered auxilliary albeit absolutely essential parts of a hospital. They give clinical doctors answers to questions and have dramatically reduced the need over the years for operations to see what is going on and the harm these procedures would cause as a side effect.

Radiologists in ireland have to pass the MRCP, MRCS or MRCPaeds to be considered for the training scheme and thus are fully qualified clinicians before they enter their radiology training.

Plain x-rays can normally be ordered by any hospital doctor because they are cheap and the amount of radiation is very low. These are all the limb x-rays for fractures and chest x-rays for chest complaints.

Although orthopaedic surgeons are fantastic at interpreting limb x-rays themselves and most senior medical staff can interpret perfectly well other x-rays - they don't have the formal training in x-ray or years upon years of viewing these images.

Hence there is a small but real risk of something subtle but significant being missed when a non-radiologist (albeit experienced) views x-rays. The other difficulty is it can be interpreted by a junior medical officer who may not have the time to show a senior doctor the image for a second opinion.

The net result is that potentially serious things like subtle fractures and subtle chest x-ray changes may be missed and the patient may come to harm. Radiologists who report these films represent the backup level to catch anything significant that clinicians may inadvertantly miss and are hugely important in this role.

I don't think this issue applies at all to more complex imaging like CT, MRI or ultrasound.

The chief difficulty is when a hospital is understaffed, you simply cannot report on everything thoroughly, giving due time needed to make sure something is not missed. When these scandals also do arise - remember that a hospital is not composed of single individual doctors - there are administrative units and hospital atructures.

When something like this happens, its a PROCESS failure - not down to individuals doing their assigned jobs (although the HSE and Mary Harney love blaming individual doctors in the media and spin like hell - it takes the weight off them as they govern and are ultimately to blame for the processes). Why the PROCESS failed will be interesting, but will have resulted from underfunding and a lack of appointment of senior consultant and registrar staff.

You have to understand the enormous pressure the health service is under at individual staff level and the significance of a rush job that often has to happen. If pathology slides are rushed - cancer is misdiagnosed or even worse - missed entirely. If x-rays are rushed - they may go unreported or cancer or fractures can be missed.

No-one in the HSE addresses the processes and this is why morale is low and these dreadful events unfold. This is the tip of the iceberg folks - keep watching this space.

Of incidental note. Prof Conlon is a consultant surgeon who has taken over the role of CEO (he has an MBA from Harvard) and is not your typical HSE stooge - this is why he has in fact come forward to the media openly about this. What is going on everywhere else where it is still swept under the carpet?

Delancey

Thanks for that detailed reply Dr. Indy - interesting to learn just what exactly Radioogists do ( though I had guessed there had to be more to their job than just reading x-rays ).
I agree that this ' scandal ' is probably the tip of the iceberg but I have to say that I think I can predict what any inquiry report will say - it will be peppered with references to '' systemic failures '' , '' communication breakdowns '' , '' process failures '' , etc. It will blame organisational shortcomings .
Is this not a problem in itself in that report after report fail to hold any individual to account ?

DrIndy

This is the problem and why doctors are singled out - they are in charge of their own patients, but they are not in charge of the finances or processes and are not managers. Non-clinicians do this and one of the biggest problems is that non-medically trained people do have a bit of difficulty grasping what it going on on the clinical side. This results in a lot of friction as clinicians simply think about their patients and managers think about their finances (and indirectly the patients - but if you sit behind a desk - a person very easily becomes a unit of liability in the same way insurance companies think).

In any radiology department - one radiologist is responsible for reporting xrays for 40 hours per week. There can be 5-20 radiologists. They do their quota. The x-rays which go beyond the quota - who does those? This is the ORGANISATIONAL problem, the funding and the process problem - not the individual clinicians problem.

If one clinician stayed in late every single night for 3 hours to report a few more - do you think they are even thanked or paid extra?

Delancey

DrIndy wrote: »

If one clinician stayed in late every single night for 3 hours to report a few more - do you think they are even thanked or paid extra?

Good heavens no , in fact I would not be in the least surprised if a H.S.E. bureacrat ordered them to leave the building because they're '' not insured to be on the premises outside normal working hours '' :mad:

DrIndy

it gets lost in the mires of beaurocracy. No one person is to blame - this is fair enough - but who is in charge of the processes and the systems which run the hospitals?

Recent newspaper articles commented that there should be 18 full time consultants in tallaght to manage the workload - instead there are 7. Who is responsible for staffing a department at a safe level? Its easy to blame an individual radiologist and a group of 7 - but in fairness only 1 or 7 people can do so much.

I also notice the spin is starting about consultants doing private practise outside of their contracted hours - but remember that they are also on call within their public hospitals without any extra pay or renumeration which no-one speaks of. Also few people know that many, many consultants work overtime in their normal working day in public hospitals without any overtime pay.

So what really happened here?