Wednesday, November 23, 2011

Informal Second Opinion in Hospital Practise-"To do or not to do"


There is a query that is often faced by radiologists in hospital practise, where clinicians often send films or CDs done outside the facility for second opinion and sometimes say please send a written note of my observations Often these are not accompanied by report of the previous films. 

What should be done in such a scenario?
If i dont read them- I risk spoiling the relations and often the referal to the centre?
If i do- is there a risk of malpractise? 
Should we charge for these studies? 

Even if these opinions are given verbally, i have often seen clinicians add a line in their files "as discussed with Dr X" and make me legally liable for my opinion even if we did not charge for the read. Are their any guidelines for such practise? What is the correct thing to be done according to Indian Radiology Association?

All comments and opinions are welcome.

3 comments:

Anonymous said...

Well, I'm my country (Spain) I can explain you what we did in the last hospital I worked. Specifically, I worked in a breast radiology unit. We used IBM-SAP software from reporting, which was also used for the clinician to read the report.

One of the most common situations was when a clinician came to us for a second opinion in regard to mammograms done elsewhere. We just picked the mammograms and wrote a proper report. Where? The catalogue of services (the list that contains all the radiology techniques avaibles for the clinician to ask for using IBM-SAP, such as "breast ultrasound", "abdomen ultrasound", "Brain CT"... also included "External Technique Second Opinion Report" where we wrote our own impression).

Whether you charge for it or not it's up to you or your centre (we did), but I think that anyway if you do it, it should be done in a proper formal way just to avoid legal problems.

Regards

ommiletta said...

I am not familiar with the Indian Radiology Association but I agree with the former comment.

My thoughts are.... When you are asked for a written note you could create a standard document where you put in a proper disclaimer. You should not hesitate to ask for existing report.

Regarding "spoiling the relations" I think you should not worry, creating a standard procedure regarding the matter just shows good practice and if that is a problem for anyone than it´s not the relations that you need:)

If you should charge for these studies or not I think you should, specially if asked for written opinion. When asked for opinion verbally (and no charge) you could put some ground rules. Most likely they put your name in the files do to respect (I would think) so you can just put your disclaimer in the conversation to avoid the legal part. What I mean is that you tell the person that your opinion is only for assistant to him/her but not your diagnose, for that you can not give without the case going through your general and standard procedure.
By doing this you just show good and responsible practice witch should not threat anyone or anything, it just emphasize the quality of your work.

My best,
Ommiletta

DR VINEET MARWAHA said...

What we do here is that we charge the patient 1000 for any CT/MR reporting.
we give a full report and mention this on the top that The study has been done elsewhere, only a CD is presented. No records available.

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